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WCS > PFD2 Chronic Pelvic Pain, Pudendal Neuralgia > Flashcards

PFD2 Chronic Pelvic Pain, Pudendal Neuralgia Flashcards

1
Q

What is Urologic Chronic Pelvic Pain Syndrome (UCPPS)?

A

Pelvic region pain lasting greater than 3 to 6 months
Including chronic pelvic pain syndrome, chronic prostatitis, interstitial cystitis or painful bladder syndrome

Includes chronic pelvic pain syndrome or chronic prostatitis (CP/CPPS) in men and interstitial cystitis or painful bladder syndrome (IC/PBS) in women.

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2
Q

What are some risk factors for UCPPS?

A
  • Previous infection
  • Surgery
  • Chemical irritation
  • Trauma
  • Pelvic abnormalities
  • Psychosocial factors

Specific surgeries include pelvic ring, hysterectomy, rectal cancer removal, and vaginal mesh.

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3
Q

What psychosocial factors can contribute to chronic pelvic pain?

A
  • Depressive symptoms
  • Physical disability
  • Sexual functioning
  • Home environment
  • Occupation
  • Socioeconomic status
  • Individual response to pain
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4
Q

What systems can be involved in UCPPS?

A
  • Urogenital
  • Neurologic
  • Endocrine
  • Gastrointestinal
  • Musculoskeletal
  • Psychological component
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5
Q

What is a common pathophysiological mechanism in UCPPS?

A

Pudendal nerve entrapment at sacrotuberous ligament, ischiorectal space, and pubic symphysis area, cauda equina is rare.
Sx hx may be associated to fibrotic changes and affect pelvic nerve anatomy

Rarely involves cauda equina nerve root.

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6
Q

What is the significance of pelvic floor muscle mobility in men with CPPS?

A

Men with CPPS have significantly lower pelvic floor muscle mobility with a full bladder compared to controls without CPPS.
Altered tension in the pubprostatic ligaments

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7
Q

What is the approach to patient assessment for UCPPS?

A

Disease of exclusion

Differential diagnosis must rule out UTI, bacterial prostatitis, benign prostatic hypertrophy (BPH), overactive bladder, pelvic floor dysfunction, malignancy, calculi, interstitial cystitis, and irritable bowel syndrome.

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8
Q

What role does peripheral nerve mechanosensitivity play in UCPPS?

A

It may play a role in the pathophysiology and is correlated with minor nerve injuries.

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9
Q

What conservative treatments are available for UCPPS?

A
  • Manual therapy
  • Therapeutic exercises
  • Biofeedback
  • Injections for pain relief
    Yoga
  • topical essential oil over perineum
  • gut Microbiome
  • acupuncture
  • tens
  • extra corporeal shockwave therapy

Pudendal nerve block is an example of an injection.

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10
Q

What pharmaceutical treatments are used for UCPPS?

A
  • Alpha-blockers
  • Antibiotics
  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs
  • Gabapentenoids (better than pregabalin)
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11
Q

Fill in the blank: _______ is a type of minimally invasive interventional therapy for UCPPS. via injection

A

Trigger point injections

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12
Q

What are the components of trigger point injections?

A
  • Local anesthetic
  • Botulinum toxin or
  • Dry needle used to penetrate piriformis iliococcygeus pubococcygeus levator ani , coccygeus obturator internus superficial and deep transverse perineum

These target specific muscles like piriformis and levator ani.

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13
Q

What is the effect of pudendal nerve blockade?

A

Interrupts pudendal innervation within the penis, clitoris, bulbospongiosus muscle, ischiocavernosus muscles, perineum, and anus.

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14
Q

What surgical procedure is often controversial in pain management for UCPPS?

A

Hysterectomy

67% of women experienced pain improvement 46 months post-hysterectomy.

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15
Q

What percentage of patients experienced symptomatic improvement after exploratory laparoscopy?

A

59%
following surgical treatment of lesions identified by laproscopy

98% of cases demonstrated a previously undiagnosed pelvic anomaly.

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16
Q

True or False: Radical prostatectomy has shown significant pain relief for CP and CPPS.

A

False
Limited pain relief and needs to be studied more

It requires further study for its effectiveness.

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17
Q

What are differences between the superior hypogastric nerve and the inferior hypogastric plexus

A

Superior hypogastric nerve sympathetically mediates pain pathways associated cancer related pain rather than CP/CPPS. Inferior hypogastric plexus blocks affect lower pelvic viscera especially in females

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18
Q

What is chronic perineal pain?

A

A complex interaction between neuro, MSK, and endocrine systems affected by behavioral and psychological factors
Foods functional disorder such as levator ani syndrome, proctalgia fugax , myofascial syndrome and coccydynia

It is not classified as a disease.

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19
Q

What characterizes levator ani syndrome?

A

Dull anorectal pain aggravated by sitting and tenderness to palpation of the levator ani, failed coordination of anorectal and pelvic floor muscles during defecation

It is often idiopathic and can be linked to various stressors.

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20
Q

What are the common symptoms of levator ani syndrome?

A
  • Pain exacerbated by sitting
  • Constipation
  • Obstructed defecation
  • Incomplete defecation
  • Rare dyspareunia

Symptoms may vary based on individual cases.

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21
Q

How is levator ani syndrome diagnosed?

A

Recurrent rectal pain lasting at least 20 minutes with exclusion of organic anorectal or endopelvic disease

Diagnosis requires careful evaluation of symptoms and exclusion of other conditions.

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22
Q

What are the treatment options for levator ani syndrome?

A
  • Manual therapy
  • Hot baths
  • Muscle relaxants
  • Electrogalvanic stimulation
  • Biofeedback
  • Medication
  • Injection

A multidisciplinary approach may be beneficial.

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23
Q

What is proctalgia fugax?

A

Sharp anorectal pain lasting several seconds to minutes, typically at night

The pain disappears quickly and is often associated with pelvic floor spasms.

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24
Q

What are the alleviating effects for proctalgia fugax?

A
  • Change position
  • Pressure on anal area
  • Supine knees to chest
  • Warm bath
  • Passing gas
  • Bowel movement

These methods may provide temporary relief from symptoms. die to less pressure on rectum

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25
Q

What is the diagnosis criteria for proctalgia fugax?

A

Recurrent anorectal pain lasting less than 30 minutes with absence of pain between episodes

Diagnosis focuses on the duration and frequency of episodes.

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26
Q

What treatments are available for proctalgia fugax?

A
  • Inhaled beta adrenergic agonists
  • Oral alpha adrenergic agonist
  • Nifedipine
  • Topical nitrates
  • Low epidural anesthesia
  • IV lidocaine
  • Botox injection

Treatment options vary based on severity and patient response.

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27
Q

What defines myofascial syndrome?

A

Sharp or chronic deep muscle pain with localized trigger points

It often affects the levator ani, obturator internus, and other pelvic muscles.

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28
Q

What symptoms are associated with myofascial syndrome?

A
  • Sharp/severe perineal or anorectal pain
  • Painful defecation
  • Constipation
  • Obstructed defecation
  • Dyspareunia

Symptoms can worsen with stress or emotional factors.

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29
Q

How is myofascial syndrome diagnosed?

A

Digital exam of trigger points with exclusion of organic anorectal or endopelvic disease

Diagnosis relies on physical examination and symptom assessment.

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30
Q

What is coccygodynia?

A

Pain in or around the coccyx

It can be due to various causes, including trauma or idiopathic factors.

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31
Q

How much more frequent is coccygodynia in women compared to men?

A

5 times more frequent

This condition is also 3 times more frequent in obese patients.

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32
Q

What are common causes of coccygodynia?

A
  • Acute trauma
  • Congenital abnormalities
  • Idiopathic causes
  • Rarely neoplasm, infection, or arthritis

Identifying the cause is essential for appropriate treatment.

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33
Q

What diagnostic methods are used for coccygodynia?

A
  • Pain during digital palpation
  • Mobilization
  • Possible spasm or tenderness of pelvic floor muscles
  • Radiographs

These methods help determine the underlying issues.

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34
Q

What treatment options are available for coccygodynia?

A
  • Medications
  • Protection while sitting
  • Hot baths
  • Manual therapy
  • Ultrasound
  • Diathermy
  • Pelvic floor muscle relaxation
  • Injection if conservative treatment fails

A variety of approaches may be required based on individual responses.

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35
Q

What is crucial for the evaluation of chronic perineal pain?

A

Excluding underlying organic disease

Accurate diagnosis is essential for effective treatment.

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36
Q

Why is the diagnosis of chronic perineal pain challenging?

A

Due to overlapping functional entities

Careful assessment and differentiation are necessary for accurate diagnosis.

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37
Q

What is the main nerve of sexuality?

A

Pudendal nerve

The pudendal nerve carries autonomic, sensory, and motor fibers to the anal, perineal, and genital regions.

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38
Q

What are the branches of the pudendal nerve?

A

Dorsal nerve of the penis or clitoris

This branch supplies erectile tissue and the dorsal and lateral skin of the penis and clitoris.

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39
Q

Where does the pudendal nerve exit the pelvis?

A

Infra-piriform notch of the greater sciatic foramen

It exits anterior to the sciatic nerve and the sacrotuberous ligament.

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40
Q

What is Alcock canal?

A

A canal made up of obturator internus fascia

The pudendal nerve passes through Alcock canal.

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41
Q

What are common causes of pudendal nerve injury?

A
  • Pelvic surgeryMid urethral sling, hysterectomy, anterior colporrhaphy
  • Inflammation from herpes simplex
  • Pelvic tumoral compression
  • Chemoradiation
  • Vaginal delivery
  • Back or glute injury
  • Chronic constipation
  • Excessive cycling
  • Prolonged sitting

Mid-urethral sling surgeries, hysterectomies, and anterior colporrhaphy are specific surgeries that may risk pudendal nerve injury.

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42
Q

What are the components of normal sexual function in females?

A
  • Swelling of the clitoris and labia minora
  • Vaginal lubrication
  • Lengthening of the vagina
  • Nipple erection
  • Increased genital sensitivity
  • Orgasm

These components occur during the arousal and plateau phases.

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43
Q

What is required for normal sexual function in males?

A
  • Libido
  • Initiating and maintaining erection
  • Orgasm
  • Ejaculation
  • Refractory period

These elements are crucial for male sexual function.

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44
Q

What processes are involved in sexual response?

A
  • Social
  • Psychological
  • Neurological
  • Vascular
  • Hormonal

Sexual response is influenced by the central nervous system, peripheral neurovascular system, and hormonal influences.

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45
Q

What role does the dorsal nerve of the penis play in erection?

A

Regulates erectile and ejaculatory function

It contains nNOS-containing fibers.

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46
Q

What are the requirements for achieving an erection?

A
  • Operational cavernous nerves
  • Good blood flow through internal pudendal arteries and eventually bulbo and cavernosus A.
  • Healthy erectile tissue
  • Pudendal nerves capable of stimulating contraction of perineal musculature
    Contraction of ischio cavernosus repeated contraction and compression of bulbocavernosus

These factors must be intact for an erection to occur.

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47
Q

What is Persistent Genital Arousal Disorder (PGAD)?

A
  • Sexual arousal extending in time and not subsiding on its own
  • Arousal not relieved by ordinary orgasm
  • Arousal unrelated to sexual desire
  • Arousal triggered by sexual and non-sexual stimuli
  • Arousal experienced as unbidden, intrusive, and unwanted

PGAD is characterized by unwanted and persistent sexual arousal.

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48
Q

What treatments are available for PGAD?

A
  • Medications (SNRIs, SSRIs, benzodiazepines)
  • Physical therapy (decompression techniques)
  • TENS
  • Surgery (implantable pulse generator, neurolysis)

These treatments aim to alleviate symptoms of PGAD.

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49
Q

What defines erectile dysfunction (ED)?

A

Inability to achieve or maintain an erection adequate for sexual satisfaction

ED involves vascular, neural, hormonal, and structural factors.

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50
Q

What are common causes of erectile dysfunction?

A
  • Psychological disorders
  • Neurogenic disorders
  • Hormonal disorders
  • Arterial disorders
  • Venous disorders

ED can also be associated with conditions like hyperlipidemia, diabetes, and hypertension.

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51
Q

What are first-line treatments for erectile dysfunction?

A
  • Lifestyle changes
  • Phosphodiesterase type 5 inhibitors (PDE5 inhibitors)
  • Intraurethral or intracavernosal injections
  • Vacuum devices
  • Low-intensity shockwave therapy
  • Penile prosthesis implantation

These treatments aim to restore erectile function.

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52
Q

What characterizes premature ejaculation?

A
  • Occurs before or within 1 minute of vaginal penetration (lifelong PE)
  • About 3 minutes or less (acquired PE)

Premature ejaculation can be classified as lifelong or acquired.

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53
Q

What are first-line medications for premature ejaculation?

A
  • Dapoxetine
  • SSRIs
  • Topical lidocaine
  • Prilocaine

These medications help manage symptoms of premature ejaculation.

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54
Q

What is vestibulodynia?

A

A condition characterized by entry dyspareunia and vulvodynia

find more support for vestibilo vs vulvo

It is associated with the pudendal nerve, which supplies the vulva.

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55
Q

What are first-line treatments for vestibulodynia?

A
  • Local application of anesthetics (lidocaine)
  • Amitriptyline
  • Gabapentin
  • Pregabalin
  • TENS with vaginal diazepam

These treatments aim to alleviate pain associated with vestibulodynia.

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56
Q

What is the pathway of the pudendal nerve?

A

Passes between performance and coccygeus muscle. Exits the pelvis via infra piriformis not a greater sciatic foramen anterior to sciatic nerve and sacrotuberous ligament. Passes medial to sacrospinous ligament and returns to pelvis via lesser sciatic foramen. Passes through Alcock canal

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57
Q

List some diagnoses associated with Chronic Pelvic Pain.

A
  • Dyspareunia
  • Vaginismus
  • Vulvodynia
  • Vestibulodynia
  • Endometriosis
  • Interstitial cystitis
  • Painful bladder syndrome
  • Chronic nonbacterial prostatitis
  • Prostadynia
  • Chronic proctalgia
  • Piriformis syndrome
  • Hip dysfunction
  • Pudendal neuralgia
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58
Q

What are the primary physical therapy (PT) treatments for pelvic pain?

A
  • Therapeutic exercise (TE) for muscle function
  • Neuromuscular re-education (NMR) for coordination, posture, mechanics
  • Manual therapy to reduce soft tissue restrictions, normalize muscle activity, joint alignment, blood flow
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59
Q

What is the relationship between pelvic floor muscle underactivity and hip weakness?

A

There is a link between pelvic floor muscle underactivity and hip weakness.Obturator internus is part of PFM & hip rotator coupled posteriorly with piriformis muscle

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60
Q

Define viscerosomatic convergence.

A

Overlap in communication between viscera and muscle/bones due to innervation at the same spinal levels.

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61
Q

What brain structure is associated with the genital area in the context of pain response?

A

Cingulate gyrus

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62
Q

What are some components of PT treatment for pelvic pain?

A
  • Postural correction
  • Muscle flexibility restoration
  • Deep squats
  • Yoga
  • Biofeedback
    Overactive muscles frequently lead to shortened top bands and referred pain
    When pelvic floor musculoskeletal abnormalities are treated the sensation of bladder pain is typically reduced
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63
Q

What is the goal of downtraining in pelvic floor therapy?

A

To reduce muscle activity.

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64
Q

Name some manual therapy techniques used in pelvic pain treatment.

A
  • Myofascial release (MFR)
  • Trigger point massage
  • Joint mobilizations
  • Dry needling
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65
Q

What is the purpose of desensitization in pelvic pain therapy?

A
  • Light touch
  • Graded motor imagery
  • Progressive relaxation meditation
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66
Q

What are the objectives of PT for sexual dysfunction?

A
  • Desensitize soft tissues
  • Normalize muscle activity and compliance
  • Improve muscle discrimination and relaxation
  • Improve elasticity of introital tissues
  • Reduce fear
  • Referral to sex therapy/counseling as appropriate
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67
Q

Fill in the blank: Increasing _______ exercise can help improve blood flow and release endorphins.

A

[cardiovascular]

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68
Q

List some lifestyle and behavior modifications recommended for pelvic pain management.

A
  • Increase cardiovascular exercise
  • Dietary changes (increase water, reduce caffeine)
  • Hygiene recommendations and skin protection
  • Bowel and bladder habits
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69
Q

What evidence supports the effectiveness of pelvic floor PT?

A
  • Reduced pelvic pain for those receiving :
  • internal manual therapy
  • Trigger point injections
  • Biofeedback
  • Breathing techniques
  • Posture correction
  • Use of dilators/wand
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70
Q

Briefly explain the examination of muscles of over active, under active or combination

A

Perform assesment of over active skeletal muscles, poor flexibility, length, coordination, blood flow ,reduced optimal resting length, functional strength.
* Proper length equals proper strength.
* An under active muscle is functionally weak due to sub optimal length.
*An under active muscle is not a shortened muscle it is not typically painful

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71
Q

Characteristics of underactive PFM

A

Hypotonic, weak, lengthened do not voluntarily appropriately contract,
* pregnancy childbirth prolong stretch straining aging obesity

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72
Q

Characteristics of overactive PFM

A
  • Hypertonic spastic short
  • impaired relaxation or coordination
  • preceded or exacerbated by stress or or trauma
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73
Q

What does UPOINT stand for and what does it classify?

A

In order to diagnose chronic pelvic pain first a physical examination and history are taken in order to determine if chronic pain is secondary or primary. If a symptom of a known disease is ruled out the pelvic pain syndrome is primary. Depending on the organ specific symptoms present, treatment will be based on phenotype classification.

Urology
Physchology
organ speciic
infection
nueological
tender muscle
sexology

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74
Q

Summary of evidence for primary prostate pain syndrome PPPS

A

Alpha blockers have moderate treatment effect for pain voiding QOL.
* Antimicrobial therapy is effective
* NSAIDS moderate overall treatment effect
* phytotherapy has some beneficial effects on pain
* acupunture

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75
Q

Strong level recommendations for primary bladder pain syndrome PBPS management

A
  • Offer subtype and phenotype oriented therapy
  • Offer oral pentosan polysulfate medication
  • do not recommend oral corticosteroids for longterm treatment
  • consider submucosal bladder wall and trigonal injection of Botox and hydrodistention
  • only perform ablative or reconstruction surgery as a last resort
  • offer transurethral resection or coagulation/laser of bladder lesions button PBPS type 3C bc tx by phenotype classification works
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76
Q

Strong level recommendations for Scrotal pain syndrome

A
  • Inform about the risk of post vasectomy pain when planning for a vasectomy
  • do open instead of laparoscopic inguinal hernia repair to reduce risk of scrotal pain
  • vasovasostomy is effective for postvasectomy pain
77
Q

Strong level recommendations for Gynecological aspects of chronic pelvic pain

A
  • Involve gynecologist for options such as hormone therapy or surgery
  • provide multidisciplinary approach for pain management
  • for patients with developed complications after mash insertion refer to multidisciplinary service including pain medicine and surgery
78
Q

Strong level recommendations for urethral pain syndrome

A

There is no specific treatment for primary urethral pain syndrome level of evidence four. In literature has been associated with bladder and sexual dysfunction concerns

79
Q

Strong level recommendations for Anal rectal pain syndrome

A

Biofeedback is preferred treatment. Electrostimulation is less effective than biofeedback

80
Q

Strong level recommendations for Pudendal neuralgia

A

Neuropathic pain guidelines are well-established. Use standard approaches to management of neuropathic pain

81
Q

recommendations for Sexological aspects and chronic pelvic pain

A

Weak evidence exists for behavioral strategies for reducing sexual dysfunctions and pelvic floor muscle therapy as a part of treatment planned for improved QOL and sexual function

82
Q

Strong level recommendations for management of pelvic floor dysfunction in chronic pelvic pain

A

Strong evidence for biofeedback as therapy adjunct to muscle exercises in patients with anal pain due to overactive muscles. Weak evidence for myofascial treatment as first line

83
Q

Strong level recommendations for managemetnnt of chronic/non-acute urogenital pain by opioids

A

Prescribed only following multidisciplinary assessment and after other reasonable treatments have filled. Long-term therapy should be made by specialist and consult with patient and family doctor. With history or suspicion of drug abuse, psychiatrist and psychologist involvement is recommended

84
Q

Review pain mechanisms

A

do it

85
Q

Define primary vaginal and Volvar pain

A

Pain lasting greater than three months equals primary Bulevar pain syndrome previously known as vulvodynia or chronic vaginal pain no known cause I’m poorly understood subtypes include pain at different areas of over at different times that his constant or occasional pain. Touch or pressure does not initiate pain but can worsen it.

86
Q

1.

How is chronic pelvic pain related to prolapse and incontinence

A

10% complication rate with the surgeries

87
Q

What is chronic post surgical pain

A
  • Can happen in masectomies 11 to 57%
  • risk factors: younger age female preop chronic pain high number of surgeries, use of opioids, higher postop and
  • protective factors: older age.
  • Can be seen in bariatric procedures inguinal hernia repair hysterectomy vasectomy cesarean
88
Q

What are subdivisions of primary scrotal pain syndrome

A

Postvasectomy scrotal pain syndrome post
Inguinal hernia repair pain
Lab tests for primary bladder pain syndrome include urine dipstick and culture. Primary prostate pain syndrome includes for glass test for bacterial localization and sterile pre-post massage test PPMT

89
Q
A
90
Q

What is the main symptom of pudendal nerve entrapment syndrome?

A

Neuropathic pain spanning from pudendal sensory nerve distribution from anus to penis/clitoris

This can include sensations of intrarectal or intravaginal foreign body.

91
Q

What complications can arise from pudendal nerve entrapment syndrome?

A

Digestive, sexual, or urinary complications

These complications can significantly affect the quality of life.

92
Q

What are the main characteristics of the pain associated with pudendal nerve entrapment?

A

Mainly perineal, aggravated by sitting, relieved by standing or laying down

The pain can also occur in surrounding areas.

93
Q

What diagnostic criteria are used for pudendal nerve entrapment?

A

Five Nantes criteria
* 1 One neuropathic leg pain and sensory area pudendal nerve *2 aggravated by sitting
* 3 not usually waking the patient at night
* 4 no objective sensory deficit
* 5 positive block test after injection at ishial spine

These include neuropathic-like pain, aggravated by sitting, and a positive block test.

94
Q

What is the recommended imaging technique for diagnosing pudendal nerve entrapment?

A

MRI on pelvis

This is suggested for better visualization of the pelvic area.

95
Q

What is not recommended for diagnosing pudendal nerve entrapment?

A

Perineal electroneuromyography

It is considered not specific enough.

96
Q

What ergonomic advice is given for managing pudendal nerve entrapment?

A

Use of a doughnut-shaped seat cushion, avoiding pain-inducing perineal pressure, ergonomic workspace modifications

Activities such as cycling and horse riding should be avoided.

97
Q

What are the first-line drug treatments recommended for general neuropathic pain?

A

Tricyclic antidepressants, SNRIs, or anti-epileptics

Opiates are not recommended due to addictive potential and side effects.

98
Q

What physiotherapy techniques are recommended for pudendal nerve entrapment?

A

Techniques aimed at promoting muscle relaxation, endocavital maneuvers for hypertonia

Physiotherapy is recommended particularly for patients with myofascial syndromes.

99
Q

What is the recommended frequency and duration for TENS application?

A

10-30 minutes a day

High frequency of 75-100Hz is recommended.

100
Q

What psychological treatment is recommended for managing pudendal nerve entrapment?

A

Cognitive Behavioral Therapy (CBT)

CBT has shown significant effects on pain and associated psychological factors.

101
Q

What criteria must be met for surgical candidacy for pudendal nerve release surgery?

A

Five Nantes criteria, including a positive block test, and failure of conservative treatment

The surgical method is not specifically established.

102
Q

What is the purpose of injection tests in the context of pudendal nerve entrapment?

A

To provide immediate symptom reduction and determine surgical candidacy, used as a test and not therapeutic treatment

Injections should not be provided with prolonged phases.

103
Q

True or False: Pulsed radiofrequency has enough evidence to recommend its use for pudendal nerve entrapment.

A

False

There is not enough evidence to recommend pulsed radiofrequency.

104
Q

What alternative treatments lack sufficient study for pudendal nerve entrapment?

A

Lipofilling, cryotherapy, decompression

These methods have not been studied enough to warrant recommendations.

105
Q

What are the types of prostatitis syndromes?

A

Infectious, Chronic Pelvic Pain Syndrome (CPPS), Asymptomatic

CPPS can be further subclassified as inflammatory or non-inflammatory.

106
Q

What is the definition of CPPS/CP?

A

Urologic pain associated with urinary symptoms or sexual dysfunction lasting >3 of the previous 6 months

107
Q

How is CPPS subclassified?

A

Inflammatory type or non-inflammatory type based on the presence of leukocytes in prostatic samples

108
Q

What is the threshold for a positive therapeutic response according to the NIH-CPSI outcome tool?

A

6 point decrease from baseline score

109
Q

Which antibiotics were found to be effective for CPPS?

A

Tetracycline

110
Q

List some effective alpha blockers for the management of CPPS.

A
  • Tamsulosin
  • Silodosin
  • Doxazosin
  • DIt
  • Terazosin
  • Alfuzosin
111
Q

What anti-inflammatory medication is effective for CPPS?

A

Celecoxib

112
Q

Which hormonal agent is noted to be effective for CPPS?

A

Mepartricin

113
Q

What phytotherapy agents have shown effectiveness in treating CPPS?

A
  • Cernilton
  • Quercetin
114
Q

True or False: Neuromodulation is effective for the management of CPPS.

A

False, neither is modulation of bladder

115
Q

What physical therapy methods are effective for CPPS?

A
  • Post tibial nerve stimulation (but not for puedendal N based of 2.7)
  • Acupuncture
  • Electroacupuncture
  • Extracorporeal shock wave therapy
  • Aerobic exercise
116
Q

Which physical therapy methods are not effective for CPPS?

A
  • Global therapeutic massage
  • Myofascial PT
  • Sono-electromagnetic therapy
117
Q

What is the effectiveness of combination therapy in CPPS management?

A

1 vs 3 medications both effective

118
Q

What is a challenge identified in the metanalysis of CPPS treatments?

A

Difficult to pool heterogeneous data

119
Q

What does the UPOINTS system do in relation to CPPS?

A

Profiles patients and indicates individual treatment targets to implement

120
Q

What do positive domains in the UPOINTS system correlate with?

A
  • Symptom severity
  • Duration of disease
  • Total NIH-CPSI score
121
Q

What is the main problem identified in the conclusions regarding CPPS treatment?

A

Inability to formulate recommendations with a high grade of evidence for efficient monotherapies

122
Q

What does a positive Tinel sign at the 3rd segment suggest?

A

Possibility of PN entrapment in Alcock canal

Indicates potential nerve compression.

123
Q

What sensory tests are used for diagnosing pudendal neuralgia?

A

Cotton swab test and palpation of vestibule

Tests target the S2-4 dermatome map.

124
Q

What symptoms are associated with pudendal neuralgia?

A

Wide variety including:
* S3 radiculopathy
* Small fiber neuropathy
* Symptoms affecting clitoris, perineum, vulva, vagina, and/or rectum

125
Q

What does pain in the perineum and lower limbs indicate?

A

Disorder of the second segment of the pudendal nerve

Pain is often muscular in origin.

126
Q

What is the anatomical origin of pudendal nerve entrapment?

A

Greater sciatic notch between piriformis and internal obturator muscles

May occur simultaneously with other nerve compressions.

127
Q

What are the segments of the pudendal nerve?

A

Three segments:
* 1st segment: S3 nerve root with S2,4 contributions
* 2nd segment: Infrapiriform canal
* 3rd segment: Pudendal canal (Alcock canal)

128
Q

What does the second segment of the pudendal nerve enter?

A

Gluteal region below the pyramidal muscle

Ends between the sacrospinous and sacrotuberous ligaments.

129
Q

What are the terminal branches of the pudendal nerve?

A

Three terminal branches:
* Perineal nerve
* Dorsal clitoris nerve
* Inferior anal nerves

130
Q

What does the perineal nerve provide sensation to?

A

Inferior third of vagina, urethra, and labia

Reflex test includes striated sphincter of urethra, levator ani muscles, external anal sphincter.

131
Q

Which terminal branch is the most affected in pudendal neuralgia?

A

Dorsal clitoris nerve

Provides sensation to clitoris, pubis, and inguinal territory.

132
Q

What is a negative prognostic factor for surgery in pudendal neuralgia?

A

Pain duration >4 years

Other factors include pain at DCN, mild fiber sensory neuropathy, and menopausal status.

133
Q

What is a potential early indicator of peripheral neuropathy in pudendal neuralgia?

A

C-fiber damage

Quantitative somatosensory thermotest could confirm small fiber neuropathy.

134
Q

At what age is pudendal neuralgia more frequently observed?

A

Patients >37 years old

Older age is associated with a higher incidence of symptoms.

135
Q

Surgery for pudendal neuralgia is necessary when what conditions are met?

A

Confirmed PN entrapment at the 2nd or 3rd segment and all major Nantes criteria are met.

136
Q

True or False: 30% of chronic pelvic pain patients had motor deficits related to pudendal neuralgia.

A

True

Indicates a correlation between chronic pelvic pain and pudendal nerve issues.

137
Q

List some examples of Chronic Overlapping Pain Conditions (COPCs).

A
  • Endometriosis
  • Vulvodynia
  • Interstitial cystitis/bladder pain syndrome
  • Irritable bowel syndrome (IBS)
  • Fibromyalgia
  • TMJ disorder
  • Migraine headache
  • Chronic tension-type headache
  • Chronic low back pain
  • Myalgic encephalomyelitis/chronic fatigue syndrome
138
Q

What is endometriosis?

A

Presence of endometrial-like tissue outside the uterus.

139
Q

What symptoms are associated with endometriosis?

A
  • Dysmenorrhea
  • Non-cyclical pelvic pain
  • Dyspareunia
  • Dysuria
  • Dyschezia
  • Infertility
140
Q

How is endometriosis diagnosed?

A

Surgical confirmation or MRI; may be suspected based on symptoms.

141
Q

Define vulvodynia.

A

Persistent vulvar pain present for at least 3 months without another identifiable etiology.

142
Q

What are the types of pain in vulvodynia?

A
  • Spontaneous
  • Provoked by contact
  • Mixed
143
Q

What is interstitial cystitis/bladder pain syndrome (IC/BPS)?

A

Condition in which patients experience bladder discomfort, most commonly pain, but may report primarily pressure or spasm symptoms.

144
Q

What improves the symptoms of interstitial cystitis/bladder pain syndrome?

A

Improves after bladder emptying.

145
Q

What is the prevalence of interstitial cystitis/bladder pain syndrome?

A

2-6%.

146
Q

What is irritable bowel syndrome (IBS)?

A

Functional gastrointestinal condition in which patients experience chronic abdominal pain and altered bowel habits.

147
Q

What is the prevalence of irritable bowel syndrome?

A

11%.

148
Q

What is the third most prevalent condition in the world?

A

Migraine headache.

149
Q

What are the two types of migraine headaches?

A
  • Migraine without aura
  • Migraine with aura
150
Q

Define chronic tension-type headache.

A

Non-throbbing headache present for at least 15 days per month for at least 6 months.

151
Q

What is fibromyalgia?

A

A condition characterized by widespread musculoskeletal pain often accompanied by fatigue, sleep, memory, and mood issues.

152
Q

what is Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

A

Moderate to severe fatigue at least 50% of time, not relieved by rest associated with post-exertional malaise, sleep disturbance, cognitive dysfunction, pain, orthostatic symptoms
Full diagnostic prevalence <0.5%

153
Q

What factors contribute to chronic pain risk?

A
  • Chronic pain in one location doubles the risk for new chronic pain
  • Significant genetic or heritable vulnerability
154
Q

What common mechanisms are shared among chronic pain conditions?

A
  • Central nervous system abnormalities in sensory and pain processing pathways
  • Global hyperalgesia
  • Sensory sensitivity to bodily sensations
  • Sleep disturbances
  • Fatigue
  • Cognitive dysfunction
155
Q

What is the role of central sensitization in chronic pain?

A

It is a common feature that leads to an increased perception of pain.

156
Q

What is pelvic myofascial pain?

A

Condition in which pain originates from hypertonic or hypercontractile muscles.

157
Q

What percentage of CPP patients have musculoskeletal dysfunction contributing to pain symptoms?

A

60-90%.

158
Q

What screening tools can be utilized for chronic pelvic pain management?

A
  • Complex Medical Symptoms Inventory (CMSI)
  • Rome criteria for IBS
  • Pain, Urgency, and Frequency (PUF) score for IC/BPS
159
Q

What is the importance of communication in managing chronic pelvic pain?

A

Clear and empathetic communication is essential to develop a therapeutic alliance.

160
Q

What are some non-pharmacologic strategies for managing chronic pelvic pain?

A
  • Exercise interventions
  • Cognitive behavioral therapy
  • Acupuncture
161
Q

What is the mechanism of action for exercise interventions in chronic pain?

A

Unknown; theories include anti-inflammatory effects and improved pain tolerance.

162
Q

What types of exercises have been studied for chronic pain?

A
  • Aerobic
  • Resistance
  • Yoga
163
Q

What medications are commonly used in pharmacologic strategies for chronic pelvic pain?

A
  • Antidepressants (TCAs and SNRIs)
  • Cyclobenzaprine
  • Gabapentinoids
  • Cannabinoids
164
Q

What is the optimal approach for managing chronic pelvic pain?

A

A personalized treatment plan that is multimodal.

165
Q

What is the definition of chronic pelvic pain?

A

Pelvic pain lasting for 6 months or longer.

166
Q

What is the distinction between primary and secondary chronic pain?

A
  • Chronic primary pain: disability or emotional distress not better accounted for by another diagnosis
  • Chronic secondary pain: associated with other diagnoses
167
Q

Give an example of chronic secondary pain.

A

Endometriosis-associated pain.

168
Q

What factors may lead to the classification of endometriosis pain as secondary?

A

Presence of underlying pathology.

169
Q

What is the most common location for endometriotic deposits?

A

Parietal peritoneum.

170
Q

What model is used to conceptualize chronic pelvic pain?

A

The ‘three P’s’ model: Predispose, Precipitating, Perpetuating.

171
Q

What are predisposing factors for chronic pelvic pain?

A
  • Heredity
  • Endometriosis
  • Inflammatory bowel disease
  • Irritable bowel syndrome
  • Dysmenorrhoea
  • Vulval pain syndrome
  • Interstitial cystitis/painful bladder syndrome
172
Q

What is a significant challenge in determining predisposing factors?

A

Difficult to determine whether they are a cause or effect of the pain.

173
Q

What symptoms can also be hereditary

A

menstrual cycle length, menstrual Flow
urinary incontinence, frequency and nocturia
transit time through the gastro-intestinal tract
Sex differences in the prevalence of chronic pain conditions begin to emerge after puberty

174
Q

What can dysmenorrhoea lead to in terms of chronic pain conditions?

A

Increased chances of developing chronic pain.

175
Q

What are some precipitating factors for chronic pelvic pain?

A
  • Menarche
  • Change in gait
  • Prolonged lithotomy position
  • Reactive muscle spasm
176
Q

What are perpetuating factors associated with chronic pelvic pain?

A

Comorbidity with other pelvic and chronic pain conditions.

177
Q

What should assessment of chronic pelvic pain include?

A
  • Discussion of previous explanations
  • Understanding patient’s beliefs about symptoms
  • Key concerns regarding fertility
  • Model of pain to validate experiences
178
Q

What is important for self-management of chronic pelvic pain?

A

Reducing unhelpful pain-related behaviors.

179
Q

What is the rationale for prioritizing non-steroidal anti-inflammatory drugs?

A

Many chronic pelvic pain pathologies are associated with increased inflammation.

Little evidence to inform use of analgesics and chronic pelvic pain. Information has not been directly correlated with pain symptoms but can still be used

180
Q

When should opioids be used in managing chronic pelvic pain?

A

For flare-ups, post-op, or short-term use.

181
Q

What types of medications can be used for neuropathic-like pain?

A
  • Tricyclic antidepressants
  • Gabapentinoids
  • Selective noradrenaline and serotonin reuptake inhibitors
182
Q

What types of therapies can be beneficial for chronic pelvic pain management?

A
  • Physical therapy
  • Psychological approaches
  • Lifestyle advice
183
Q

What role does acceptance and commitment therapy play in chronic pelvic pain management?

A

Develops psychological flexibility.

184
Q

What barriers exist to challenge healthy body awareness

A

Hypervigilance, self criticism disconnection with the body is common

185
Q

What is a key aspect of mindfulness-based interventions?

A

Present moment focus and compassion.

186
Q

What is a critical consideration regarding lifestyle advice for women with chronic pelvic pain?

A

Reflecting on how lifestyle relates to pain.
Many women with CPP hold several rolls: job family sex self marriage. Sleep diet and exercise impact chronic pelvic pain

187
Q

How does diet impact chronic pelvic pain?

A

It can affect bowel and bladder function.

188
Q

True or False: Chronic pain conditions are equally prevalent in men and women.

A

False

WCS (6 decks)

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