A pilot study of botulinum toxin A for male chronic pelvic pain syndrome Should women with chronic pelvic pain have adhesiolysis? GaPP: a pilot randomised controlled trial of the efficacy of action of gabapentin for the management of chronic pelvic pain in women: study protocol Prevalence and correlates of three types of pelvic pain in a nationally representative sample of Australian women. Correlation between endometriosis and pelvic pain. Short-term results of bilateral S2-S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful bladder syndrome, and chronic pelvic pain. Efficacy of static magnetic field therapy in chronic pelvic pain: a double-blind pilot study. Chronic Pelvic Pain in Women in New Zealand: Comparative Well-Being, Comorbidity, and Impact on Work and Other Activities Efficacy of Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome: A Randomized, Controlled Trial Long-term outcomes after surgical and nonsurgical management of chronic pelvic pain: one year after evaluation in a pelvic pain specialty clinic. Intravaginal electrical stimulation for the treatment of chronic pelvic pain. Chronic pelvic pain in New Zealand: prevalence, pain severity, diagnoses and use of the health services Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Use of intravaginal electrical stimulation for the treatment of chronic pelvic pain: a randomized, double-blind, crossover clinical trial. Predictive factors for pain experienced at office fluid minihysteroscopy. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial Laparoscopic uterine nerve ablation versus vaginal uterosacral ligament resection in postmenopausal women with intractable midline chronic pelvic pain: a randomized study. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. A novel mouse model of chronic prostatitis/chronic pelvic pain syndrome induced by immunization of special peptide fragment with aluminum hydroxide adjuvant. Bias effects in three common self-report pain assessment measures. Issues in planning a placebo-controlled trial of manual methods: results of a pilot study.
Abstract Objective . Male chronic pelvic pain syndrome ( CPPS ) has been the subject of numerous clinical trials , but so far , no uniformly effective treatment has been identified . A commonly reported tender spot in men with CPPS is the bulbospongiosus muscle . A r and omized placebo controlled pilot trial of botulinum toxin A ( BTX-A ) injection into the perineal skeletal musculature for the treatment CPPS was conducted . Material and methods . Twenty-nine men with CPPS were identified from a urology clinic . Symptom evaluation was performed using a Global Response Assessment ( GRA ) and the Chronic Prostatitis Symptom Index ( CPSI ) .  All subjects were r and omized to receive either BTX-A 100 U or normal saline injected into the perineal body and bulbospongiosus muscle . Results . BTX-A  injection was administered in 13 men . At the 1 month follow-up there was a 30 % response rate for BTX-A treatment compared with 13 % for placebo ( p = 0.0002 ) , based on GRA results . Total CPSI score did not reach significance in the BTX-A-treated group , compared with controls . The CPSI pain subdomain score reached statistical significance in the BTX-A patients compared with controls ( p = 0.05 ) . The injections were well tolerated . There were no complications from the injections and no patients reported side-effects . Conclusions . BTX-A injection into the perineal body and bulbospongiosus muscle results in a modest response rate on the GRA compared with placebo for overall symptoms associated with CPPS . The treatment is well tolerated and safe . BTX-A use may enhance polytherapeutic pain management Background Pelvic adhesions are found in up to 50 % of women with CPP during investigative surgeries and adhesiolysis is often performed as part of their management although the causal or casual association of adhesions , and the clinical benefit of adhesiolysis in the context of CPP is still unclear . Our aim was to test the hypothesis of whether laparoscopic adhesiolysis leads to significant pain relief and improvement in quality of life ( QoL ) in patients with chronic pelvic pain ( CPP ) and adhesions . Methods This was a double-blinded RCT . This study was conducted in 2 tertiary referral hospitals in United Kingdom over 4 years . Women with chronic pelvic pain ( CPP ) were r and omized into having laparoscopic adhesiolysis or diagnostic laparoscopy .  Women were assessed at 0 , 3 and 6 months for Visual analogue scale scores ( VAS ) and Quality of Life ( QoL ) measures ( SF-12 and EHP-30 ) . Results A total of 92 participants were recruited ; 50 qualified to be r and omized , with 26 in the adhesiolysis and 24 in the control group . The results are expressed in median ( interquartile ranges ) . In women who underwent adhesiolysis , there was a significant improvement at 6 months in VAS scores ( -17.5 ( -36.0 - -5.0 ) compared to controls ( -1.5 ( -15.0 – 4.5 ; p = 0.048 ) ; SF-12 scores physical component score ( 25.0 ( 18.8 – 43.8 ) ) compared to controls ( 6.3 ( -6.3 – 18.8 ) ; p = 0.021 ) , SF-12 emotional component score 32.5 ( 4.4 – 48.8 ) compared to controls -5 ( -21.3 – 15.0 ) ; p < 0.0074 ) and EHP-30 emotional well being domain 32.5 ( 4.4 – 48.8 ) compared to the controls -5 ( -21.3 – 15.0 ; p < 0.0074 ) . Conclusions This study stopped before recruitment reached the statistically powered sample size due to difficulty with enrollment and lack of continued funding . In selected population of women presenting to the gynecological clinic with chronic pelvic pain , adhesiolysis in those who have adhesions may be of benefit in terms of improvement of pain and their quality of life . Trial registration numberIS RCT N Introduction Chronic pelvic pain ( CPP ) affects > 1 million UK women . Annual healthcare costs are estimated at > £ 150 million . Proven interventions for CPP are limited , and treatment is often unsatisfactory . Gabapentin is increasingly prescribed due to reports of effectiveness in other chronic pain conditions , but there are insufficient data supporting value in CPP specifically . The mechanism by which gabapentin exerts its analgesic action is unknown . Given the prevalence and costs of CPP , the authors believe that a large , multicentre , placebo-controlled , double-blind r and omised controlled trial to evaluate the efficacy of gabapentin in management of CPP is required . The focus of this study is a pilot to inform planning of a future r and omised controlled trial . Methods and analysis The authors plan to perform a two-arm , parallel , r and omised controlled pilot trial . The authors aim to recruit 60 women with CPP in NHS Lothian and NHS Grampian ( UK ) and r and omise them to gabapentin or placebo . Response to treatment will be monitored by question naire compared at 0 , 3 and 6 months . The primary objective is to assess recruitment and retention rates . The secondary objectives are to determine the effectiveness and acceptability to participants of the proposed methods of recruitment , r and omisation , drug treatments and assessment tools and to perform a pretrial cost-effectiveness assessment of treatment with gabapentin . Ethics and dissemination Ethical approval has been obtained from the Scotl and A Research Ethics Committee ( LREC 12/SS/0005 ) . Data will be presented at international conferences and published in peer- review ed journals . Trial registration number IS RCT N70960777 OBJECTIVE To identify the prevalence and correlates of three types of pelvic pain ( dysmenorrhoea , dyspareunia , and other chronic pelvic pain [ CPP ] ) in a nationally representative sample of Australian women . DESIGN AND SETTING The CPP survey was part of a broader national study of health and relationships . Computer-assisted telephone interviews were administered to a r and om sample of 8656 Australian households ; 4366 women aged between 16 and 64 years were interviewed in 2004 and 2005 . Eighteen of the more than 200 potential survey questions related to pelvic pain . MAIN OUTCOME MEASURES Self-reports of dysmenorrhoea , dyspareunia , and any other CPP not associated with sexual intercourse or menstruation . RESULTS Data on 1983 women aged 16 - 49 years who were still menstruating and sexually active were analysed . Prevalences were 71.7 % for dysmenorrhoea , 14.1 % for dyspareunia and 21.5 % for other CPP ; 23.3 % of women reported no pelvic pain of any kind . Severe pain was reported by 15.0 % ( 95 % CI , 13.0%-17.1 % ) of women with dysmenorrhoea , 7.8 % ( 95 % CI , 5.0%-11.9 % ) of women with dyspareunia and 20.0 % ( 95 % CI , 16.1%-24.6 % ) of women with other CPP . Just over a third ( 34.2 % ) of women who reported any pain had sought advice from a health professional . Women reporting CPP were also likely to report other health conditions , most notably depression and anxiety . There were clear associations between CPP and sexual difficulties , pregnancy and pregnancy outcomes . CONCLUSIONS Rates of pelvic pain in Australian women are high . General practitioners need to be ready to discuss these issues with patients , particularly in relation to underlying anxiety and depression STUDY OBJECTIVE To evaluate the relationship between prevalence and severity of  chronic pelvic pain ( CPP ) and stage , site , and type of endometriosis . DESIGN Prospect i ve , observational study ( Canadian Task Force classification II-2 ) . SETTING University Hospital . PATIENTS Of 90 consecutive women with biopsy-proved endometriosis , laparoscopy was performed in 69 for pelvic pain and in 21 for infertility or clinical and ultrasonographic suspicion of ovarian endometriosis . INTERVENTION Preoperatively , using a 10-point visual analog scale , the severity of dysmenorrhea , CPP , and deep dyspareunia was assessed . During laparoscopy all visible endometriotic lesions were recorded and treated . MEASUREMENTS AND MAIN RESULTS Ten women ( 11.1 % ) had no pain ; 72 had dysmenorrhea ( mild in 13 , moderate in 37 , severe in 22 ) ; 55 had CPP ( mild in 11 , moderate in 25 , severe in 19 ) ; and 39 deep dyspareunia ( mild in 5 , moderate in 31 , severe in 3 ) . The severity of dysmenorrhea significantly correlated with the presence and extent of pelvic adhesions ( p = 0.004 ) ; the severity of CPP correlated with deep endometriosis on the uterosacral ligaments ( p = 0.0001 ) and extent of pelvic adhesions ( p = 0.02 ) ; and deep dyspareunia correlated with deep endometriosis on the uterosacral ligaments ( p = 0.04 ) . Total pain score significantly correlated with deep endometriosis on the uterosacral ligaments ( p = 0.0001 ) , peritoneal adhesions ( p = 0.01 ) , and extent of adnexal adhesions ( p = 0.01 ) . No significant correlation was found among revised American Fertility Society stage of endometriosis ; presence and size of ovarian endometriomas ; extent , type , and site of peritoneal lesions ; and pain scores . By logistic regression analysis , the presence and intensity of total pain could be predicted simultaneously by the presence of deep endometriosis ( p = 0.0001 ) and presence and extent of adnexal adhesions without cystic endometriosis ( p = 0.01 ) , and by the presence of ovarian endometrioma with periovarian adhesions ( p = 0.03 ) . Chronic pelvic pain was predicted by both deep endometriosis ( p = 0.0001 ) and ovarian endometriomas with adnexal adhesions ( p = 0.03 ) . Deep dyspareunia was predicted simultaneously by deep endometriosis ( p = 0.01 ) and an ovarian endometrioma with periovarian adhesions ( p = 0 . 008 ) . Conclusion . Deep endometriosis , pelvic adhesions , and ovarian cystic endometriosis were independent predictors of pelvic pain . These data strongly suggest that it is not the size of ovarian cystic endometriosis but the association with adhesions that causes pelvic pain We evaluated the efficacy of bilateral caudal epidural sacral neuromodulation for the treatment of refractory chronic pelvic pain ( CPP ) , painful bladder syndrome , and interstitial cystitis ( IC ) . Thirty consecutive patients ( 21 female , 9 male ) with severe refractory symptoms underwent bilateral S2-S4 sacral neuromodulation for CPP/IC . Patients were evaluated with the O'Leary IC symptom and problem index ( ICSI , ICPI ) , the short form of the Urogenital Distress Inventory ( UDI-6 ) , and the R AND 36-item health survey ( SF-36 ) preoperatively and 6 months postoperatively . The mean and minimum follow-up were 15 and 6 months , respectively . Of the 30 patients , 23 ( 77 % ) had a successful trial stimulation and were permanently implanted . Among these patients , the ICSI and ICPI scores improved by 35 ( p = 0.005 ) and 38 % ( p = 0.007 ) , respectively . The pain score improved by 40 % ( p = 0.04 ) and the UDI-6 score by 26 % ( p = 0.05 ) . On average , patients reported a 42 % improvement in their symptoms . SF-36 scores did not improve significantly . In refractory patients , bilateral caudal epidural sacral neuromodulation is another possible mode of treatment , which appears to improve both pelvic pain and voiding symptoms OBJECTIVE The aim of the study was to determine the efficacy of static magnetic field therapy for the treatment of  chronic pelvic pain ( CPP ) by measuring changes in pain relief and disability . STUDY DESIGN Thirty-two patients with CPP completed 2 weeks and 19 patients completed 4 weeks of r and omized double-blind placebo-controlled treatment at a gynecology clinic .  Active ( 500 G ) or placebo magnets were applied to abdominal trigger points for 24 hour per day . The McGill Pain Question naire , Pain Disability Index , and Clinical Global Impressions Scale were outcome measures . RESULTS Patients receiving active magnets who completed 4 weeks of double-blind treatment had significantly lower Pain Disability Index ( P < .05 ) , Clinical Global Impressions-Severity ( P < .05 ) , and Clinical Global Impressions-Improvement ( P < .01 ) scores than those receiving placebo magnets , but were more likely to correctly identify their treatment ( P < .05 ) . CONCLUSION SMF therapy significantly improves disability and may reduce pain when active magnets are worn continuously for 4 weeks in patients with CPP , but blinding efficacy is compromised This article reports the findings of a population -based study in New Zeal and that investigated comparative well-being , comorbidity , and the impact of chronic pelvic pain ( CPP ) on activities . Chronic pelvic pain was defined as lower abdominal pain that is associated with neither the menstrual cycle nor sexual activity . A postal question naire was administered to a r and om sample result ing in a study group of 1,160 . The negative impact of CPP on women 's general well-being is significant . They were more likely than women without CPP to have other long-st and ing illnesses , other unspecified conditions involving pain or fatigue , and sleep patterns were more seriously disturbed . Pain restricted their activities . Comparisons with the limited data available from other studies are made Objectives . To investigate the effectiveness of extracorporeal shock wave therapy ( ESWT ) for symptoms alleviation in chronic pelvic pain syndrome ( CPPS ) . Material s and Methods . 40 patients with CPPS were r and omly allocated into either the treatment or sham group . In the first group , patients were treated by ESWT once a week for 4 weeks by a defined protocol . In the sham group , the same protocol was applied but with the probe being turned off . The follow-up assessment s were done at 1 , 2 , 3 , and 12 weeks by Visual Analogue Scale ( VAS ) for pain and NIH-developed Chronic Prostatitis Symptom Index ( NIH-CPSI ) . Results . Pain domain scores at follow-up points in both treatment and sham groups were reduced , more so in the treatment group , which were significant at weeks 2 , 3 , and 12 . Urinary scores became significantly different at weeks 3 and 12 . Also , quality of life ( QOL ) and total NIH-CPSI scores at all four follow-up time points reduced more significantly in the treatment group as compared to the sham group . Noticeably , at week 12 a slight deterioration in all variables was observed compared to the first 3 weeks of the treatment period . Conclusions . our findings confirmed ESWT therapy as a safe and effective method in CPPS in short term OBJECTIVE The purpose of this study was to describe long-term outcomes for women with chronic pelvic pain ( CPP ) after evaluation in a CPP specialty clinic . STUDY DESIGN This was a prospect i ve observational cohort study of women treated for CPP at the UNC Pelvic Pain clinic between 1993 and 2000 . The primary outcome was improvement in pain and the main exposure was treatment group : primarily medical ( pharmacotherapy , psychotherapy , physical therapy , or combinations of the 3 ) or surgical ( hysterectomy , resection or ablative procedures , oophrectomy , diagnostic surgery , pain mapping , vulvar or vestibular repair ) . Univariate , bivariate , and multivariable analyses were performed to look for relationships between background characteristics , treatment group , and improvement in pain . RESULTS Of 370 participants ; 189 had surgical treatment and 181 had medical treatment . One year after evaluation , 46 % reported improvement in pain and 32 % improvement in depression . Improvement in pain was similar in both treatment groups and odds of improvement were equal even after adjusting for background characteristics , psychosocial comorbidity , and previous treatments . CONCLUSION One year after evaluation in a CPP specialty clinic , women experienced modest improvements in pain and depression after recommended surgical or nonsurgical treatment OBJECTIVE To evaluate the efficacy of intravaginal electrical stimulation in women with chronic pelvic pain ( CPP ) . STUDY DESIGN Between May 2002 and February 2004 , 24 women with CPP with no apparent cause were evaluated . They underwent 10 sessions of intravaginal electrical stimulation . A program for measuring chronic diffuse pain , with a frequency of 8 Hz , variation in intensity and frequency , pulse length of 1 msec , and adjustment to the bearable intensity of each individual patient ( in milliamps ) was utilized . Treatment consisted of 30-minute applications , 2 or 3 times per week , and the pain was evaluated using a visual analog scale before and after each session and immediately after completion of the total treatment . The women were asked to evaluate the pain 2 weeks , 4 weeks and 7 months following the end of treatment . RESULTS Intravaginal electrical stimulation was effective in alleviating pain in women with CPP , as evaluated at the end of treatment and 2 weeks , 4 weeks and 7 months after completion of treatment ( p<0.05 ) . There were significantly fewer complaints of dyspareunia following treatment ( p = 0.0005 ) . CONCLUSION Intravaginal electrical stimulation is effective in the alleviation of pain in women with CPP Chronic  pelvic pain ( CPP ) in women is often debilitating and isolating . Problems with diagnosis continue to make CPP one of the most perplexing conditions in gynaecology , and one of the most difficult to treat OBJECTIVES To investigate the clinical effect of electroacupuncture ( EA ) for chronic prostatitis/chronic pelvic pain syndrome ( CP/CPPS ) . METHODS We recruited 63 participants meeting the U.S. National Institutes of Health ( NIH ) consensus criteria for CP/CPPS . After the inclusion /exclusion criteria were applied , 39 men were r and omized to 3 treatment groups : group 1 , advice and exercise plus 12 sessions of EA ; group 2 , advice and exercise plus 12 sessions of sham EA ( SEA ) ; and group 3 , advice and exercise alone ( A&E ) for 6 weeks . A total of 6 acupuncture points were used to stimulate the sacral nerve and release the piriformis muscle using an electrical pulse generator . Symptoms related to CP/CPPS were assessed using the NIH-Chronic Prostatitis Symptom Index ( NIH-CPSI ) . Prostagl and in E(2 ) and beta-endorphin levels in postmassage urine sample s were measured using an enzyme-linked immunosorbent assay . RESULTS At 6 weeks , the NIH-CPSI total score had decreased significantly in the EA group compared with the SEA and A&E groups ( P < .001 ) . On a subscale analysis of the NIH-CPSI , the EA group showed significant decreases in pain-related symptoms compared with the SEA and A&E groups ( P < .01 ) . All 12 EA participants experienced at least a 6-point decrease in the NIH-CPSI total score compared with 2 of 12 SEA participants ( 16.7 % ) and 3 of 12 A&E participants ( 25.0 % ; P < .0001 ) . The mean prostagl and in E(2 ) level in the postmassage urine sample s had significantly decreased in the EA group ( P = .023 ) . In contrast , it had increased in the other 2 groups . CONCLUSIONS In a 3-arm r and omized trial investigating the clinical effects of EA on CP/CPPS , EA therapy proved to have independent therapeutic effects , particularly for pain relief superior to SEA or A&E therapy OBJECTIVE To assess the efficacy of intravaginal electrical stimulation ( IVES ) or placebo in women with chronic pelvic pain ( CPP ) with no apparent cause . STUDY DESIGN A double-blind , crossover , r and omized clinical trial in which 26 women were r and omly allocated to active ( group I , n = 15 ) or placebo ( group II , n = 11 ) IVES . All women underwent 10 30-minute , twice-weekly sessions . The groups were then crossed over for a further 10 sessions . Pain was evaluated using a visual analog scale ( VAS ) before and after each series . RESULTS At the end of the first series , 5 of 11 women who initiated with the placebo had a VAS pain score > 3 ( p = 0.0253 ) ; however , when they crossed over to active IVES , only 1 had a VAS pain score > 3 at the end of the series ( p = 0.0143 ) . In the 15 women who initiated with active IVES , 2 had a score > 3 at the end of the series ( p = 0.0005 ) ; however , when they crossed over to the placebo , 3 had a VAS pain score > 3 at the end of treatment ( p = 0.0833 ) . After the 2 sessions , 54.6 % who initiated with placebo and 80 % who initiated with active IVES had a VAS pain score < 3 . CONCLUSION Intravaginal electrical stimulation was more effective than a placebo in alleviating pain in women with CPP STUDY OBJECTIVE Fluid minihysteroscopy is in most cases a painless procedure . However , rarely , severe pain and side effects are reported . The goal of this study was to identify predictive factors of pain at minihysteroscopy . DESIGN Prospect i ve study ( Canadian Task Force classification II-2 ) . SETTING Academic environment . PATIENTS Five hundred thirty-three women undergoing fluid minihysteroscopy .  INTERVENTIONS Diagnostic fluid minihysteroscopy . MEASUREMENTS AND MAIN RESULTS The women were asked to score pain perception on a visual analog scale from zero ( no pain ) to 5 ( unbearable pain ) . Correlation between pain at procedure and parity , previous cesarean section ( PCS ) , menopausal status , anxiety , and chronic pelvic pain ( CPP ) was evaluated . Four hundred thirteen women ( 78 % ) reported no pain or discomfort ( 0 - 1 pain score , group A ) , while 120 ( 22 % ) experienced mild to unbearable pain ( 2 - 5 pain score , group B ) . Instances of PCS , CPP , anxiety , and menopause were significantly lower in group A than in group B ( 4 % vs 82 % , 0 % vs 29 % , 62 % vs 72 % , 25 % vs 72 % , respectively ) , whereas menopausal status was less frequent in group A ( 25.2 % ) than in group B ( 72.5 % ) . At binary logistic regression , all the variables were independent risk factors for pain ; however , when CPP was stratified for intensity , no correlation between pain at procedure and intensity of CPP was found . CONCLUSION Previous cesarean section , CPP , anxiety , and menopause are predictive factors for pain perception during fluid minihysteroscopy , and history of CPP even of low intensity is predictive of pain at hysteroscopy . These patients may benefit from local anesthesia OBJECTIVE To compare efficacy of the levonorgestrel-releasing intrauterine system ( LNG-IUS ; Mirena ) with depot GnRH analogue ( GnRH-a ; gosareline acetate ; Zoladex ) on endometriosis-related chronic pelvic pain ( CPP ) in patients with severe endometriosis during 12 months . DESIGN Prospect i ve , r and omized , controlled study . SETTING The reproductive endocrinology unit of a tertiary , research and education hospital . PATIENT(S ) Forty women with severe endometriosis ( revised The American Fertility Society [ AFS ] classification > 40 ) and endometriosis-related CPP and control groups were enrolled in the study . INTERVENTION(S ) The patients were treated with either LNG-IUS ( n = 20 ) or GnRH-a ( n = 20 ) . The GnRH-a dose was repeated every 4 weeks for 24 weeks . MAIN OUTCOME MEASURE(S ) Scores of CPP were evaluated using a visual analogue scale ( VAS ) and total endometriosis severity profile ( TESP ) . RESULT ( S ) The TESP score decreased in the LNG-IUS group at first , third , and sixth month follow-up visits , whereas at the 12th month follow-up visit , the TESP scores were increased to values similar to pretreatment values . Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group , the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year . The LNG-IUS treatment showed a lower patient satisfaction . CONCLUSION ( S ) Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis Background : There are multiple approaches to the management of chronic prostatitis/chronic pelvic pain syndrome ( CP/CPPS ) ; and lately the data suggesting the ability of acupuncture treatment to decrease pain , positively impact quality of life and potentially modulate inflammation has suggested it as a potential therapeutic option for men with CP/CPPS . We conducted this study to determine whether acupuncture is really an effective therapeutic modality for CP/CPPS in terms of > 50 % decrease in total National Institutes of Health Chronic Prostatitis Symptom Index ( NIH-CPSI ) score from baseline compared with sham . Methods : One hundred patients with CP/CPPS ( category III B ) in an outpatient urology clinic were r and omized to receive acupuncture at either seven acupoints bilaterally or sham points adjacent to these points . NIH-CPSI was completed by each patient before and 6 , 8 , 16 , 24 weeks after the treatment . Mean values of total CPSI score and subscores after the treatment and on follow-up following the treatment were compared . Results : Of the acupuncture participants , 92 % were NIH-CPSI responders ( > 50 % decrease in total NIH-CPSI score from baseline ) compared with 48 % of sham participants , 8 weeks after the end of the therapy . Both groups experienced significant decrease in CPSI subscores throughout the whole follow-up period ; however , the decline remained significantly greater in the active acupuncture group as compared with the sham group . Conclusions : Our results show that the use of acupuncture in treatment of men with CP/CPPS symptoms result ed in a significant decrease in total NIH-CPSI scores OBJECTIVE To assess and compare the laparoscopic uterine nerve ablation ( LUNA ) and the vaginal uterosacral ligament resection ( VUSR ) in postmenopausal women with chronic pelvic pain ( CPP ) . STUDY DESIGN Eighty postmenopausal women with intractable and severe midline CPP were r and omized to undergo LUNA or VUSR .  Costs of two surgical procedures were assesses . Cure rate , severity of CPP , and deep dyspareunia were also evaluated after 6 and 12 months from surgery . RESULTS The mean cost of LUNA  result ed significantly higher in comparison with VURS ( 2078+/-637 versus 1497+/-297 , P<0.001 ) . The cure rate was not significantly different between the two groups at 6 ( 33/40 , 82.5 % versus 35/40 , 87.5 % for groups A and B , respectively ; P=0.530 ; RR 0.94 , 95 % CI 0.78 - 1.13 ) , and 12 months ( 27/36 , 75.0 % versus 28/38 , 73.7 % , for groups A and B , respectively ; P=0.901 ; RR 0.90 , 95 % CI 0.78 - 1.33 ) of follow-up . At same times , a significant ( P<0.01 ) decrease in severity of CPP and deep dyspareunia was observed in both groups with no difference between them . CONCLUSIONS Both LUNA and VUSR are equally effective surgical treatments in postmenopausal women with central CPP but VUNR is significantly cheaper than LUNA BACKGROUND The objective of this multicentre r and omized , controlled clinical trial was to compare the efficacy of a levonorgestrel-releasing intrauterine system ( LNG-IUS ) and a depot-GnRH-analogue in the control of endometriosis-related pain over a period of six months . METHODS Eighty-two women , 18 to 40 years of age ( mean 30 years ) , with endometriosis , dysmenorrhoea and /or CPP , were r and omized using a computer-generated system of sealed envelopes into either LNG-IUS ( n = 39 ) or GnRH analogue ( n = 43 ) treatment groups at three university centres . Daily scores of endometriosis-associated CPP were evaluated using the Visual Analogue Scale ( VAS ) , daily bleeding score was calculated from bleeding calendars , and improvement in quality of life was evaluated using the Psychological General Well-Being Index Question naire ( PGWBI ) . The pain score diary was based on the VAS in which women recorded the occurrence and intensity of pain on a daily basis . A monthly score was calculated from the result of the sum of the daily scores divided by the number of days in each observation period . RESULTS CPP decreased significantly from the first month throughout the six months of therapy with both forms of treatment and there was no difference between the groups ( P > 0.999 ) . In both treatment groups , women with stage III and IV endometriosis showed a more rapid improvement in the VAS pain score than women with stage I and II of the disease ( P < 0.002 ) . LNG-IUS users had a higher bleeding score than GnRH-analogue users at all time points of observation with 34 % and 71 % of patients in the LNG-IUS and GnRH-analogue groups , respectively , reporting no bleeding during the first treatment month , and 70 % and 98 % reporting no bleeding during the sixth month . No difference was observed between groups with reference to improvement in quality of life . CONCLUSIONS Both , the LNG-IUS and the GnRH-analogue were effective in the treatment of CPP-associated endometriosis , although no differences were observed between the two treatments . Among the additional advantages of the LNG-IUS is the fact that it does not provoke hypoestrogenism and that it requires only one medical intervention for its introduction every 5 years . This device could therefore become the treatment of choice for CPP-associated endometriosis in women who do not wish to conceive BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome ( CP/CPPS ) afflicts 2%-10 % of adult men . Available therapies offer little or no proven benefit . Because acupuncture represents an attractive " natural " therapy , we compared the efficacy of acupuncture to sham acupuncture for CP/CPPS . METHODS Participants met US National Institutes of Health ( NIH ) consensus criteria for CP/CPPS , were aged > or = 20 years old , and had a total score > or = 15 on the NIH Chronic Prostatitis Symptom Index ( NIH-CPSI ) and symptoms for at least 3 of the preceding 6 months . They were r and omized 1:1 to acupuncture or sham acupuncture . Treatment consisted of twice-weekly 30-minute sessions for 10 weeks ( 20 sessions total ) without needle stimulation , herbs , or adjuvants . The primary response criterion was a 6-point decrease from baseline to week 10 in NIH-CPSI total score ( range 0 - 43 ) . RESULTS Thirty-two ( 73 % ) of 44 participants responded in the acupuncture group compared with 21 ( 47 % ) of 45 sham group participants ( relative risk 1.81 , 95 % confidence interval , 1.3 - 3.1 , P = .02 ) . Long-term responses 24 weeks after completing therapy without additional treatment occurred in 14 ( 32 % ) of 44 acupuncture group participants and in 6 ( 13 % ) of 45 sham group participants ( relative risk 2.39 , 95 % confidence interval , 1.0 - 5.6 , P = .04 ) . CONCLUSIONS After 10 weeks of treatment , acupuncture proved almost twice as likely as sham treatment to improve CP/CPPS symptoms . Participants receiving acupuncture were 2.4-fold more likely to experience long-term benefit than were participants receiving sham acupuncture OBJECTIVES CP/CPPS is a commonly observed distress in male patients . Because of its little-known etiology , no effective therapy has been developed which has promising outcomes . Therefore , there is a need to develop a valid model which can mimic the etiology of CP/CPPS . MATERIAL S AND METHODS Fifty male C57BL/6 mice were r and omly and averagely divided into 5 groups of 10 mice each . The control group was injected with 0.9 % NaCl solution . Aluminum hydroxide and T2 groups were injected with aluminum hydroxide adjuvant and T2 peptide . T2 plus complete Freund adjuvant ( CFA ) with aluminum hydroxide group was injected with a mixture of T2 , CFA and aluminum hydroxide adjuvant . At the same time , CFA group was injected with complete Freund adjuvant . Hematoxylin-eosin stain and immunohistochemistry were used to investigate inflammatory lesion and expression of IL-β1 . Furthermore , TNF-α and CRP protein levels were evaluated by using commercially available ELISA kits . The ANOVA test was used to compare the statistical differences among groups . RESULTS Prostates from a mixture of T2 plus CFA with aluminum hydroxide immunized mice showed elevated lesions and high level of inflammatory cells infiltration compared to the other groups . In addition , the levels of TNF-α , IL-β1 , and CRP were also higher in the T2 plus CFA with aluminum hydroxide group as compared to the other groups . CONCLUSION Our results showed that T2 with CFA plus aluminum hydroxide adjuvant injection could successfully induce CP/CPPS in mice . This autoimmune novel model provides a useful , economic , safer , and easy tool for exploring the etiology and pathophysiology of CP/CPPS which will improve the therapeutic outcomes OBJECTIVE Past research has shown response biases to influence the accuracy of results from self-report measures . In pain assessment , where a percentage of patients have financial and other reasons to minimize or exaggerate psychological disturbance , it becomes especially important to identify the influence of response bias in self-report of adjustment . This study investigated the susceptibility of three commonly used self-report pain assessment  measures to response bias . DESIGN This study used a within-subjects ( asymptomatic subjects ) design with two experimental conditions and nonequivalent control group ( chronic pain patients ) . SUBJECTS Experimental group : 40 students enrolled in an occupational therapy program at a major southeastern United States university . CONTROL GROUP 200 subjects referred to a multidisciplinary pain clinic at a major teaching hospital . MEASURES  Coping Strategies Question naire , Multidimensional Pain Inventory , and Pain Beliefs and Perceptions Inventory .  RESULTS With few exceptions , asymptomatic subjects scored significantly differently on these measures while portraying themselves as either coping well or coping poorly . In addition , when using the " coping poorly " response set , asymptomatic subjects reproduced scores similar to those of symptomatic chronic pain patients . CONCLUSION The susceptibility to manipulation appeared constant across the three measures , a finding that highlighted the difficulties clinicians and research ers encounter in accurate interpretation of results from these measures in the absence of validity indicators . This study also emphasizes the ease with which subjects with sufficient motivation can present themselves in an untruthful and manipulative manner and can generate scores that are , on their own , difficult to distinguish from those of a group of typical chronic pain patients OBJECTIVE There are fundamental differences between the administration of medications and the application of manual procedures , such as those used by chiropractors . The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite , r and omized placebo-controlled trial of chiropractic care for women with chronic pelvic pain ( CPP ) . DESIGN Pilot study for a multisite , r and omized , placebo-controlled clinical trial . SETTING Three chiropractic research clinics in the midwest United States . SUBJECTS Thirty-nine ( 39 ) women with CPP of at least 6 months ' duration , diagnosed by board-certified gynecologists . INTERVENTIONS The active intervention consisted of the chiropractic technique , lumbar spine flexion-distraction , combined with manual Trigger Point Therapy . The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage ( light massage ) . OUTCOME MEASURES The primary outcome measure was the change in the Pain Disability Index ( PDI ) from baseline to the end of treatment ( 6 weeks ) , assessed by group and site . If the change score was in the same direction at all sites , the results were to be combined to estimate treatment effect size . RESULTS Patient characteristics were similar to those of patients with CPP in other studies . Recruitment methods , particularly in respect to the eligibility criteria and screening protocol s , would require modification in order to recruit an adequate sample for the planned r and omized controlled trial . Clinicians followed st and ardized procedures with apparently minimal deviation , patients in both groups were satisfied with their care and blinding appeared to be successful . PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated . CONCLUSIONS The technical and personnel re sources required to achieve adequate st and ardization of procedures at multiple sites may make a placebo-controlled trial unfeasible , given our current lack of knowledge about the active agent in manual chiropractic procedures
RESULTS The instruments most frequently used were single-item VAS and Biberoglu and Behrman pain score , while multidimensional inventories were used in few studies .
The results of clinical studies in CPP are more frequently based on one-dimensional measurements .
RATIONALE Many types of  pain assessment are available to research ers carrying out clinical trials in chronic pelvic pain ( CPP ) , ranging from a single-item scale to multidimensional inventories .
AIM Our objective was to investigate which assessment s of pain are more commonly used in clinical trials on CPP .