Interventions in treating chronic pelvic pain in women
Sübutlu məlumatların xülasələri
03.11.2015 • Sonuncu dəyişiklik 03.11.2015
Editors
Progestagens appear to provide symptom relief for chronic pelvic pain in women.
An updated Cochrane review
included 14 studies, with a total of 1190 subjects (mean ages 27 to 35 years in most studies). Progestogen (medroxyprogesterone acetate, MPA) was effective at the end of treatment as reflected in pain scores (OR 2.64, 95% CI 1.33 to 5.25, n = 146) and a self-rating scale (OR 6.81, 95% CI 1.83 to 25.3, n = 44), but benefit, measured nine months post-treatment, was not sustained. MPA plus psychotherapy was effective in terms of pain scores (OR 3.94, 95% CI 1.2 to 12.96, n = 43) but not the self rating scale, at the end of treatment. Benefit was not sustained
post-treatment.
Counseling supported by ultrasound scanning was effective both in terms of pain scores (OR 6.77, 95% CI 2.83 to 16.19, n = 90) and mood (OR 4.63, 95% CI 1.68 to 12.75). The use of a multidisciplinary approach led to a positive outcome in a self-rating scale (OR 4.15, 95% CI 1.91 to 8.99, n = 106) and daily activity but not in pain scores.
Benefit was not demonstrated for adhesiolysis (apart from where adhesions were severe), uterine nerve ablation, sertraline or photographic reinforcement after laparoscopy. Writing therapy and static magnetic field therapy showed some evidence of short-term benefit.A Cochrane review about non-surgical interventions for the management of chronic pelvic pain included 13 studies, with a total of 750 subjects. MPA was more effective than placebo at the end of treatment in terms of the number of women achieving a greater than 50% reduction in visual analogue scale (VAS) pain score immediately after treatment (Peto OR 3.00, 95% CI 1.70 to 5.31, 2 studies, n=204). Evidence of benefit was maintained up to nine months. Head-to-head comparisons showed that women taking goserelin had greater improvement in pelvic pain score (MD 3, 95% CI 2.08 to 3.92, 1 study, n=47) at one year than those taking progestogen. The study comparing goserelin versus progestogen did not report on adverse effects.
Women who underwent reassurance ultrasound scans and received counselling were more likely to report improved pain than those treated with a standard 'wait and see' policy (Peto OR 6.77, 95% CI 2.83 to 16.19, n = 90).
Distension of painful pelvic structures was more effective for pain when compared with counselling (MD 35.8, 95% CI 23.08 to 48.52 on a zero to 100 scale, one study, n=48). No difference in pain levels was observed when magnetic therapy was compared with use of a control magnet.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).
Ədəbiyyat
-
Stones RW, Mountfield J.. Interventions for treating chronic pelvic pain in women. Cochrane Database Syst Rev. 2005;(3):CD000387.
- Cheong YC, Smotra G, Williams AC. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev 2014;(3):CD008797.