Therapeutic ultrasound versus injection of local anesthetic in the treatment of women with chronic pelvic pain secondary to abdominal myofascial syndrome: a randomized clinical trial.

BACKGROUND: Chronic pelvic pain (CPP) is defined as recurrent or continuous pain in the lower abdomen or pelvis, either non-menstrual or noncyclical, lasting for at least 6 months. There is strong evidence that up to 85% of patients with CPP have serious dysfunctions of the musculoskeletal system, including abdominal myofascial pain syndrome (AMPS). AMPS is characterized by intense and deep abdominal pain, originating from hyperirritable trigger points, usually located within a musculoskeletal band or its lining fascia. In the literature, there are few studies that address AMPS. OBJECTIVES: To evaluate and compare the efficacy of therapeutic ultrasound (TUS) and injection of local anesthetic (IA) to improve pain in women with abdominal myofascial syndrome secondary to CPP. STUDY DESIGN: Randomized controlled clinical trial. SETTING: Tertiary University Hospital. MATERIALS AND METHODS: A randomized clinical trial was conducted, patients were allocated to two types of treatment: group TUS (n = 18), and group IA (n = 20). The instruments used for evaluation and reassessment were the Visual Analog Scale, Numerical Categorical Scale, McGill Pain Questionnaire, and SF-36 quality of life assessment questionnaire. They were evaluated before starting treatment, 1 week after the end of treatment, and at 1, 3, and 6 months. RESULTS: TUS and IA were effective in reducing clinical pain and improving quality of life through the variables analyzed among study participants. There was no significant difference between groups. LIMITATIONS: absence of blinding; exclusion of women with comorbidities and other causes of CPP, the absence of a placebo group, the difference between the number of sessions used for each technique, and the COVID-19. CONCLUSION: Treatment with TUS and IA were effective in reducing clinical pain and improving quality of life in women with AMPS secondary to CPP. TRAIL REGISTRATION: We declare that this clinical trial has been registered under the number [(ReBEC) no. RBR-39czsv] on 07/18/2018 in the Brazilian Registry of Clinical Trials.

Ashi Acupuncture Versus Local Anesthetic Trigger Point Injections in the Treatment of Abdominal Myofascial Pain Syndrome: A Randomized Clinical Trial.

BACKGROUND: Chronic pelvic pain (CPP) is defined as recurrent or continuous pain in the lower abdomen or pelvis, non-menstrual or non-cyclic, lasting at least 6 months. There is strong evidence that up to 85% of patients with CPP have serious dysfunction of the musculoskeletal system, including abdominal myofascial syndrome (AMPS). AMPS is characterized as deep abdominal pain, originating from hyperirritable trigger points, usually located within a musculoskeletal range or its fascia of coating. In the literature, there are few studies that address AMPS. OBJECTIVE: This study aimed to compare the responses of ashi acupuncture treatment and local anesthetic injection in the treatment of chronic pelvic pain secondary to abdominal myofascial pain syndrome in women. STUDY DESIGN: Randomized controlled clinical trial. SETTING: Tertiary University Hospital. METHODS: Women with a clinical diagnosis of CPP secondary to AMPS were randomized and evaluated using instruments to assess clinical pain, namely, the visual analogue scale (VAS), numerical categorial scale (NCS), and the McGill Questionnaire, after receiving treatment with ashi acupuncture (group A, n = 16) or local anesthetic injections (group B, n = 19). They were reevaluated after one week and one, 3, and 6 months after each treatment, in addition to assessments of pain and adverse events performed during the sessions. RESULTS: Ashi acupuncture and local anesthetic injections were both effective in reducing clinical pain assessed through the analyzed variables among study participants. There was no difference between the groups and there was a strong correlation between these pain assessment instruments. LIMITATIONS: The absence of blinding to the different forms of treatment among the patients and the researcher directly involved in the treatment, the absence of a placebo group, the selective exclusion of women with comorbidities and other causes of CPP, and the difference between the number of sessions used for each technique. CONCLUSION: Treatments with ashi acupuncture and local anesthetic injections were effective in reducing clinical pain in women with abdominal myofascial pain syndrome.

Analysis of Body Composition and Pain Intensity in Women with Chronic Pelvic Pain Secondary to Endometriosis.

OBJECTIVE: To determine the average body composition (percentage of body fat), the anthropometric markers, and the intensity of clinical pain in women with a clinical diagnosis of chronic pelvic pain (CPP) secondary to endometriosis. METHODS: A case-control study performed with 91 women, 46 of whom with CPP secondary to endometriosis and 45 of whom with CPP secondary to other causes. They underwent an evaluation of the anthropometric parameters by means of the body mass index (BMI), the perimeters (waist, abdomen, hip), and the percentage of body fat (%BF), which were assessed on a body composition monitor by bioimpedance; the intensity of the clinical pain was evaluated using the visual analog scale (VAS), and the symptoms of anxiety and depression, using the hospital's anxiety and depression scale (HAD). RESULTS: The groups did not differ in terms of mean age, BMI, %BF or regarding the available waist-to-hip ratio (WHR). The mean intensity of the clinical pain by the VAS was of 7.2 ± 2.06 in the group with CPP secondary to endometriosis, and of 5.93 ± 2.64 in the group with CPP secondary to other causes (p = 0.03), revealing significant differences between the groups. CONCLUSION: We concluded that, despite the difference in the pain score assessed between the two groups, there was no difference regarding body composition and anthropometry.

OBJETIVO: Determinar a composição corporal média (porcentagem de gordura corporal), os marcadores antropométricos, e a intensidade de dor clínica em mulheres com diagnóstico clínico de dor pélvica crônica (DPC) secundária a endometriose. MéTODOS: Um estudo de caso-controle realizado com 91 mulheres, 46 das quais com DPC secundária a endometriose, e 45 das quais com DPC secundária a outras causas. As pacientes foram submetidas à avaliação dos parâmetros antropométricos por meio do índice de massa corporal (IMC), dos perímetros (cintura, abdômen, quadril), e do percentual de gordura corporal (%GC), que foram avaliados em monitor de composição corporal por bioimpedância; a intensidade clínica da dor foi avaliada usando-se a escala visual analógica (EVA), e os sintomas de ansiedade e depressão, usando a escala de ansiedade e depressão do hospital (EADH). RESULTADOS: Os grupos não diferiram quanto à idade média, ao IMC, ao %GC, nem quanto à relação da cintura­quadril (RCQ) disponível. A média da intensidade clínica da dor pela EVA foi de 7,2 ± 2,06 no grupo com DPC secundária a endometriose, e de 5,93 ± 2,64 no grupo com DPC secundária a outras causas (p = 0,03), revelando diferenças significativas entre os grupos. Em relação à EADH, ambos os grupos estavam acima da média de corte. CONCLUSãO: Concluímos que, apesar da diferença no escore de dor avaliado entre os dois grupos, não houve diferença com relação à composição corporal e à antropometria.

Analysis of body composition and pain intensity in women with chronic pelvic pain secondary to endometriosis / Análise da composição corporal e intensidade de dor em mulheres com dor pélvica crônica secundária a endometriose

Abstract Objective To determine the average body composition (percentage of body fat), the anthropometric markers, and the intensity of clinical pain in women with a clinical diagnosis of chronic pelvic pain (CPP) secondary to endometriosis. Methods A case-control study performed with 91 women, 46 of whom with CPP secondary to endometriosis and 45 of whom with CPP secondary to other causes. They underwent an evaluation of the anthropometric parameters by means of the body mass index (BMI), the perimeters (waist, abdomen, hip), and the percentage of body fat (%BF), which were assessed on a body composition monitor by bioimpedance; the intensity of the clinical pain was evaluated using the visual analog scale (VAS), and the symptoms of anxiety and depression, using the hospital's anxiety and depression scale (HAD). Results The groups did not differ in terms of mean age, BMI, %BF or regarding the available waist-to-hip ratio (WHR). The mean intensity of the clinical pain by the VAS was of 7.2 ± 2.06 in the group with CPP secondary to endometriosis, and of 5.93 ± 2.64 in the group with CPP secondary to other causes (p = 0.03), revealing significant differences between the groups. Conclusion We concluded that, despite the difference in the pain score assessed between the two groups, there was no difference regarding body composition and anthropometry.

Resumo Objetivo Determinar a composição corporal média (porcentagem de gordura corporal), os marcadores antropométricos, e a intensidade de dor clínica em mulheres com diagnóstico clínico de dor pélvica crônica (DPC) secundária a endometriose. Métodos Um estudo de caso-controle realizado com 91 mulheres, 46 das quais com DPC secundária a endometriose, e 45 das quais com DPC secundária a outras causas. As pacientes foram submetidas à avaliação dos parâmetros antropométricos por meio do índice de massa corporal (IMC), dos perímetros (cintura, abdômen, quadril), e do percentual de gordura corporal (%GC), que foram avaliados emmonitor de composição corporal por bioimpedância; a intensidade clínica da dor foi avaliada usando-se a escala visual analógica (EVA), e os sintomas de ansiedade e depressão, usando a escala de ansiedade e depressão do hospital (EADH). Resultados Os grupos não diferiram quanto à idade média, ao IMC, ao %GC, nem quanto à relação da cintura-quadril (RCQ) disponível. Amédia da intensidade clínica da dor pela EVA foi de 7,2 ± 2,06 no grupo com DPC secundária a endometriose, e de 5,93 ± 2,64 no grupo com DPC secundária a outras causas (p = 0,03), revelando diferenças significativas entre os grupos. Emrelação à EADH, ambos os grupos estavam acima da média de corte. Conclusão Concluímos que, apesar da diferença no escore de dor avaliado entre os dois grupos, não houve diferença com relação à composição corporal e à antropometria.

Effect of Acupuncture on Chronic Pelvic Pain Secondary to Abdominal Myofascial Syndrome Not Responsive to Local Anesthetic Block: A Pilot Study.

Objective: Strong evidence shows that 85% of women with chronic pelvic pain (CPP) have musculoskeletal disorders, such as abdominal myofascial pain syndrome (AMPS). The aim of this research was to assess the efficacy of local acupuncture treatment for women with CPP secondary to AMPS unresponsive to treatment with trigger-point injection. Materials and Methods: This pilot study involved 17 women with moderate-to-severe AMPS-related CPP. Acupuncture treatments were given at abdominal-wall trigger points once per week for 10 consecutive weeks. Pain relief was assessed with a visual analogue scale (VAS), the McGill questionnaire, and pressure dynamometer. Quality of life and psychosocial function (risk for anxiety and depression) were evaluated using the Short-Form-36 questionnaire and the Hospital Anxiety and Depression scale. Assessments were performed at baseline and after 1, 3, and 6 months of treatment. Results: Both the VAS and McGill pain questionnaire showed significantly decreased pain intensity (VAS, P < 0.001; and McGill, P 0.049), and the effects were sustained even at 6 months after treatment. Conclusions: Acupuncture treatment was effective for the women who participated in this study, and the current authors believe that these preliminary results suffice to recommend performing randomized controlled trials.

Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles / Massagem perineal melhora a dispareunia causada por tensão dos músculos do assoalho pélvico

ABSTRACT Aim: To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles. Methods: A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group - 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group - 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks. Results: All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain. Conclusion: Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.

RESUMO Objetivo: Avaliar a eficácia em longo prazo da massagem perineal de Thiele no tratamento de mulheres com dispareunia provocada pela tensão dos músculos do assoalho pélvico. Métodos: Foram incluídos no estudo dezoito mulheres com diagnóstico de dispareunia provocada pela tensão dos músculos do assoalho pélvico. As mulheres foram divididas em dois grupos: o grupo dispareunia (D) - 8 mulheres com dispareunia causada pela tensão dos músculos do assoalho pélvico; e o grupo de dor pélvica crônica (DPC): 10 mulheres com dispareunia causada pela tensão dos músculos do assoalho pélvico associados à DPC. Cada paciente preencheu Escala Visual Analógica (EVA), Índice de Dor de McGill, Índice de Função Sexual Feminino (IFSF) e Escala Hospitalar de Ansiedade e Depressão (EHAD). Após a avaliação, as mulheres foram submetidas a massagem transvaginal utilizando a técnica de Thiele ao longo de um período de 5 minutos, 1 vez por semana durante 4 semanas. Resultados: Todas as mulheres tiveram melhora significativa da dispareunia de acordo com a EVA e o Índice de Dor de McGill (p < 0,001), mas na pontuação do EHAD não mostraram diferenças significativas. Em relação à função sexual, o grupo D apresentou melhora de todos os aspectos da função sexual, enquanto o grupo DPC mostrou diferenças apenas no domínio dor. Conclusão: A massagem perineal de Thiele é eficaz no tratamento da dispareunia causada pela tensão dos músculos do assoalho pélvico, com alívio da dor a longo prazo.

Perineal Massage Improves the Dyspareunia Caused by Tenderness of the Pelvic Floor Muscles.

Aim To evaluate the long-term effectiveness of perineal Thiele massage in the treatment of women with dyspareunia caused by tenderness of the pelvic floor muscles. Methods A total of 18 women with diagnoses of dyspareunia caused by tenderness of the pelvic floor muscles were included in the study. The women were divided in two groups: the dyspareunia (D) group - 8 women with dyspareunia caused by tenderness of the pelvic floor muscles; and the chronic pelvic pain group (CPP) group - 10 women with dyspareunia caused by tenderness of the pelvic floor muscles associated with CPP. Each patient filled out the Visual Analogue Scale (VAS), the McGill Pain Index, the Female Sexual Function Index (FSFI) and the Hospital Anxiety and Depression Scale (HADS). After an evaluation, the women underwent transvaginal massage using the Thiele technique over a period of 5 minutes, once a week for 4 weeks. Results All women had significant improvements in their dyspareunia according the VAS and the McGill Pain Index (p < 0,001), but the HADS scores did not show significant differences. Regarding sexual function, the D group showed improvements on all aspects of sexual function, while the CPP group showed differences only in the pain domain. Conclusion Thiele massage is effective in the treatment of dyspareunia caused by tenderness of the pelvic floor muscles with a long-term pain relief.

Caracterização dos acometimentos relacionados à morbimortalidade na esclerose sistêmica / Characterization of involvement related to morbidity and mortality in systemic sclerosis

Introdução: A esclerose sistêmica é uma doença difusa do tecido conectivo de natureza autoimune com etiologia desconhecida, caracterizada primariamente pelo aumento de deposição de colágeno na matriz extracelular. Objetivo: Caracterização dos acometimentos relacionados à morbimortalidade na esclerose sistêmica por meio da revisão de literatura. Métodos: Elaborado a partir de revisão literária de artigos publicados entre os anos de 1993 e 2013 indexados nas línguas portuguesa e inglesa, que utilizou como fonte de pesquisa as bases de dados Scielo, Bireme, Pedro e Pubmed nacionais e internacionais, por meio de método de mensuração baseada na quantidade de citações. Resultados: O estudo revelou como características da esclerose sistêmica, os seguintes acometimentos: fenômeno de Raynaud, úlceras cutâneas, complicações esofágicas, insuficiência renal, hipertensão pulmonar e doença intersticial pulmonar. O maior percentual (47,63%) de acometimento refere-se à doença intersticial pulmonar, acompanhada por um percentual (45,16%) atribuído aos episódios de fenômeno de Raynaud. Conclusão: Conclui-se, portanto, que, por meio da análise de citações dos acometimentos da esclerose sistêmica, o que prevalece principalmente são as manifestações pulmonares como causa importante de morbimortalidade neste tipo de paciente. (AU)

Introduction: Systemic sclerosis is a diffuse connective tissue disease of autoimmune unknown etiology, characterized primarily by increased collagen deposition in the extracellular matrix. Aim: Characterization of involvement related to morbidity and mortality in systemic sclerosis through literature review. Methods: Compiled from literature review of articles published between the years 1993 to 2013 indexed in Portuguese and English, which used as a research resource bases Scielo, Bireme, Pedro and Pubmed national and international data, using method based on the number of citations. Results: The study revealed as characteristics of systemic sclerosis, the following causes: Raynaud's phenomenon, esophageal complications, skin ulcers, renal failure, pulmonary hypertension and interstitial lung disease. The highest percentage (47.63%) involvement refers to interstitial lung disease, accompanied by the percentage (45.16%) attributed to episodes of Raynaud's phenomenon. Conclusion: It is therefore concluded that, by making a citation analysis of Systemic Sclerosis occurrence, pulmonary manifestations prevails and are an important cause of morbidity and mortality in this patient. (AU)

Treatment of bladder pain syndrome and interstitial cystitis: a systematic review.

INTRODUCTION AND HYPOTHESIS: Bladder pain syndrome/interstitial cystitis (BPS/IC) has various treatments; however, no standardized treatment has been established. The aim was to analyze different types of treatment of BPS/IC and their effectiveness. METHODS: A literature review with a search strategy for articles related to BPS/IC published between 1990 and 2014 was conducted on MEDLINE, PUBMED, and SCOPUS. Only randomized controlled trials in women were included in the meta-analysis, while other experimental studies were used as bases for a systematic review of the topic. Clinical trial quality was defined according to the Jadad scale. RESULTS: Of 356 articles, 13 were included in the analysis. The intervention methods were as follows: instillation of hyaluronic acid, botulinum toxin A, intravesical lidocaine, hyperbaric chamber, massage, physiotherapy, phosphate-buffered saline, piroxicam in combination with doxepin, and others. We did not find any treatment with at least two randomized controlled trials for meta-analysis. Among the assessment tools for symptoms of BPS/IC, the most frequently used were the visual analogue scale, voiding record, and the O'Leary-Sant questionnaire. CONCLUSION: Existing studies were not able to define the best approach for the treatment of BPS/IC. The lack of standardized treatment may be related to the diversity of interventions used; therefore, further studies with better methodological quality are needed.

Measurement of pain and anthropometric parameters in women with chronic pelvic pain.

RATIONALE, AIMS AND OBJECTIVES: To analyse anthropometric parameters, clinical pain and experimental pain in women with chronic pelvic pain (CPP). METHODS: Ninety-one women with a clinical diagnosis of CPP, mean age of 40.03 ± 9.97 years, submitted to anthropometric evaluation based on body mass index (BMI) and percent body fat (%BF) using bioimpedance body composition monitor; pain intensity was determined by visual analogue scale (VAS), numerical categorical scale (NCS) and McGill Pain Questionnaire; experimental pain was determined by transcutaneous electrical nerve stimulation (TENS), and anxiety and depression symptoms were determined by the Hospital Anxiety and Depression scale. RESULTS: A total of 54.8% of the women showed %BF >32 risk of disease associated with obesity. Regarding the anthropometric data, a statistically significant difference was observed between groups for both BMI and %BF (P<0.0001). In the analysis of pain intensity by the VAS, NCS and total McGill, there was no significant difference between the groups, and experimental pain by TENS revealed significant difference only between the normal weight and overweight groups (P=0.0154). The results of anxiety symptoms were above the cut-off point in all groups, with no significant difference between them (P=0.3710). The depression symptoms were below the cut-off point in the normal weight group and above the cut-off point in the overweight and obese groups, 9.469(4.501) and 9.741(4.848), respectively, with no significant difference between them (P=0.6476). CONCLUSION: Evaluation of anthropometric parameters and pain measurements can be applied in clinical practice, making a contribution to the diagnosis and influencing the choice of a more effective treatment for women with CPP.

Rastreamento da função cognitiva de idosos não-institucionalizados / Screening cognitive function of non-institutionalized elderly

O objetivo deste trabalho foi avaliar a função cognitiva dos idosos e determinar a frequência do déficit cognitivo, estratificando-os por idade, escolaridade, passatempo, relação social, doenças crônicas informadas e depressão. A uma amostra aleatória de 394 idosos com idade igual ou maior que 60 anos do município de Batatais (SP) foi aplicado questionário sobre condições socioeconômicas, saúde e Escala de Depressão Geriátrica (EDG). Para rastrear o déficit cognitivo, foi utilizado o MEEM - Mini-Exame do Estado Mental modificado. Na avaliação do desempenho cognitivo, usou-se ponto de corte 23. Observou-se que 81,7% dos idosos ficaram acima desse ponto e 18,3% ficaram abaixo. Os idosos que tiveram os escores mais elevados foram associados a fatores como idade (60-69 anos), nível de escolaridade, hábito de leitura, boa relação social, principalmente com familiares, e não ter hipertensão arterial, diabete, incontinência urinária, catarata e ou sintomas depressivos. O desempenho cognitivo global dos idosos avaliado pelo instrumento baseado no MEEM revelou que aqueles com escores abaixo do ponto de corte tiveram proporção semelhante à encontrada em outros estudos.

This study aimed to evaluate the cognitive function of elderly people and determine the frequency of cognitive impairment, stratified by age, education, hobby, social relationship, informed chronic diseases and depression. In a random sample of 394 elderly aged over 60 years in the city of Batatais, state of São Paulo, Brazil, was administered a questionnaire on socioeconomic conditions, health and Geriatric Depression Scale (GDS). To track the cognitive impairment, we used the MMSE - Mini Mental State Examination modified. In the assessment of cognitive performance, we used a cutoff point of 23. It was observed that 81.7% of the subjects were above this point and 18.3% were below. The elderly who had higher scores were associated with factors such as age (60-69 years), educational level, reading habits, good social relations, especially with family and no hypertension, diabetes, urinary incontinence, cataracts and/or depressive symptoms. The global cognitive performance of older people assessed by the tool based on the MMSE showed that those with socres below the cutoff point had a similar proportion to that found in other studies.