Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey.

BACKGROUND: Evidence of overlap between endometriosis and chronic pain conditions is emerging; however, little is known about how the pain experience differs based on the presence or absence of endometriosis. OBJECTIVES: In a sample of women reporting chronic pelvic-abdominal pain (CPP), the aim of this study was to characterize differences in pain symptomatology between women with and without endometriosis and to examine the influence of chronic overlapping pain conditions (COPCs) on pain among these two groups. DESIGN: This was a cross-sectional study, based on an online survey. METHODS: Participants (aged 18+ years) completed a survey collecting pain diagnoses and symptoms assessing pelvic pain severity, pain interference, and pain impact. Independent sample t-tests, chi-square, and multiple linear regression models were employed to analyze group differences in pain symptomatology and COPCs. RESULTS: Of the 525 respondents with CPP, 25% (n = 133) reported having endometriosis. Women with endometriosis were younger at the onset of pelvic pain, relative to women without endometriosis (p = 0.04). There were no differences in age, race, ethnicity, or duration of pelvic pain between women with and without endometriosis. Women with endometriosis reported higher pelvic pain severity (+0.8, 95% CI = 0.4-1.1), pain interference (+5.9, 95% CI = 2.4-9.3), and pain impact (+1.9, 95% CI = 0.8-2.9). Endometriosis was associated with a higher number of COPCs (p = 0.003), with 25% (n = 33) of women reporting ⩾3 overlapping pain conditions compared with 12% (n = 45) of those without endometriosis. Women with endometriosis had a higher frequency of fibromyalgia (p < 0.001), chronic fatigue syndrome (p < 0.001), and temporomandibular disorder (p = 0.001). The number of COPCs was associated with higher pain severity, interference, and impact, independently of endometriosis. CONCLUSION: Women with endometriosis experienced higher levels of pain-related burden and COPCs compared with those without endometriosis. Pain intensity, interference, and impact increased with a higher number of pain conditions regardless of endometriosis presence.

Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic­abdominal pain: A cross-sectional surveyThe presence of endometriosis was associated with a higher number of chronic overlapping pain conditions (COPCs) and greater pain symptomatology, while a greater number of COPCs corresponded to increased pain burden among women with and without endometriosis. These findings underscore the need for a more comprehensive assessment of endometriosis that addresses the full experience of the disease, including its comorbidities. A greater characterization and measurement of COPCs has the potential to facilitate the development of tailored interventions for individuals with pain comorbidities, thereby contributing to improved clinical care strategies for endometriosis-related pain.

"The constant worry": Urinary incontinence self-management in rural women: A qualitative study.

Urinary incontinence (UI) is experienced by approximately 60% of women in the United States and has a negative impact on self-esteem, sexual function, social participation, and quality of life. Rural women, who are underrepresented in the UI literature, face many health disparities and unique barriers to accessing care. The purpose of this qualitative descriptive study was to explore UI self-management behaviors in rural women with UI, including the contextual factors that influence their approach to self-management. This study recruited rural women, ages 30-60 years, using purposive sampling via social media. Demographic information was collected. A semi-structured interview guide was used to conduct individual, in-depth interviews via Zoom. Interview data were analyzed using qualitative description. Sections of interview text were coded using a priori and emergent codes, grouped into categories, and distilled into themes. A total of 31 participants (mean age = 47.2 years) met inclusion/exclusion criteria, enrolled, and completed the study. Qualitative analysis revealed rural as a cross-cutting theme and five major themes: self-management behaviors, familial influence, medical encounters, talking about UI, and resource scarcity. Participants described the rural environment as having a substantial impact on their approach to UI self-management. Specifically, rural social enmeshment made seeking care for UI in rural communities challenging. Findings shed light on how the rural environment influences various aspects of UI self-management in midlife women. Diverse perspectives in UI self-management are needed to advance knowledge in this field.

Methodologies Used in Studies of Self-Management Interventions for Urinary Incontinence in Adult Women: An Integrative Review.

BACKGROUND: Urinary incontinence (UI) affects approximately 60% of women in the United States and negatively impacts self-esteem, sexual function, participation in social activities, and quality of life (QOL). Self-management interventions show promise for improving UI symptoms and QOL. Previous reviews of UI self-management studies have focused on outcomes for older women. However, the literature lacks a synthesis of methodologies of these studies. PURPOSE: The purpose of this integrative review was to synthesize and evaluate methodologies used in studies of self-management interventions for UI in adult women. METHODS: Using an integrative review approach, a search of PubMed, CINAHL, and Embase was conducted yielding 1404 results, 23 of which met inclusion criteria. Data abstracted from each article included author(s), year of publication, study design and purpose, sample, country and setting, measures of UI symptoms, and intervention description. RESULTS: Findings showed methodological differences, particularly in design, assessment of UI subtypes, measures of UI symptoms, and intervention components. Multicomponent self-management interventions were used in 18 studies and 1 component used in 5 studies. Education, pelvic floor muscle exercises, and bladder training were the intervention components most frequently used, either alone or in combination; however, intervention components were not consistently aligned with the UI subtypes. Analysis of ethical matters revealed areas for improvement, specifically in reporting privacy and confidentiality and in methods to obtain informed consent. CONCLUSIONS: Results highlight opportunities to improve the rigor of methodologies used in studies of self-management interventions for UI in adult women.

Pain and Dysfunction Reported After Gender-Affirming Surgery: A Scoping Review.

OBJECTIVE: The goal of this scoping review was to determine the types and rates of pain and dysfunction outcomes reported after gender-affirming surgical procedures. In addition, a summary of the involvement of conservative care reported in the literature was produced. METHODS: A research librarian conducted searches through multiple databases from inception to 2021. Abstracts and full texts were reviewed by a team of at least 2 reviewers. Data were extracted from a custom survey and exported for summary. RESULTS: Thirty-one papers discussed masculinizing interventions, and 87 papers discussed feminizing procedures. Most of the studies emphasized surgical outcomes. Of the studies reporting pain or dysfunction, few standardized outcomes were used to collect information from patients. The pain was experienced across body regions after surgery for both feminizing and masculinizing procedures. Vaginal stenosis and incontinence were the most common complications reported. Patients were most often managed by physical therapists for vaginal stenosis or dyspareunia. CONCLUSION: Many published studies do not systematically collect specific or standardized information about pain and dysfunction after gender-affirming surgery. Of those studies that do report these outcomes, few detail the involvement of physical therapists in the recovery after surgery. IMPACT: Pain and urogenital dysfunction, often managed by physical therapists, occur after gender-affirming surgery, suggesting that physical therapists could have a larger role in the recovery of this patient population after surgery. The extent to which interventions used to manage these conditions in cisgender people will be equally effective in transgender people is unknown at this time. Future studies should use recognized measures to characterize patients' experiences with pain and dysfunction after surgery.

Implementation of a Cancer Rehabilitation Navigation Program: a qualitative analysis of implementation determinants and strategies.

BACKGROUND: Cancer rehabilitation navigation (CRNav) is a care delivery model that expedites identification and management of symptom-related functional morbidity for individuals undergoing cancer treatment. A CRNav program is unique in that it embeds a cancer rehabilitation professional in the cancer center for patient screening and assessment. The implementation of CRNav programs has not been studied and doing so could facilitate greater uptake of these programs. METHODS: Using implementation science frameworks, we conducted a qualitative, post-implementation analysis of a CRNav program that was implemented in 2019. Semi-structured, 1:1 interviews were guided by the Consolidated Framework for Implementation Research (CFIR) and a combination of deductive and inductive analyses, using a priori established codes, was used to assess the implementation context, and identify emergent themes of barriers and facilitators to implementation. Participant described implementation strategies were characterized and defined using the Expert Consensus Recommendations for Implementing Change (ERIC) taxonomy. RESULTS: Eleven stakeholders including physicians, administrators, clinical staff, and patients, involved with program development and the implementation effort, participated in interviews. Predominant barriers to implementation included developing the program infrastructure, and lack of awareness of rehabilitation services among oncology professionals, predominant facilitators of implementation included; physical co-location of the navigator in the cancer center, individual characteristics of the navigator, and unique characteristics of the program. Strategies described that supported implementation included developing stakeholder interrelationships, evaluating and iteratively adapting the program, creating infrastructure, training and education, and supporting clinicians. CONCLUSION: This analysis uses implementation science to methodically analyze and characterize factors that may contribute to successful implementation of a CRNav program. These findings could be used alongside a prospective context-specific analysis to tailor future implementation efforts. IMPLICATIONS FOR CANCER SURVIVORS: Implementing a CRNav program expedites a patient's direct contact with a rehabilitation provider complementing the cancer care delivery team, and providing an additive and often missing service.

Potential for elimination of folate and vitamin B12 deficiency in India using vitamin-fortified tea: a preliminary study.

INTRODUCTION: The majority of Indian women have a poor dietary folate and vitamin B12 intake resulting in their chronically low vitamin status, which contributes to anaemia and the high incidence of folate-responsive neural-tube defects (NTDs) in India. Although many countries have successfully deployed centrally-processed folate-fortified flour for prevention of NTDs, inherent logistical problems preclude widespread implementation of this strategy in India. Because tea-the second most common beverage worldwide (after water)-is consumed by most Indians every day, and appeared an ideal vehicle for fortification with folate and vitamin B12, we determined if daily consumption of vitamin-fortified tea for 2 months could benefit young women of childbearing-age in Sangli, India. METHODS: Women (average age=20±2 SD) used teabags spiked with therapeutic doses of 1 mg folate plus either 0.1 mg vitamin B12 (Group-1, n=19) or 0.5 mg vitamin B12 (Group-2, n=19), or mock-fortified teabags (Group-0, n=5) to prepare a cup of tea every day for 2 months, following which their pre-intervention and post-intervention serum vitamin and haemoglobin concentrations were compared. RESULTS: Most women had baseline anaemia with low-normal serum folate and below-normal serum vitamin B12 levels. After 2 months, women in both Group-1 and Group-2 exhibited significant increases in mean differences in pre-intervention versus post-intervention serum folate levels of 8.37 ng/mL (95% CIs 5.69 to 11.04, p<0.05) and 6.69 ng/mL (95% CI 3.93 to 9.44, p<0.05), respectively; however, Group-0 experienced an insignificant rise of 1.26 ng/mL (95% CI -4.08 to 0.16). In addition, over one-half and two-thirds of women in Group-1 and Group-2, respectively, exhibited increases in serum vitamin B12 levels over 300 pg/mL. There was also a significant post-interventional increase in the mean haemoglobin concentration in Group-1 of 1.45 g/dL (95% CI 0.64 to 2.26, p=0.002) and Group-2 of 0.79 g/dL (95% CI 0.11 to 1.42, p=0.027), which reflected a bona fide clinical response. CONCLUSION: Tea is an outstanding scalable vehicle for fortification with folate and vitamin B12 in India, and has potential to help eliminate haematological and neurological complications arising from inadequate dietary consumption or absorption of folate and vitamin B12.

Sex moderates the effects of experimentally induced musculoskeletal pain on alcohol demand in healthy drinkers.

BACKGROUND: Pain may serve as an antecedent for alcohol use, increasing risk for hazardous drinking and associated consequences. Delayed onset muscle soreness (DOMS) induction produces clinically relevant but time-limited musculoskeletal pain. This study was conducted to determine whether DOMS induction on the dominant elbow flexors influenced alcohol demand using the Alcohol Purchase Task (APT). We hypothesized DOMS would increase alcohol demand relative to a sham control. Based on existing studies of pain self-medication, we expected DOMS-related increases in alcohol demand would be greatest in men. METHODS: Participants (N = 53; 57 % women) were randomly assigned to a DOMS (eccentric exercise) or sham condition (concentric exercise). Participants completed the APT pre-exercise and 48 -hs post-exercise. Repeated measures GLM was used to characterize group by sex by time interactions on APT indices, including intensity, breakpoint, essential value (EV), Omax, and Pmax. RESULTS: The DOMS procedure significantly increased pain ratings at the elbow flexors. Men had significantly higher demand intensity than women across groups and time points. Significant interactive effects were detected for breakpoint and EV. From pre- to post-test, breakpoint significantly increased in men in the DOMS group. However, breakpoint and EV significantly decreased in women in the DOMS group. CONCLUSIONS: Increased alcohol demand in men in the DOMS group was consistent with epidemiological data suggesting men are at higher risk for self-medicating pain with alcohol than women. However, decreased demand in women was unexpected. Taken together, results indicate DOMS induction may be a useful means to characterize pain as an antecedent for alcohol use.

Chronic Pelvic Pain and Sexual Dysfunction Among Females and Males Receiving Treatment for Opioid Use Disorder.

Introduction: Chronic pain brings complexity to opioid use disorder (OUD). Psychosocial and neurobiological risks for Chronic Pelvic Pain (CPP) and OUD overlap. The primary objective of this exploratory study is to compare sex-specific prevalence of CPP and sexual dysfunction between individuals receiving buprenorphine for OUD and a comparison group receiving treatment for other chronic medical conditions (CMC). Methods: Participants from an OUD treatment (n = 154) and primary care clinic (n = 109) completed a survey between July 2019 and February 2020 assessing reproductive and sexual health. Sex-stratified CPP and pain interference measures were adapted from the Brief Pain Inventory for females, and for males, the Brief Male Sexual Function Inventory and NIH Chronic Prostatitis Symptom Index. The Male and Female Sexual Function Index assessed sexual dysfunction. Prevalence of CPP and sexual dysfunction between groups were compared using Pearson χ2 and Fisher's Exact tests. Results: Participants were 54.4% female and 75.0% Black with almost half having a psychiatric diagnosis. Among OUD females, the highest pain severity reported was for menstrual-related pain, and for OUD males, testicular pain. CPP most interfered with mood in OUD females vs. sleep and enjoyment of life in OUD males. There were no differences in prevalence for global sexual dysfunction with 91.6% of females and 84.2% of males screening positive across groups. Discussion/Implications: CPP and sexual dysfunction are important components of wellness and may play a role in OUD recovery trajectories. The value of addressing CPP and sexual dysfunction in tailored comprehensive, sex-informed OUD treatment approaches should be further investigated.

Predictors of Mucosal and Muscle Pain in Vulvodynia: A Cross-Sectional Analysis From the National Vulvodynia Registry.

Diagnostic criteria for provoked vestibulodynia (PVD) rely on mucosal pain in the vulvar vestibule, with less emphasis on pain from pelvic floor muscles. It is unknown how psychosocial variables associated with PVD are differentially associated with mucosal versus muscle pain. Analysis of data from the National Vulvodynia Registry (n = 202) revealed several factors associated with increased mucosal pain: pain duration (P = .043), the McGill sensory subscore (P = .0086) and the Gracely pain scale (P< .001). Increased mucosal pain was also associated with decreased arousal (P = .036). On the other hand, factors significantly associated with greater muscle pain included number of comorbid pain conditions (P = .001), decreased intercourse frequency post PVD onset (P = .02) and higher scores on the McGill sensory (P = .0001) and affective (P = .0002) subscores, the Gracely pain scale (P = .0012), and state anxiety (P < .001). Sexual function was also significantly impacted by high pelvic floor muscular pain, with lower scores for arousal (P = .046), orgasm (P = .0014) and satisfaction (P = .013), and higher pain (P = .01). Significant differences in the relationship between muscle and mucosal pain for pain duration (P = .005), McGill affective score (P = .001), orgasm (P = .049), change in intercourse frequency (P = .027), and state anxiety (P = .030) suggest the possibility of mucosal or muscle pain predominant PVD subtypes. PERSPECTIVE: Patients with higher pelvic floor muscle pain scores than mucosal pain scores may represent different subgroups or characteristics of patients with provoked vestibulodynia. This research highlights the importance of assessment of the pelvic floor muscles in addition to the cotton swab test of the vestibule.

Regional increases in brain signal variability are associated with pain intensity reductions following repeated eccentric exercise bouts.

BACKGROUND: Traditional pain interventions limit fluctuations in pain sensation, which may paradoxically impair endogenous pain modulatory systems (EPMS). However, controlled exposures to clinically relevant pain (e.g. delayed onset muscle soreness [DOMS]) may build capacity in the EPMS. Emerging evidence suggests that regional signal variability (RSV) may be an important indicator of efficiency and modulatory capacity within brain regions. This study sought to determine the role of RSV in both susceptibility to and trainability of pain response following repeated DOMS inductions. METHODS: Baseline and follow-up resting-state fMRI was performed on 12 healthy volunteers ~40 days apart. Between scanning visits, participants received four weekly DOMS inductions in alternating elbow flexors and were supplied seven days of post-induction pain ratings. Voxel-wise standard deviation of signal intensity was calculated to measure RSV. Associations among DOMS-related pain and RSV were assessed with regression. Relationships among baseline and change measurements were probed (i.e. susceptibility to DOMS; trainability following multiple inductions). RESULTS: Significant association between baseline RSV in left middle frontal gyrus (MFG) and right cerebellum and reductions in DOMS-related pain unpleasantness were detected. Furthermore, increases in RSV were associated with reduced DOMS pain intensity (left lingual gyrus, right MTG, left MTG, left precuneus) and unpleasantness (left MTG, right SFG). DISCUSSION: Findings suggest that RSV may be an indicator of EPMS resilience and responsivity to training, as well as an indicator that is responsive to training. Involved regions underlie cognitive, affective and representation processes. Results further clarify the potential role of RSV as an indicator of pain modulation and resilience. SIGNIFICANCE: Regional signal variability may be an important indicator of endogenous pain modulatory system responsivity to training following repeated bouts of clinically relevant pain and may in fact be responsive to training itself.

Riding a Tiger: Maximizing Effects of Manual Therapies for Pelvic Pain.

Manual therapy interventions are frequently used during the management of pelvic pain conditions. Pain relief after any intervention results from effects unrelated to the intervention, effects specific to the intervention, and effects of context in which the intervention is provided. Understanding these multiple mechanisms allows providers of manual therapy to maximize outcomes by deliberately harnessing each of these core elements of pain relief.

Training endogenous pain modulation: a preliminary investigation of neural adaptation following repeated exposure to clinically-relevant pain.

Analgesic treatments that aim to eliminate pain display marginal success in relieving chronic pain and may increase pain vulnerability. Repeated exposure to pain may result in increased pain modulation via engagement of anti-nociceptive brain regions. It was hypothesized that repeated exposure to delayed onset muscle soreness (DOMS) would result in increased pain modulatory capacity (PMC) via functional neural adaptation. 23 healthy participants completed Baseline and Follow Up resting-state fMRI and quantitative sensory testing (QST) visits 40 days apart. Participants were randomized to two groups: A Repeated DOMS Group (RD Group) that received four, weekly DOMS inductions and a Control Group that received one baseline induction. Daily pain ratings were collected for seven days post-induction, as were quantitative sensory testing (QST) metrics at baseline and Follow Up. Regional functional connectivity (FC) was estimated among areas involved in pain modulation. Seed and network FC was estimated among areas involved in pain modulation and sensory processing. Changes in FC were compared between groups. The RD Group displayed significant reductions in post-DOMS pain ratings and significant changes in thermal QST measures. RD Group participants displayed greater adaptation in nucleus accumbens-medial prefrontal cortex (NAc-mPFC) FC and in sensorimotor network (SMN) connectivity with the dorsomedial, ventromedial, and rostromedial prefrontal cortices. Changes in SMN-PFC connectivity correlated with reductions in post-DOMS affective distress. Results suggest that repeated exposure to clinically-relevant pain results in adaptations among brain regions involved in pain modulation. Repeated exposure to clinically-relevant pain may serve as a mechanism to increase PMC via inhibition of emotional valuation of painful stimuli.

The Efficacy of Manual Therapy for Treatment of Dyspareunia in Females: A Systematic Review.

BACKGROUND: Pelvic floor physical therapy is a noninvasive option for relieving pain associated with dyspareunia, genital pain associated with sexual intercourse. Manual therapy is a clinical approach used by physical therapists to mobilize soft tissues, reduce pain, and improve function. To date, the systematic efficacy of manual therapy for treating dyspareunia has not been investigated. OBJECTIVE: To examine the efficacy of manual therapy in reducing pelvic pain among females with dyspareunia. STUDY DESIGN: Systematic review. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, and CINAHL databases for articles published between June 1997 and June 2018. Articles were reviewed and selected on the basis of defined inclusion and exclusion criteria. The articles were assessed for quality using the PEDro and Modified Downs and Black scales. RESULTS: Three observational studies and 1 randomized clinical trial met inclusion criteria. The primary outcome measured was the pain subscale of the Female Sexual Function Index. All studies showed significant improvements in the pain domain of the Female Sexual Function Index (P < .5), corroborating manual therapy as a viable treatment in relieving pain associated with dyspareunia. However, the quality across studies ranged from poor to good. CONCLUSIONS: Although these findings support the use of manual therapy for alleviating pain with intercourse, few studies exist to authenticate this claim. Moreover, the available studies were characterized by small sample sizes and were variable in methodological quality. More extensive research is needed to establish the efficacy of manual therapy for dyspareunia and the specific mechanisms by which manual therapy is beneficial.

An International Survey of Commonly Used Interventions for Management of Pelvic Pain.

BACKGROUND: Pelvic pain (PP) is a debilitating condition that is challenging to manage. Despite differences in suspected etiologies of different PP conditions, common clinical signs and symptoms make it appropriate to group these diagnoses. The presence of neuro-musculoskeletal impairments in PP suggests that physical therapists are ideally situated to be included as part of the health care team managing this condition; however, little information is available to guide physical therapist management of PP. OBJECTIVES: As a first step to developing management guidelines, we sought to determine common interventions currently used by physical therapists to manage PP. STUDY DESIGN: Descriptive survey. METHODS: A modified Delphi approach was used to identify broad categories of interventions that were then used to build a survey. Purposeful selection with snowball recruiting methods was used to collect responses from practitioners. Frequency data were collected for survey responses. Chi-square analysis determined associations among responses based on practitioner training. RESULTS: A total of 984 responses from 17 different countries were analyzed. The primary responses were from physical therapists in the USA and Canada. The majority of respondents were board-certified clinical specialists. More than 80% of physical therapist respondents indicated that they "frequently used" education, exercise, and manual therapy for patients with PP. The most common interventions considered effective but not frequently used were cognitive-behavioral therapy, dry needling, acupuncture, topical medications, and internal pelvic manual therapy techniques. Geographical differences in patterns of usespecific manual therapy and exercise interventions were noted. Differences were also noted on the basis of the levels of advanced postprofessional training. CONCLUSION: Physical therapists routinely use education, manual therapy, and exercise to manage pelvic pain conditions.

Musculoskeletal Considerations in Female Patients with Chronic Pelvic Pain.

Persistent pelvic pain conditions are common and affect nearly 25% of the female U.S. population. In a sizable proportion of pelvic pain patients, the pain is caused by musculoskeletal dysfunction; yet, healthcare providers do not routinely evaluate patients for musculoskeletal etiologies. This article provides an overview of the pathophysiology of persistent pelvic pain, as it relates to musculoskeletal disorders. The symptomatology, anatomy, evaluation, and treatment of these disorders are summarized specifically for healthcare providers (including gynecologists) who do not have pelvic musculoskeletal expertise.

Patterns in Vulvodynia Treatments and 6-Month Outcomes for Women Enrolled in the National Vulvodynia Registry-An Exploratory Prospective Study.

BACKGROUND: Vulvodynia is a poorly characterized condition with multiple treatment options that have been described as largely ineffective in research settings. AIM: To describe treatment patterns in women enrolled in the National Vulvodynia Registry and determine if there is an association between selected treatments and patient-reported outcomes such as pain, sexual function, and psychological distress after 6 months of treatment. METHODS: Participants completed questionnaires on general medical history and patient-reported outcomes using the short-form McGill Pain Questionnaire, the Female Sexual Function Index, the Short Form-12 quality-of-life questionnaire, the Coping Strategies Questionnaire, and the State-Trait Anxiety Inventory. The evaluation also included pain sensitivity assessment of the vaginal mucosa using a cotton-tipped applicator and the vaginal muscles using a single-digit. In this prospective cohort study, all measurements were collected at baseline and again at 6 months after treatment. OUTCOMES: Type of treatment, number of treatments, self-reported pain intensity, dyspareunia, and pain-related psychological distress measures are reported at baseline and 6 months. RESULTS: Of 344 women enrolled, 282 received treatment; 78 different treatments were identified and categorized by type (eg, topical, oral, physical therapy) and number. The most commonly used treatments were topical (85%, n = 241), physical therapy (52%, n = 147), and oral medications (45%, n = 128). Notably, 73% of participants received ≥2 treatments. There was no association between type or number of treatments and patient characteristics. At 6 months, women reported improvements in general pain (P = .001), pain during intercourse (P = .001), catastrophizing (P = .000), and anxiety (P = .000). The Short Form-12 quality-of-life questionnaire showed improvements in physical limitations (P = .024), emotional limitations (P = .003), well-being (P = .025), and social function (P = .010). However, all domains of the Female Sexual Function Index indicated worsening in sexual function (P = .000) except for pain. CLINICAL TRANSLATION: Multi-modal treatments were most commonly used in clinical practice and improvements in patient-reported outcomes such as quality of life, distress, and pain were noted; however, participants who returned at 6 months continued to report poor sexual function. CONCLUSIONS: Strengths include a prospective and long-term study design that evaluated women in clinical settings. Limitations include a high rate of loss to follow-up for certain measures and inability to evaluate efficacy of individual treatments. In a setting where women were receiving highly specialized care, we found wide variation in the type and number of treatments used to treat vulvodynia. Despite this heterogeneity in treatment selection, women reported significant improvements in all study measures except sexual function. Lamvu G, Alappattu M, Witzeman K, et al. Patterns in Vulvodynia Treatments and 6-Month Outcomes for Women Enrolled in the National Vulvodynia Registry-An Exploratory Prospective Study. J Sex Med 2018;15:705-715.

Oncology Section EDGE Task Force on Urogenital Cancer: A Systematic Review of Clinical Measures for Incontinence.

BACKGROUND: Compared to the general population, women and men with urogenital and colorectal cancer experience higher rates of urinary and fecal incontinence. Although a variety of measures exist to assess these areas, currently, there are no guidelines recommending which outcomes rehabilitation professionals should administer to examine these impairments in those with cancer. PURPOSE: To identify outcome measures for assessing urinary and fecal incontinence and evaluate their psychometric data and applicability to the cancer population. METHODS: Multiple electronic databases (CINAHL, Medline, PsycInfo) were reviewed using specific search terms to locate articles that identify outcome measures assessing urinary and fecal incontinence. As part of a larger effort to identify outcome measures for both incontinence and sexual dysfunction, 1118 articles were initially identified, 228 articles were reviewed, and 37 outcome measures were selected for analysis, 13 of which were related to urinary and fecal incontinence. Each incontinence outcome measure was independently reviewed and rated by two reviewers using the Cancer EDGE Task Force Outcome Measure Rating Form. Any discrepancies between reviewers were discussed and an overall recommendation for each outcome measure was made using the 4-point Cancer EDGE Task Force Rating Scale. RESULTS: The Task Force was able to highly recommend 1 measure addressing urinary incontinence (American Urological Association Symptom Index) and 2 measures assessing both urinary and fecal incontinence (Pelvic Floor Distress Inventory - Short Form, Pelvic Floor Impact Questionnaire - Short Form). The Task Force also recommended two measures of urinary incontinence that demonstrated strong psychometric properties, but had not yet been evaluated in the cancer population (Incontinence Quality of Life Questionnaire, International Consultation on Incontinence Questionnaire - Short Form). The Task Force was unable to recommend any measures that solely addressed fecal incontinence. CONCLUSIONS: Five of the 13 outcome measures assessing urinary incontinence and two of the 13 measures assessing both urinary and fecal incontinence demonstrated satisfactory psychometric properties and application to the urogenital cancer population and are thereby recommended for use by the Task Force.

Oncology Section EDGE Task Force on Cancer: A systematic review of patient-reported measures for sexual dysfunction.

BACKGROUND: Sexual dysfunction is an important and infrequently addressed issue in patients with cancer. PURPOSE: To identify self-report measures for assessing sexual dysfunction and to evaluate their psychometric properties and relevance to patients with cancer. METHODS: Multiple electronic databases (CINAHL, Medline, PsycInfo) were reviewed using specific search terms to locate articles that identify self-report measures assessing sexual dysfunction. From the 1118 articles reviewed, 21 measures were selected for analysis. Each measure was independently reviewed and rated by two reviewers using the Cancer EDGE Task Force Outcome Measure Rating Form. Any discrepancies between reviewers were discussed and an overall recommendation for each measure was made using the 4-point Cancer EDGE Task Force Rating Scale. RESULTS: Based on the psychometric properties and relevance to patients with cancers, we highly recommend the following four measures: Sexual Function - Vaginal Changes Questionnaire; International Index of Erectile Function; Erection Hardness Score; Sexual Health Inventory for Men (aka International Index of Erectile Function-5). We recommend one measure, the Sexual Interest and Desire Inventory. We are unable to recommend eight measures based on limited psychometric information and/or clinical utility. Finally, we do not recommend an additional eight measures. CONCLUSIONS: Five of the 21 sexual dysfunction measures demonstrated satisfactory psychometric properties and application to the cancer population and are thereby recommended for clinical use in patients with cancer.

Vulvodynia is not created equally: empirical classification of women with vulvodynia.

BACKGROUND: Vulvodynia classification is based on the sensory dimensions of pain and does not include psychological factors associated with the pain experience and treatment outcomes. Previous work has shown that individuals with chronic pain can be classified into subgroups based on pain sensitivity, psychological distress, mood, and symptom severity. OBJECTIVE: The aim of this study was to identify distinct subgroups of women with vulvodynia enrolled in the National Vulvodynia Registry. We hypothesized that women with vulvodynia can be clustered into subgroups based on distress and pain sensitivity. DESIGN: A cross-sectional study. METHODS: We conducted an exploratory hierarchical agglomerative cluster analysis using Ward's cluster method and squared Euclidean distances to identify unique subgroups based on baseline psychological distress and pain sensitivity. The variables included the catastrophizing subscale of the Coping Strategies Questionnaire, the Beck Depression Inventory, the State Trait Anxiety Index-Trait scale, McGill Pain Questionnaire-Affective subscale, and vulvar and pelvic muscle pressure pain sensitivity. SUBJECTS: Eight sites enrolled women who presented with vaginal or vulval pain of at least 3-month duration. RESULTS: Two distinct subgroups, high pain sensitivity with high distress (n=27) and low pain sensitivity with low distress (n=100), emerged from the cluster analysis. Validation indicated that subgroups differed in terms of clinical pain intensity, sensory aspects of pain, and intercourse pain. CONCLUSION: Empirical classification indicates that unique subgroups exist in women with vulvodynia. Providers should be aware of the heterogeneity of this condition with respect to pain-related distress and pain sensitivity.

The influence of clinical equipoise and patient preferences on outcomes of conservative manual interventions for spinal pain: an experimental study.

BACKGROUND: Expected pain relief from treatment is associated with positive clinical outcomes in patients with musculoskeletal pain. Less studied is the influence on outcomes related to the preference of patients and providers for a specific treatment. OBJECTIVES: We sought to determine how provider and patient preferences for a manual therapy intervention influenced outcomes in individuals with acutely induced low back pain (LBP). PARTICIPANTS AND METHODS: Pain-free participants were randomly assigned to one of two manual therapies (joint biased [JB] or constant touch [CT]) 48 hours after completing an exercise protocol to induce LBP. Expectations for pain relief and preferences for treatment were collected at baseline, prior to randomization. Pain relief was assessed using a 100 mm visual analog scale. All study procedures were conducted in a private testing laboratory at the University of Florida campus. RESULTS: Sixty participants were included in this study. After controlling for preintervention pain intensity, the multivariate model included only preintervention pain (B=0.12, p=0.07) and provider preference (B=3.05, p<0.0001) and explained 35.8% of the variance in postintervention pain. When determining whether a participant met his or her expected pain relief, receiving an intervention from a provider with a strong preference for that intervention increased the odds of meeting a participant's expected pain relief 68.3 times (p=0.013) compared to receiving any intervention from a provider with no preference. Receiving JB intervention from any provider increased the odds of meeting expected relief 29.7 times (p=0.023). The effect of a participant receiving an intervention they preferred was retained in the model but did not meet the criteria for a significant contribution. CONCLUSION: Our primary findings were that participant and provider preferences for treatment positively influence pain outcomes in individuals with acutely induced LBP, and joint-biased interventions resulted in a greater chance of meeting participants' expected outcomes. This is contrary to our hypothesis that the interaction of receiving an intervention for which a participant had a preference would result in the best outcome.