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Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Related Experiment Video

Updated: Jun 12, 2025

Author Spotlight: Enhancing Women's Chronic Pelvic Pain Management Through Acupoint Catgut Embedding
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A Pain Desensitization Algorithm for Phenotyping and Treating Chronic Pelvic Pain.

Liane Silva Rafael Rogério1, Maurice K Chung2, Charles W Butrick3

  • 1Clínica Aurora, Manaus, Amazonas, Brazil.

JSLS : Journal of the Society of Laparoendoscopic Surgeons
|September 18, 2024
PubMed
Summary

A new algorithm simplifies chronic pelvic pain management by guiding treatment through nerve blocks and intravesical therapy, significantly improving patient pain scores and quality of life.

Keywords:
Central nervous system sensitizationChronic pelvic painEndometriosis painInterstitial cystitisMyofascial painPainful bladder syndromePudendal nerve pain

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Area of Science:

  • Pain Management
  • Urology
  • Neurology

Background:

  • Chronic pelvic pain (CPP) presents management challenges due to central/peripheral sensitization and multiple pain generators (bladder, pelvic floor, pudendal nerve).
  • Nerve blocks are established diagnostic and therapeutic tools for pain management providers.
  • A novel desensitization algorithm was developed to offer a stepwise approach for CPP management.

Purpose of the Study:

  • To evaluate the efficacy of a novel desensitization algorithm in improving pain scores for patients with chronic pelvic pain.
  • To assess the outcomes of intravesical therapy and pudendal nerve blocks guided by an Anesthetic Challenge Test (ACT).

Main Methods:

  • A prospective observational cohort study included 182 women (aged 15-90) with CPP from 2016-2018.
  • The algorithm initiated with an Anesthetic Challenge Test (ACT) of the bladder.
  • Treatment progressed to intravesical therapy and/or pudendal nerve blocks based on ACT results.

Main Results:

  • For ACT POSITIVE patients receiving intravesical therapy, 84% experienced ≥50% Visual Analog Scale pain improvement, with 64% achieving ≥80% improvement (41% pain-free).
  • Patients receiving subsequent pudendal blocks showed 83% with ≥50% improvement (67% pain-free).
  • ACT NEGATIVE patients undergoing pudendal blocks achieved ≥50% relief in 80% and ≥80% improvement in 65% (35% pain-free). All outcomes were statistically significant (P < .05).

Conclusions:

  • The developed algorithm simplifies the management of CPP, which often involves multiple pain generators.
  • This stepwise approach effectively reduced pain severity, potentially preceding surgical interventions.
  • The algorithm demonstrated significant improvements in pain scores, offering a structured treatment pathway for complex pelvic pain cases.