Complementary and Alternative Approach to Chronic Pelvic Pain

Year 2018, , 46 - 49, 31.10.2018

Huri Güvey

https://doi.org/10.18678/dtfd.455376

Cited By: 3

Abstract

Chronic pelvic pain (CPP) is defined as pain of at least 6 months' duration that occurs in the lower abdomen or below the umbilicus and has resulted in functional or psychological disability, and required intervention and treatment. Therapeutic interventions center around the treatment of CPP as a diagnosis in and of itself, and treatment of specific disorders that may be related to CPP. A multidisciplinary approach for diagnosis and treatment seems to be most effective for symptomatic relief. The evidence for such interventions as psychological treatments including the use of complementary and alternative medicine techniques for CPP treatment is reviewed in this study. Unfortunately, finding the best evidence in this setting is difficult as very few randomized controlled trials are available. A combination of treatments is usually required over time for the treatment of refractory CPP. The multifactorial nature of CPP needs to be discussed with the patient and a good rapport as well as a partnership needs to be developed to plan a management program with regular follow up. Promotion of a multidisciplinary approach which includes complementary and alternative medicine techniques in managing CPP in women seems to yield the best results.

Keywords

Chronic pelvic pain, acupuncture, Chinese herbal medicine, psychotherapy

Kronik Pelvik Ağrıya Tamamlayıcı ve Alternatif Yaklaşım

Abstract

Kronik pelvik ağrı (KPA) en az 6 ay süren, alt karın bölgesinde veya umbilikusun altında yerleşen fonksiyonel veya psikolojik hastalığa neden olabilen, değerlendirme ve tedavi gerektiren bir ağrıdır. Tedaviye yönelik girişimler, bir tanı olarak KPA tedavisi ve KPA ile ilişkili belli başlı hastalıkların tedavisi etrafında yoğunlaşır. Semptomatik rahatlama için tanı ve tedavide multidisipliner bir yaklaşımın en etkilisi olduğu görülmektedir. Bu çalışmada KPA tedavisinde, tamamlayıcı ve alternatif tıp tekniklerinin de kullanıldığı psikolojik tedavi gibi girişimlerin kanıtları gözden geçirilmiştir. Maalesef bu konuda yapılmış çok az randomize kontrollü çalışma olduğundan en iyi kanıtı bulmak çok zordur. Refrakter KPA tedavisi için zaman geçtikçe bir tedavi kombinasyonuna ihtiyaç duyulmaktadır. KPA’nın multifaktöriyel doğası hastayla tartışmayı, onunla iyi bir uyum içinde bir partner kadar yakın olmayı ve düzenli takip edilecek bir yönetim planı geliştirmeyi gerektirir. Kadınlarda KPA yönetiminde tamamlayıcı ve alternatif tıp tekniklerinin de dahil olduğu multidisipliner bir yaklaşımı teşvik etmek en iyi sonuçları doğuracak gibi görünmektedir.

Keywords

Kronik pelvik ağrı, akupunktur, Çin bitkisel tıbbı, psikoterapi

References

• 1. Williams RE, Hartmann KE, Steege JF. Documenting the current definitions of chronic pelvic pain: Implications for research. Obstet Gynecol. 2004;103:686–691.
• 2. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996;87:55–58.
• 3. Tripoli TM, Sato H, Sartori MG, Fernando de Araujo F, Girao MJ, Schor E. Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med. 2011;8:497–450.
• 4. Andrews J, Yunker A, Reynolds W, Likis F, Sathe N, Jerome R. Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness. Agency for Healthcare Research and Quality; Rockville, MD: 2012. AHRQ Publicaton No. 11(12)-EHC088-EF.
• 5. Shin J. H., Howard F. M. Management of chronic pelvic pain. Current Pain and Headache Reports. 2011;15(5):377–385.
• 6. Won H. R., Abbott J. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach. International Journal of Women's Health. 2010;2(1):263–277.
• 7. Stones R W, Mountfield J. Interventions for treating chronic pelvic pain in women. Cochrane Database of Systematic Reviews. 2000;(4)
• 8. O'Hare PG, Hoffmann AR, Allen P, Gordon B, Salin L, Whitmore K. Interstitial cystitis patients' use and rating of complementary and alternative medicine therapies. Int Urogynecol J. 2013;24(6):977–982.
• 9. Wang G, Mao B, Xiong ZY, Fan T, Chen XD, Wang Let al; CONSORT Group for Traditional Chinese Medicine. The quality of reporting of randomized controlled trials of traditional Chinese medicine: a survey of 13 randomly selected journals from mainland China. Clin Ther 2007; 29(7):1456–67.
• 10. Borchers AT, Hackman RM, Keen CL, Stern JS, Gershwin ME. Complementary medicine: a review of immunomodulatory effects of Chinese herbal medicines. Am J Clin Nutr 1997;66(6):1303–12.
• 11. Napadow V, Ahn A, Longhurst J, Lao L, Stener-Victorin E, Harris R, Langevin HM. The status and future of acupuncture mechanism research. J Altern Complement Med 2008;14(7):861–9.
• 12. Wang XM. On the therapeutic efficacy of electric acupuncture with moxibustion in 95 cases of chronic pelvic infectious disease (PID). J Tradit Chin Med 1989;9(1):21–4.
• 13. RCOG Scientific Advisory Committee Opinion Paper 30, Acupuncute and Chinese herbal medicine for women with chronic pelvic pain, 2012.
• 14. Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol 2008;198(2):166.e1–8.
• 15. Smith CA, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev 2011;(1):CD007854.
• 16. Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2006;(4):CD005111.
• 17. Zhen HL, Wang Y, Liu XJ. Observation of the therapeutic effect of warming needle moxibustion on chronic pelvic inflammation of cold-damp stagnation type. Zhongguo Zhen Jiu 2008;28(10):736–8.
• 18. Wang XM. On the therapeutic efficacy of electric acupuncture with moxibustion in 95 cases of chronic pelvic infectious disease (PID). J Tradit Chin Med 1989;9(1):21–4.
• 19. Flower A, Liu JP, Chen S, Lewith G, Little P. Chinese herbal medicine for endometriosis. Cochrane Database Syst Rev 2009;(3):CD006568.
• 20. Zhu X, Proctor M, Bensoussan A, Smith CA, Wu E. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database Syst Rev 2007;(4):CD005288.
• 21. Shen BQ, Situ Y, Huang JL, Su XM, He WT, Zhang MW, Chen QB. A clinical study on the treatment of Chronic pelvic Inflammation of Qi stagnation with Blood stasis syndrome by Penyangqing capsule. Chin J Integr Med 2005;11(4):249–54.
• 22. Zhang Q, He J, He S, Xu P. Clinical observation in 102 cases of Chronic pelvic inflammation treated with qi jie granules. J Tradit Chin Med 2004;24(1):3–6.
• 23. Martin C. E., Johnson E., Wechter M. E., Leserman J., Zolnoun D. A. Catastrophizing: a predictor of persistent pain among women with endometriosis at 1 year. Human Reproduction. 2011;26(11):3078–3084.
• 24. Eccleston C., Palermo T. M., Williams A. C., Lewandowski A., Morley S. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews. 2009;(2)CD003968.
• 25. Proctor ML, Murphy PA, Pattison HM et al. Behavioural interventions for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD002248.
• 26. Butler A. C., Chapman J. E., Forman E. M., Beck A. T. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review. 2006;26(1):17–31.
• 27. National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health, U.S. Department of Health and Human Services. Mind-body medicine: an overview. NCCAM no. D239, 2007.
• 28. Teixeira M. E. Meditation as an intervention for chronic pain: an integrative review. Holistic Nursing Practice. 2008;22(4):225–234.
• 29. Shapiro S. L., Oman D., Thoresen C. E., Plante T. G., Flinders T. Cultivating mindfulness: effects on well-being. Journal of Clinical Psychology. 2008;64(7):840–862.
• 30. Zeidan F., Grant J. A., Brown C. A., McHaffie J. G., Coghill R. C. Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain. Neuroscience Letters. 2012;520(2):165–173.
• 31. Lutz A., Slagter H. A., Dunne J. D., Davidson R. J. Attention regulation and monitoring in meditation. Trends in Cognitive Sciences. 2008;12(4):163–169.
• 32. Kingston J., Chadwick P., Meron D., Skinner T. C. A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity. Journal of Psychosomatic Research. 2007;62(3):297–300.
• 33. Chiesa A., Serretti A. Mindfulness-based interventions for chronic pain: a systematic review of the evidence. Journal of Alternative and Complementary Medicine. 2011;17(1):83–93.
• 34. Baer R. A., Smith G. T., Lykins E., et al. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15(3):329–342.
• 35. Montenegro ML, Mateus-Vasconcelos EC, Candido dos Reis FJ, Silva JC Re, Nogueira AA, Poli Neto OB. Thiele massage as a therapeutic option for women with chronic pelvic pain caused by tenderness of pelvic floor muscles. J Eval Clin Pract. 2010;16(5):981–2.