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1.
BMC Womens Health ; 18(1): 54, 2018 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-29587728

RESUMO

BACKGROUND: Chronic pelvic pain (CPP) affects 15-24% of women and can have a devastating impact on quality of life. Laparoscopy is often used in the investigation, although in one third of the examinations there is no visible pathology and the women may be dismissed without further investigation. Also, the contribution of skeletal, muscular, periosteal and ligamentous tissues to CPP remains to be further elucidated. The objective of the present study was to compare pain intensity provoked from anatomical landmarks of the intra-pelvic side-wall in women with pregnancy-related CPP after childbirth and women without such pain. METHODS: This is a descriptive study of 36 non-randomly selected parous women with CPP after childbirth and 29 likewise selected parous women after childbirth without CPP. Pain was determined by questionnaire and clinical examination. The primary outcome measure was reported pain intensity provoked on 13 anatomical landmarks of the intra-pelvic side-wall. All women reported their perceived pain intensity for each anatomical landmark on Likert scales and an individual sum score was calculated. RESULTS: Women with chronic pelvic pain were older than women without CPP. At several intra-pelvic landmarks high intensity pain was provoked in women with CPP compared with less intense pain provoked at fewer landmarks in women without low back or pelvic pain (p < 0.0001). The average sum of pain intensity scores was about 4 times higher in women with CPP (1.3) as compared with those without low back or pelvic pain (0.3), p < 0.0001. This association remained when adjusting for the age difference between the pain groups in linear regression analysis. In addition, reported pain intensity at worst past week was independently associated with sum of pain intensity scores. The maximum individual sum of pain intensity scores among women without CPP was exceeded by that of 85% of the women with CPP. CONCLUSIONS: Parous women with CPP after childbirth had a heightened pain intensity over 13 anatomical landmarks during pelvic examination compared with parous women without CPP. These results need to be confirmed in a larger cohort with different types of CPP.


Assuntos
Pontos de Referência Anatômicos , Dor Crônica/etiologia , Dor Pélvica/etiologia , Pelve , Complicações na Gravidez/etiologia , Adulto , Fatores Etários , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Parto , Exame Físico , Gravidez , Inquéritos e Questionários
2.
Lakartidningen ; 1122015 Sep 11.
Artigo em Sueco | MEDLINE | ID: mdl-26371481

RESUMO

There is a shortage of spine surgeons in Sweden. To guarantee the legal right to healthcare, many counties must hire doctors, with increasing costs. In our new out-patient department routine, the majority of the patients are examined by a physiotherapist at their first visit. History taking and clinical and radiographic examinations are discussed in a team conference, and possible candidates for spine surgery are selected for an appointment with a spine surgeon. Furthermore, the patients were more satisfied with the new routine and management plan.


Assuntos
Departamentos Hospitalares/organização & administração , Ortopedia/organização & administração , Exame Físico , Coluna Vertebral/cirurgia , Departamentos Hospitalares/normas , Humanos , Ortopedia/normas , Avaliação de Processos e Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente , Satisfação do Paciente , Modalidades de Fisioterapia , Encaminhamento e Consulta/estatística & dados numéricos , Cirurgiões/provisão & distribução , Procedimentos Cirúrgicos Operatórios , Suécia , Listas de Espera
3.
PLoS One ; 10(3): e0119542, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25793999

RESUMO

OBJECTIVES: To describe referred pain patterns provoked from intra-pelvic structures in women with chronic pelvic pain (CPP) persisting after childbirth with the purpose to improve diagnostics and give implications for treatment. MATERIALS AND METHODS: In this descriptive and comparative study 36 parous women with CPP were recruited from a physiotherapy department waiting list and by advertisements in newspapers. A control group of 29 parous women without CPP was consecutively assessed for eligibility from a midwifery surgery. Inclusion criterion for CPP was: moderate pain in the sacral region persisting at least six months after childbirth confirmed by pelvic pain provocation tests. Exclusion criteria in groups with and without CPP were: persistent back or pelvic pain with onset prior to pregnancy, previous back surgery and positive neurological signs. Pain was provoked by palpation of 13 predetermined intra-pelvic anatomical landmarks. The referred pain distribution was expressed in pain drawings and described in pain maps and calculated referred pain areas. RESULTS: Pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions, with or without pain referred down the ipsilateral leg. The average pain distribution area provoked by palpation of all 13 anatomical landmarks was 30.3 mm² (19.2 to 53.7) in women with CPP as compared to 3.2 mm² (1.0 to 5.1) in women without CPP, p< 0.0001. CONCLUSIONS: Referred pain patterns provoked from intra-pelvic landmarks in women with CPP are consistent with sclerotomal sensory innervation. Magnification of referred pain patterns indicates allodynia and central sensitization. The results suggest that pain mapping can be used to evaluate and confirm the pain experience among women with CPP and contribute to diagnosis.


Assuntos
Dor Referida , Dor Pélvica/diagnóstico , Adulto , Dor Crônica/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Palpação , Dor Pélvica/terapia , Exame Físico , Modalidades de Fisioterapia
4.
Physiother Theory Pract ; 29(5): 371-8, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23713407

RESUMO

BACKGROUND: Pregnancy-related low back and pelvic pain is a worldwide problem. A large proportion of women still experience disabling daily back pain 2 years after childbirth, resulting in major changes in activities and general well-being. In spite of this, the source of pain and effective treatment are uncertain. OBJECTIVE: To evaluate the short-term effects on function of a single corticosteroid injection treatment to the ischiadic spine in women with persistent pregnancy-related pelvic pain (PPPP). METHODS: Thirty-six women were allocated to injection treatment with slow-release triamcinolone and lidocain or saline and lidocain, given once at the sacrospinous ligament insertion on the ischiadic spine bilaterally with follow-up at 4 weeks. Outcome measures were Disability Rating Index (DRI), self-rated functional health (SF-36), gait speed and endurance (6MWT), and strength and endurance of trunk muscles (isometric trunk extensor and flexor tests). RESULTS: Women in the triamcinolone group showed significantly improved DRI (p = 0.046), 6MWT (p = 0.016), and isometric trunk extensor tests (p = 0.004), as compared with the saline group. Close co-variation was shown between improved function and reduced pain intensity. CONCLUSIONS: Improved function was achieved among women with PPPP after a single injection treatment with slow-release corticosteroid. The effect was positively correlated to the reduced pain intensity.


Assuntos
Corticosteroides/administração & dosagem , Dor Pélvica/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Triancinolona/administração & dosagem , Adulto , Anestésicos Locais/administração & dosagem , Preparações de Ação Retardada , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Marcha/efeitos dos fármacos , Humanos , Injeções Espinhais , Lidocaína/administração & dosagem , Força Muscular/efeitos dos fármacos , Medição da Dor , Dor Pélvica/diagnóstico , Dor Pélvica/fisiopatologia , Resistência Física/efeitos dos fármacos , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Recuperação de Função Fisiológica , Autorrelato , Índice de Gravidade de Doença , Suécia , Fatores de Tempo , Resultado do Tratamento
5.
Spine (Phila Pa 1976) ; 34(21): 2254-8, 2009 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-19934804

RESUMO

STUDY DESIGN: Randomized double blind controlled clinical trial. OBJECTIVE: To evaluate the pain relief effect of locally injected corticosteroid treatment in women with long-lasting sacral low back pain with onset during pregnancy. SUMMARY OF BACKGROUND DATA: Pregnancy-related low back pain is a global problem. Almost 1 of 10 women still experienced disabling daily back pain 2 years after childbirth with high impact on the individual, family, and society. On spite of this, the sources of pain and effective treatment are uncertain. METHODS: Thirty-six women were allocated to injection treatment, with slow-release triamcinolone and lidocaine or saline and lidocaine, given at the sacrospinous ligament insertion on the ischiadic spine bilaterally with 4 weeks follow-up time. Primary outcome measure was reported pain intensity on visual analogue scale and secondary outcome measures number of pain-drawing locations and pain-provoking test results. RESULTS.: The triamcinolone treatment group had significantly reduced pain intensity, number of pain locations, and pain-provoking test results between baseline and follow-up as compared with the saline treatment group. The absolute median change of visual analogue scale score in the triamcinolone treatment group was -24 mm and in the saline group +4.5 mm (P < 0.05). A reduced number of pain drawing locations was reported by 16 of 18 women in the triamcinolone group as compared with 10 of 18 in the saline group (P < 0.05). In the triamcinolone treatment group, 17 of 18 women had an improved pain provocation test result as compared with 9 of 18 in the saline treatment group (P < 0.01). CONCLUSION: The anatomic region around the sacrospinous ligament insertion on the ischial spine is suggested to be one source of long-lasting sacral low back pain with onset during pregnancy. The pain was relieved by slow-release corticosteroid injection treatment to the ischial spine.


Assuntos
Glucocorticoides/administração & dosagem , Dor Lombar/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Triancinolona/administração & dosagem , Adulto , Anestésicos Locais/administração & dosagem , Preparações de Ação Retardada , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Injeções Espinhais , Lidocaína/administração & dosagem , Dor Lombar/fisiopatologia , Região Lombossacral , Medição da Dor/métodos , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado do Tratamento
6.
Acta Obstet Gynecol Scand ; 85(11): 1360-7, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17091418

RESUMO

BACKGROUND: To evaluate the efficacy of electromyographic biofeedback and topical lidocaine treatment for women with vulvar vestibulitis. METHODS: A prospective randomized study where 46 women with vulvar vestibulitis were randomized to receive either electromyographic biofeedback or topical lidocaine treatment for four months. Assessments with vulvar pressure pain thresholds and questionnaires regarding quality of life, psychosocial adjustments, and sexual functioning were made before treatment, after treatment, and at six- and 12-month follow-ups. Nonparametric statistical methods were used to analyze differences in outcomes. RESULTS: Nine women (9/46) dropped out during the treatment period. Both treatments showed significantly improved values for vestibular pressure pain thresholds, quality of life measurements, and sexual functioning at the 12-month follow-up. No differences were found between the two treatment groups. No severe side effects were reported. CONCLUSIONS: Four months' treatment with electromyographic biofeedback and topical lidocaine gave statistically significant improvements on vestibular pain measurements, sexual functioning, and psychosocial adjustments at the 12-month follow-up. No differences in outcome between the two treatments were observed but a larger sample may be needed to obtain significance. The treatments were well tolerated but the compliance to the electromyographic biofeedback training program was low. A combination of both treatments could potentially benefit many women with vulvar vestibulitis.


Assuntos
Anestésicos Locais/uso terapêutico , Biorretroalimentação Psicológica , Eletromiografia , Lidocaína/uso terapêutico , Vulvite/terapia , Adaptação Psicológica , Administração Tópica , Adolescente , Adulto , Dispareunia/terapia , Feminino , Humanos , Medição da Dor , Qualidade de Vida , Comportamento Sexual , Ajustamento Social
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