Inferior Hypogastric Block for the Treatment of Chronic Pelvic Pain

Urits, Ivan; Schwartz, Ruben; Siddaiah, Harish; Kikkeri, Sathyadev; Cunningham, David; Charipova, Karina; Jung, Jai Won; Imani, Farnad; Mohsen, Khorramian; Varrassi, Giustino; Cornett, Elyse M.; Kaye, Alan D.; Viswanath, Omar

doi:10.5812/aapm.112225

Cited by 5 publications

(5 citation statements)

References 68 publications

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“…In addition to these publications, there are some studies regarding the efficacy of IHP blockade as a new target to relieve pain from the lower pelvic organs and genitalia [43]. Schultz [44] reported a novel technique using a fluoroscopy-guided transsacral approach towards the medial interior edge of the ventral sacral foramen to reach the IHP.…”

Section: Patient With Neuropathic Painmentioning

confidence: 99%

Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

Pereira

Herrero-Trujillano

Vaquero

et al. 2022

JPM

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Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.

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Section: Patient With Neuropathic Painmentioning

confidence: 99%

Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

Pereira

Herrero-Trujillano

Vaquero

et al. 2022

JPM

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“…While data on chronic abdominal pain remains limited, a cross-sectional survey reported that 25% of the adult population admitted to living with abdominal pain. It reported no substantial difference in prevalence when factoring in age and ethnicity but did note a substantial increase in prevalence among women compared to men ( 11 ), partly possibly due to inclusion of pelvic pain ( 12 - 14 )…”

Section: Evidence Acquisitionmentioning

confidence: 99%

“…When chronic abdominal pain is concerned, the etiologies vary, and so will the possible treatments ( 22 ). When non-syndromatic pain is diagnosed, different approaches are possible; these include conservative treatments, oral non-opioid pharmacotherapy, opioid-based therapy, continuous infusions, and interventional approaches ( 14 , 23 - 30 ). Syndromatic pain, including IBD and IBS may require specialized therapy.…”

Section: Evidence Acquisitionmentioning

confidence: 99%

Efficacy of Acupuncture in the Treatment of Chronic Abdominal Pain

Berger¹,

Liu²,

Jin³

et al. 2021

Anesth Pain Med

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Context: Abdominal pain is a widespread complaint and is one of the common reasons leading patients to seek medical care, either in emergency situations or with their primary providers. While acute abdominal pain is a better defined, usually surgical condition, chronic abdominal pain requires longer, typically lifelong, therapy. Chronic abdominal pain may also present with acute flares and complications. Here we review seminal and novel evidence discussing the use of acupuncture in the treatment of abdominal pain, indications, and conditions that may benefit from this approach. Evidence Acquisition: Chronic abdominal pain is a common complaint causing significant morbidity and disability and has a hefty price tag attached. Recent studies show it may be prevalent in as much as 25% of the adult population. It is defined as three episodes of severe abdominal pain over the course of three months. Chronic abdominal pain could be the result of chronicity of acute pain or of chronic pain syndromes, most commonly IBD syndromes and IBS. While a plethora of treatments exists for both conditions, these treatments usually fall short of complete symptom control, and there is a need for complementary measures to curb disability and increase the quality of life in these patients. Acupuncture is a form of integrative medicine that has long been used in Chinese and traditional medicine, based on the rebalancing of the patient’s Qi, or Ying/Yang balance. It has been shown to be effective in treating several other conditions, and novel evidence may expand its use into other fields as well. Clinical trials studying acupuncture in chronic pain conditions have been promising, and recent evidence supports the use of abdominal pain in chronic abdominal pain conditions as well. Though not curative, acupuncture is a complementary approach that helps reduce symptoms and improved quality of life. Conclusions: Chronic abdominal pain is a widespread condition, mostly affected by the IBS and IBD spectrum. Etiologies are still being studied for these conditions, and while novel treatment approaches are absolute game changers for these patients, many continue to experience some level of symptoms and disability. Acupuncture may provide further alleviation of these symptoms in select patients, thus improving quality of life, reducing disability, and saving healthcare dollars. It is a largely safe and inexpensive method that may significantly contribute to the quality of life of selected patients.

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“…Interventional procedures vary by complexity and invasiveness, including trigger point injections, epidural steroid injections, sympathetic nerve blocks, radiofrequency ablation, cryoneuroablation, intrathecal drug delivery systems, and spinal cord stimulators, and deep brain stimulation (40)(41)(42)(43)(44)(45)(46). Although interventional therapies have associated risks, such as infection, dural puncture, spinal cord trauma, or nerve injury, the significant improvement in quality of life for certain patients makes them attractive treatment options, particularly in those who do not respond well to topical or oral analgesic agents (47-53).…”

Section: Interventional Pain Managementmentioning

confidence: 99%

Conolidine: A Novel Plant Extract for Chronic Pain

et al. 2021

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: Pain, the most common symptom reported among patients in the primary care setting, is complex to manage. Opioids are among the most potent analgesics agents for managing pain. Since the mid-1990s, the number of opioid prescriptions for the management of chronic non-cancer pain (CNCP) has increased by more than 400%, and this increased availability has significantly contributed to opioid diversion, overdose, tolerance, dependence, and addiction. Despite the questionable effectiveness of opioids in managing CNCP and their high rates of side effects, the absence of available alternative medications and their clinical limitations and slower onset of action has led to an overreliance on opioids. Conolidine is an indole alkaloid derived from the bark of the tropical flowering shrub Tabernaemontana divaricate used in traditional Chinese, Ayurvedic, and Thai medicine. Conolidine could represent the beginning of a new era of chronic pain management. It is now being investigated for its effects on the atypical chemokine receptor (ACK3). In a rat model, it was found that a competitor molecule binding to ACKR3 resulted in inhibition of ACKR3’s inhibitory activity, causing an overall increase in opiate receptor activity. Although the identification of conolidine as a potential novel analgesic agent provides an additional avenue to address the opioid crisis and manage CNCP, further studies are necessary to understand its mechanism of action and utility and efficacy in managing CNCP.

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Inferior Hypogastric Block for the Treatment of Chronic Pelvic Pain

Cited by 5 publications

References 68 publications

Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

Efficacy of Acupuncture in the Treatment of Chronic Abdominal Pain

Conolidine: A Novel Plant Extract for Chronic Pain

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