Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy

Małgorzata Malec-Milewska 1, Bartosz Horosz 2, Agnieszka Sękowska 2, Iwona Kolęda 2, Dariusz Kosson 3, Grzegorz Jakiel 4
1 - Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland
2 - Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland
3 - Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland; Department of Continuous Education in Anaesthesiology and Intensive Care, Medical University, Warsaw, Poland
4 - 1 st Department of Obstetrics and Gynaecology, Medical Centre for Postgraduate Education, Warsaw, Poland
Ann Agric Environ Med
2015; 22 (2):
ICID: 1152094
Article type: Original article
 
 
Introduction. Chronic pelvic pain syndrome occurs in 4–14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions.
Objective. Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions.
Materials and method. 18 women were treated between January 2010 – October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3–9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7–10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin).
Results. In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms.
Conclusions. The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther) and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.
DOI: 10.5604/12321966.1152094
PMID 26094538 - click here to show this article in PubMed
  FULL TEXT STATS

Recommend this article to:

Name:
E-mail:
From:
Language:


Related articles in IndexCopernicus™
     ganglion of Walther [0 related records]
     pudendal nerve block [0 related records]
     gabapentin [44 related records]
     Amitriptyline [12 related records]
     pelvic adhesions [0 related records]
     Endometriosis [131 related records]
     chronic pelvic pain syndrome [5 related records]



 

Related articles

A Wlaz, M Kondrat-Wrobel,
Synergistic interaction of levetiracetam with gaba...
This study was aimed at characterizing the anticonvulsant effects of levetiracetam in combination with gabapentin, in the mouse 6 Hz psychomotor seizure model. Herein, psychomotor seizures were evoked in male albino Swiss mice by a current (32 mA, 6 ...
ABSTRACT
T Sekmenli, M Gündüz,
 Ruptured Hemorrhagic Cyst of Undescended Ova...
 Undescended ovary is a rare entity and usually presentedas a case report. It is associated with urinary and uterine anomalies. Symptomatic patients are diagnosed during surgery. Most of the patients are asymptomatic and treatment is unnecessary...
ABSTRACT
, ,
 A PROSPECTIVE STUDY ON LAPAROSCOPIC AND HIST...
 BACKGROUND Endometriosis is a common benign gynaecological disorder. The true prevalence is difficult to quantify as women with disease are often asymptomatic and imaging modalities have low sensitivities for diagnosis. The primary method o...
ABSTRACT