疼痛管理と医学ジャーナル

概要

Chronic Pelvic Pain Interventions in Women of Reproductive Age: A Systematic Review

Jose Gerardo Garza-Leal, Francisco J. Sosa-Bravo, José G. Garza-Marichalar, Lorena Castillo-Saenz, Carolina Quintanilla Sánchez, Linda I. Gonzalez Sariñana, César A. Ramos-Delgado

Objective: This systematic review and meta-analysis were conducted to summarize and synthesize available evidence on the management and interventions for chronic pelvic pain in women.

Data sources: Systematic reviews that included Randomized Controlled Trials (RCT) or Non-Randomized Studies of Intervention (NRSI) were selected from the Cochrane Database of Systematic Reviews, MEDLINE, Embase, Scopus, and Web of Science from inception to March 2020.

Study eligibility criteria: Systematic reviews of RCT and NRSI were selected to assess the efficacy and quality of evidence of all possible treatments improving pain and quality of pain in women of reproductive age with chronic pelvic pain lasting six months. The studies measured pain by any scale. We focused on publications that included women of reproductive age with chronic pelvic pain lasting 6 or more months.

Study appraisal and synthesis methods: Treatments were divided into four categories: pharmacological, psychological, surgical, and other treatments that included acupuncture and magnet therapy. All interventions and comparators were assessed.

Results: Twelve studies were included. Progestogen was the pharmacological treatment that yielded the best results. Psychological interventions showed improvement with patients who received ultrasound and reassurance compared with other interventions. Surgical interventions needed to focus on nerve-sparing techniques since other interventions (particularly endometriosis) could benefit but had many adverse effects. Finally, acupuncture and magnet therapy did not have a broad evidence base.

Conclusion: This paper is an overview of treatment evidence. Chronic pelvic pain can be managed with surgical, pharmacological, psychological, and other (acupuncture and magnet therapy) interventions. However, efficacy is limited due to the lack of evidence and homogenous studies. Treatment should always be multidisciplinary and individualized, depending on the specific chronic pelvic pain phenotype. Primary and secondary studies should be conducted to find better options and broaden the scope of multidisciplinary treatment.