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OBJECTIVE: To determine the optimal dose and short-term effectiveness of kinesiotaping (KT) on pain intensity and disability in pregnant women with lumbo-pelvic pain. DATA SOURCES: MEDLINE (via PubMed Central), CINAHL, Epistemonikos, Scopus, and Web of Science from inception to 21st March 2023. STUDY SELECTION: We included randomized controlled trials (RCT) conducted on pregnant women with lumbo-pelvic pain treated with KT. DATA EXTRACTION: The outcomes included pain intensity and disability. ROB-2 and GRADE were used to assess the risk of bias and the certainty of the evidence, respectively. A random effects meta-analysis was performed using the standardized mean difference (SMD) and the corresponding 95% confidence interval (CI). The dose-response association was evaluated using a restricted cubic spline model. DATA SYNTHESIS: Seven RCTs involving 527 patients were included. Meta-analysis revealed a statistically significant effect in favor of KT on pain intensity (SMD = -1.71; 95% CI = -2.51 to -0.90; P = <0.001) and on disability (SMD = -1.15; 95% CI = -2.29 to -0.02; P = <0.001). The total duration of KT use ranged from 5 to 35 days. It was estimated that a dose of 5-10 days exceeded the minimal clinically important difference (MCID) for pain intensity (mean difference at 10 days = -2.63; 95% CI = -3.05 to -2.22). Low certainty of evidence was identified for both outcomes. CONCLUSIONS: In pregnant women with lumbo-pelvic pain, the use of KT for 5 to 10 days produces a short-term reduction in pain intensity that exceeds the MCID, with a low certainty of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: Systematic Review Registration Number PROSPERO CRD42023388174. CONTRIBUTION OF PAPER.

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Background: Chronic pelvic pain remains challenging for physicians to manage due to central and peripheral sensitization and multiple pain generators including the bladder, pelvic floor, and pudendal nerve. Pain management providers have used nerve blocks for years for diagnosis and treatment. We developed a desensitization algorithm that provides a stepwise approach to improve patients pain scores. Methods: This is a prospective observational cohort study of 182 women aged 15-90 years old with chronic pelvic pain using an algorithm from 2016 to 2018. Treatment started with an Anesthetic Challenge Test of the bladder to guide us through a protocol of intravesical therapy and/or pudendal nerve blocks as a second step. Results: ACT POSITIVE patients, who received intravesical therapy: 84% had a Visual Analog Score pain improvement of at least 50%, 64% improved at least 80% (41% pain-free). Those desiring additional relief that received further Pudendal Blocks: 83% had final improvement of at least 50% (67% pain-free). ACT NEGATIVE patients received Pudendal Blocks with 80% of subjects achieving at least 50% relief, 65% improved at least 80% (35% pain-free). All final groups showed a statistically significance of P < .05% when compared to their initial pain scores. Conclusion: Management of women with chronic pelvic pain would ideally start with treating a specific diagnosis which, in most cases, is difficult to establish since the majority have more than one pain generator. Our algorithm simplified the approach and reduced the severity of pain scores prior to any further necessary surgical interventions.

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El dolor oncológico severo ocurre hasta en el 60% de los pacientes con cáncer pélvico, siendo refractario al tratamiento médico hasta en el 30% de los casos. Las presentaciones pueden incluir un síndrome de dolor visceral pélvico, una plexopatía lumbosacra maligna, dolor por metástasis óseas sacroilíacas y dolor pélvico posquirúrgico crónico. Se han desarrollado terapias intervencionales mínimamente invasivas para tratar el dolor, que en etapas tempranas en pacientes con dolor no controlado mejoran su condición de salud, mejoran su rendimiento para enfrentar la enfermedad y su tratamiento, y evitan o retrasan la escalada de opioides con sus efectos adversos asociados. Se requiere estandarizar las técnicas, mejorar la calidad de los ensayos clínicos y desarrollar guías de práctica clínica en un trabajo conjunto con oncología.

Severe cancer pain occurs in up to 60% of patients with abdominopelvic cancer, being refractory to medical management in up to 30% of cases. Presentations may include pelvic visceral pain syndromes, malignant lumbosacral plexopathy, sacroiliac bone metastasis pain, and chronic pelvic post-surgical pain. Minimally invasive interventional therapies have been developed to treat pain, which in early stages in patients with uncontrolled pain improve their health condition, improve their performance in coping with the disease and its treatment, and prevent or delay the escalation of opioids with their associated side effects. It is necessary to standardize the techniques, improve the quality of clinical trials and develop clinical practice guidelines in a joint effort with oncology.

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Hypoactive sexual desire dysfunction (HSDD) is prevalent among women. This retrospective cohort study aimed to verify the results of the strategies used by Gynecologists and Obstetricians (Ob-gyn) residents in the management of female HSDD. For this, we conducted a data collection of patient medical records of women with HSDD from the Human Sexuality Studies outpatient clinic of the Human Reproduction Center, Department of Gynecology and Obstetrics of FMRP-USP, from 2005 to 2019. Among the 437 women included, 361 (82.6%) answered the question concerning the effect of the protocol to which they were submitted, whereas 234 (64.8%) reported improvements in sexual desire. The univariate model showed that patients without chronic pelvic pain were 19.0% less likely to report improvements in HSDD than those with chronic pelvic pain (p = 0.03). Patients without depression and without orgasmic dysfunction were, respectively 32% and 23% more likely to show improvements in their HSDD than those who had depression or orgasmic dysfunction (respectively p = 0.001, p = 0.008). However, the multivariate model did not identify any associations. The assistance regarding HSDD by the Ob-gyn resident in training to deal with female sexual complaints may be effective in improving sexual complaints.

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Evaluar la eficacia y seguridad del estrógeno potenciado en comparación con el placebo en el tratamiento homeopático del dolor pélvico asociado a endometriosis (EAPP, por sus siglas en inglés). Diseño del estudio: El presente fue un estudio clínico aleatorizado, doble ciego, controlado con placebo, de 24 semanas, el cual incluyó a 50 mujeres de entre 18 y 45 años de edad con diagnóstico de endometriosis infiltrante profunda con base en ultrasonido transvaginal o imágenes de resonancia magnética después de preparación intestinal, así como puntaje ≥ 5 en una escala visual analógica (VAS: rango de 0 a 10 puntos) para el dolor pélvico asociado con la endometriosis. Se administró estrógeno potenciado (12cH, 18cH y 24cH) o placebo dos veces al día por vía oral. La medida principal de resultado fue el cambio en la severidad de los puntajes parcial y global de EAPP (VAS) de la línea basal a la semana 24, determinada como la diferencia en el puntaje medio de cinco modalidades de dolor pélvico crónico (dismenorrea, dispareunia profunda, dolor pélvico no cíclico, dolor intestinal cíclico y/o dolor urinario cíclico). Las medidas secundarias de resultado fueron la diferencia media de puntaje para la calidad de vida evaluada con el Cuestionario de Salud SF-36, los síntomas de depresión en el Inventario de la Depresión de Beck (BDI) y los síntomas de ansiedad en el Inventario de Ansiedad de Beck (BAI). Resultados: El puntaje global de EAPP (VAS: rango de 0 a 50 puntos) se redujo en 12.82 (p < 0.001) en el grupo tratado con estrógeno potenciado de la línea basal a la semana 24. El grupo que utilizó estrógeno potenciado también presentó una reducción en el puntaje parcial (VAS: rango de 0 a 10 puntos) en tres modalidades de EAPP: dismenorrea (3.28; p < 0.001), dolor pélvico no cíclico (2.71; p = 0.009) y dolor intestinal cíclico (3.40; p < 0.001). El grupo de placebo no mostró cambio significativo alguno en los puntajes global o parcial de EAPP. Además, el grupo de estrógeno potenciado mostró un mejoramiento significativo en tres de ocho ámbitos de SF-36 (dolor de cuerpo, vitalidad y salud mental) y síntomas de depresión (BDI). El grupo de placebo no mostró un mejoramiento significativo a este respecto. Estos resultados demuestran la superioridad del estrógeno potenciado sobre el placebo. Se asociaron pocos eventos adversos con el estrógeno potenciado. Conclusiones: El estrógeno potenciado (12cH, 18cH y 24cH) en dosis de 3 gotas dos veces al día durante 24 semanas fue significativamente más efectivo que el placebo para reducir el dolor pélvico asociado con la endometriosis. Registro del estudio clínico: ClinicalTrials.gov Identificador: https://clinicaltrials.gov/show/NCT02427386.

To evaluate the efficacy and safety of potentized estrogen compared to placebo in homeopathic treatment of endometriosis-associated pelvic pain (EAPP). Study design: The present was a 24-week, randomized, doubleblind, placebocontrolled trial that included 50 women aged 18-45 years old with diagnosis of deeply infiltrating endometriosis based on magnetic resonance imaging or transvaginal ultrasound after bowel preparation, and score ≥ 5 on a visual analogue scale (VAS: range 0 to 10 points) for endometriosis-associated pelvic pain. Potentized estrogen (12cH, 18cH and 24cH) or placebo was administered twice daily per oral route. The primary outcome measure was change in the severity of EAPP global and partial scores (VAS) from baseline to week 24, determined as the difference in the mean score of five modalities of chronic pelvic pain (dysmenorrhea, deep dyspareunia, non-cyclic pelvic pain, cyclic bowel pain and/or cyclic urinary pain). The secondary outcome measures were mean score difference for quality of life assessed with SF-36 Health Survey Questionnaire, depression symptoms on Beck Depression Inventory (BDI), and anxiety symptoms on Beck Anxiety Inventory (BAI). Results: The EAPP global score (VAS: range 0 to 50 points) decreased by 12.82 (p < 0.001) in the group treated with potentized estrogen from baseline to week 24. Group that used potentized estrogen also exhibited partial score (VAS: range 0 to 10 points) reduction in three EAPP modalities: dysmenorrhea (3.28; p < 0.001), non-cyclic pelvic pain (2.71; p = 0.009), and cyclic bowel pain (3.40; p < 0.001). Placebo group did not show any significant changes in EAPP global or partial scores. In addition, the potentized estrogen group showed significant improvement in three of eight SF-36 domains (bodily pain, vitality and mental health) and depression symptoms (BDI). Placebo group showed no significant improvement in this regard. These results demonstrate superiority of potentized estrogen over placebo. Few adverse events were associated with potentized estrogen. Conclusions: Potentized estrogen (12cH, 18cH and 24cH) at a dose of 3 drops twice daily for 24 weeks was significantly more effective than placebo for reducing endometriosis-associated pelvic pain.

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PURPOSE: Chronic pelvic pain (CPP) in women is a complex syndrome and symptoms are associated with sexual dysfunction, musculoskeletal and myofascial disorders, and comorbid psychiatric disorders. Its widespread prevalence results in substantial expense due to therapy and lost productivity, and it is perhaps one of the most urgent and neglected medical needs. This systematic review and meta-analysis aimed to estimate the role of mindfulness and pelvic floor physical therapy (PFPT) in the treatment or management of women with CPP. METHODS: This systematic review (CRD42020204987) searched for relevant publications between January 2000 and November 2020 on MEDLINE/PubMed, Web of Science, One File GALE, and Technology Research databases using the following search terms: chronic pelvic pain, pelvic floor physical therapy/physiotherapy, mindfulness, and their variants. Risk of bias and quality of evidence were evaluated. RESULTS: Seven clinical trials (n = 279) were included in the review, and five in the meta-analysis (n = 225). For the pain outcome and its catastrophizing, there was a statistical difference for the Pain Catastrophizing Scale after treatment and during follow-up with mindfulness and PFPT (MD = - 3.82 [- 6.97, - 0.68], p = 0.01, and MD = - 4.49 [- 7.61, - 1.37], p = 0.00, respectively). Sexual function, assessed by the female sexual function index, differed significantly during follow-up between PFPT and mindfulness (MD = - 0.72 [- 1.38, - 0.05], p = 0.03). CONCLUSION: The small number of studies applying both PFPT and mindfulness to CPP suggests that a multidisciplinary approach is required to treat women with CPP, and further studies involving these therapeutic techniques throughout the CPP cycle are needed.

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BACKGROUND: Chronic pelvic pain (CPP) is defined as recurrent or continuous pain in the lower abdomen or pelvis, either non-menstrual or noncyclical, lasting for at least 6 months. There is strong evidence that up to 85% of patients with CPP have serious dysfunctions of the musculoskeletal system, including abdominal myofascial pain syndrome (AMPS). AMPS is characterized by intense and deep abdominal pain, originating from hyperirritable trigger points, usually located within a musculoskeletal band or its lining fascia. In the literature, there are few studies that address AMPS. OBJECTIVES: To evaluate and compare the efficacy of therapeutic ultrasound (TUS) and injection of local anesthetic (IA) to improve pain in women with abdominal myofascial syndrome secondary to CPP. STUDY DESIGN: Randomized controlled clinical trial. SETTING: Tertiary University Hospital. MATERIALS AND METHODS: A randomized clinical trial was conducted, patients were allocated to two types of treatment: group TUS (n = 18), and group IA (n = 20). The instruments used for evaluation and reassessment were the Visual Analog Scale, Numerical Categorical Scale, McGill Pain Questionnaire, and SF-36 quality of life assessment questionnaire. They were evaluated before starting treatment, 1 week after the end of treatment, and at 1, 3, and 6 months. RESULTS: TUS and IA were effective in reducing clinical pain and improving quality of life through the variables analyzed among study participants. There was no significant difference between groups. LIMITATIONS: absence of blinding; exclusion of women with comorbidities and other causes of CPP, the absence of a placebo group, the difference between the number of sessions used for each technique, and the COVID-19. CONCLUSION: Treatment with TUS and IA were effective in reducing clinical pain and improving quality of life in women with AMPS secondary to CPP. TRAIL REGISTRATION: We declare that this clinical trial has been registered under the number [(ReBEC) no. RBR-39czsv] on 07/18/2018 in the Brazilian Registry of Clinical Trials.

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Objetivo: Descrever a importância da intervenção fisioterapêutica para mulheres com vaginismo. Fonte de dados: Foram utilizadas as bases de dados SciELO, PubMed, Biblioteca Virtual de Saúde (BVS) e Literatura Cinza, incluindo artigos nacionais e internacionais, sem delimitação temporal. Foram propostas para as buscas as seguintes palavras-chave e operadores boleanos: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], sendo esses posteriormente adequados para as demais bases que foram utilizadas nesta revisão sistemática. Seleção dos estudos: A seleção dos estudos foi realizada por três examinadores independentes. Coleta de dados: Inicialmente foram excluídos estudos com base no título, em seguida os resumos foram analisados e, dos 353 artigos encontrados inicialmente, quatro foram elegíveis para esta revisão. Síntese dos dados: Os artigos incluídos descreveram que o tratamento fisioterapêutico é de extrema importância para as mulheres com vaginismo, pois aumenta a força e o controle sobre a musculatura do assoalho pélvico, diminuindo os sintomas do vaginismo e promovendo o incremento da satisfação sexual. Conclusão: A intervenção fisioterapêutica é imprescindível para mulheres que apresentam vaginismo, tendo em vista que suas técnicas têm efetividade na prevenção e tratamento do vaginismo, além de promover melhora importante na qualidade de vida e na satisfação sexual das mulheres.(AU)

Objective: To describe the importance of physical therapy intervention for women with vaginismus. Data source: The SciELO, PubMed, Virtual Health Library (BVS) and Gray Literature databases were used, including national and international articles, without temporal delimitation. The following keywords and Boolean operators were proposed for the searches: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], which were later suitable for the other bases that were used in this systematic review. Study selection: Study selection was performed by three independent examiners. Data collection: Initially, studies were excluded based on the title, then the abstracts were analyzed and of the 353 articles found initially, 4 were eligible for this review. Data synthesis: The articles included described that physical therapy treatment is extremely important for women with vaginismus, as it increases strength and control over the pelvic floor muscles, decreasing the symptoms of vaginismus and promoting increased sexual satisfaction. Conclusion: Physical therapy intervention is essential for women who have vaginismus, considering that its techniques are effective in preventing and treating vaginismus, in addition to promoting an important improvement in women's quality of life and sexual satisfaction.(AU)

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Introducción: La factibilidad y seguridad del empleo de la ozonoterapia se evidencia en los resultados expuestos por varios autores, en enfermedades cuyo síntoma fundamental es el dolor crónico. Objetivo: Determinar la evolución clínica de las pacientes con dolor pélvico crónico, tratadas con ozono asociado al tratamiento médico convencional. Métodos: Estudio descriptivo, observacional, retrospectivo, en el que se determinó la evolución clínica de las pacientes con dolor pélvico crónico tratadas con ozono, asociada al tratamiento médico convencional. La muestra fue de 54 mujeres. Las variables utilizadas fueron: edad, causa del dolor pélvico, tiempo de evolución, puntuación de la escala de dolor antes y después de la aplicación de la ozonoterapia y evaluación del tratamiento. Resultados: Prevalecieron las pacientes con edad de 26-35 años. El 57,4 por ciento tenían entre 2 y 2 años de evolución del dolor. La enfermedad inflamatoria pélvica crónica fue la causa de mayor frecuencia con 42,5 por ciento. Antes de la aplicación de la ozonoterapia la media de puntuación en la escala de dolor fue de 6,31, y disminuyó a 3 después del tratamiento, con una evaluación de bien en el 81,1 por ciento de los casos. Conclusiones: Después de la aplicación de la ozonoterapia asociada al tratamiento médico convencional, se produce mejoría clínica, por lo que puede ser una alternativa de tratamiento(AU)

Introduction: The feasibility and safety of the use of ozone therapy is evidenced in the results presented by several authors, in diseases whose main symptom is chronic pain. Objective: To determine the clinical evolution of patients with chronic pelvic pain treated with ozone associated with conventional medical treatment. Methods: Descriptive, observational, retrospective study, in which the clinical evolution of patients with chronic pelvic pain treated from January 2018 to January 2020, with ozone therapy, associated with conventional medical treatment. The sample was 54 women. The variables used were: age, cause of pelvic pain, time of evolution, score on the pain scale before and after the application of ozone therapy, and evaluation of the treatment. Results: Patients aged 26-35 years prevailed. 57,4 percent had between two and four years of pain evolution. Chronic pelvic inflammatory disease was the most frequent cause with 42,5 percent. Before the application of ozone therapy, the mean score on the pain scale was 6.31, and it decreased to 3 after treatment, with an evaluation of good in 81,1percent of the cases. Conclusions: After the application of ozone therapy associated with conventional medical treatment, there is evident clinical improvement, which is why it constitutes an alternative of treatment(AU)

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AIMS: This prospective study aimed to compare the clinical outcomes between the use of Erbium:YAG (Er:YAG) laser in a nonablative mode, to the use of the pharmacological treatment of oral tadalafil for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: The laser group received two sessions of Erbium:YAG laser, administered intraurethrally in a long, nonablative train of long pulses (SMOOTH™ mode), applied at the level of the male prostatic urethra. Tadalafil group received oral tadalafil at a dose of 5 mg/day, consecutively for 2 months. Effectiveness was assessed using the International Prostate Symptom Score (IPSS) questionnaire, VAS (visual analogue scale) pain score, and maximum urethral flow at follow-up visits up to 12 months after initiating treatment. Adverse effects were recorded after each treatment and follow-up sessions. RESULTS: The results show a significant decrease in the IPSS score in both groups up to the 12-month follow-up. The increase in Q-max was evident up to 3-months follow-up in the tadalafil group and up to 6 months in the laser group. The decrease in the VAS pain score was also significant in both treatment groups, lasting up to 3 months in the tadalafil group and up to 6 months in the laser group. CONCLUSIONS: The nonablative Er:YAG SMOOTH™ laser seems to be a promising treatment for this widely occurring condition. More studies are needed to confirm its safety and efficacy.

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É descrito o caso clínico de um homem adulto com diagnóstico de Síndrome dolorosa pélvica crônica relacionada à prostatite (SDPCP), que após tentativa de tratamento alopático convencional com pouco sucesso, inicia abordagem terapêutica homeopática. A Homeopatia é uma racionalidade médica que visa tratar o indivíduo integralmente, utilizando o princípio da semelhança entre a totalidade sintomática do doente e do medicamento a ser utilizado. Foi prescrito omedicamento Colocynthis , preparado de acordo com a farmacotécnica homeopática vigente, após realização da consulta homeopática, repertorização e revisão da matéria médica. Houve resposta efetiva ao tratamento instituído, com desaparecimento dos sintomas da doença e recuperação completa. A Homeopatia mostra-se como alternativa promissora e efetiva no manejo da condição clínica descrita.(AU)

Prostatitis' chronic pelvic pain syndrome is a prevalent condition among men, bringing much suffering and social disability. The conventional therapeutic approach has little effectiveness and many side effects. It is reported a clinical case of the mentioned syndrome where was used the individualized homeopathic management and administered Colocynthis remedy. There was an excellent therapeutic response with complete resolution of symptoms along the follow up period. Presently, Homeophathy has emerged as an useful and promising tool in this pain syndrome's treatment.(AU)

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Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of the menstrual cycle. It has major implications for quality of life, such as limitation of daily activities and psychological stress, being one of the main causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, non-pharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.

Dismenorreia primária é definida como dor menstrual na ausência de patologia pélvica. Caracteriza-se pelo excesso de produção de prostaglandinas pelo endométrio que provocam hipercontractilidade uterina, resultando em isquemia e hipoxia do músculo uterino e, subsequentemente, dor. É a patologia ginecológica mais comum em mulheres em idade fértil e uma das causas mais frequentes de dor pélvica; contudo, é subdiagnosticada, subtratada, e até desvalorizada pelas próprias mulheres, que a aceitam como parte do ciclo menstrual. A dismenorreia tem grandes implicações na qualidade de vida, como limitação das atividades diárias e estresse psicológico, sendo uma das principais causas de absentismo escolar e laboral. O seu diagnóstico é essencialmente clínico, baseando-se na história clínica e num exame físico sem alterações. É importante excluir causas secundárias de dismenorreia. O tratamento pode ter diferentes abordagens (farmacológica, não farmacológica e cirúrgica), sendo que a primeira linha de tratamento consiste na utilização de anti-inflamatórios não esteroides (AINEs) e, em casos de mulheres que desejem contracepção, no uso de anticoncepcionais hormonais. Tratamentos alternativos, como a utilização de calor tópico, modificação do estilo de vida, estimulação elétrica nervosa transcutânea, suplementos alimentares, acupuntura e acupressão, podem ser uma opção nos casos de contraindicação da utilização dos tratamentos convencionais. O tratamento cirúrgico apenas se encontra indicado em casos raros de mulheres com dismenorreia grave e refratária aos tratamentos.

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BACKGROUND: The superior hypogastric plexus block has been indicated for visceral pelvic pain treatment associated with malignancy. The first international report of this technique was published by Plancarte et al, in which a posterior percutaneous approach guided by fluoroscopy was described by applying neurolytic agents. The considerable variability in the data reported gave rise to 2 clinical approaches to those who performed the blockade early and those who executed it at a later stage of cancer. OBJECTIVES: The present study aims to provide more evidence regarding the effectiveness of this procedure. STUDY DESIGN: This is a retrospective, longitudinal, descriptive study. SETTING: The study was held at the pain unit service of the National Cancer Institute, Mexico City. METHODS: A nonprobabilistic sample was selected; the data collection took place from January 2006 to December 2016 with patients diagnosed with pelvic pain, confirmed by imaging and biopsy studies. Patients who received any other type of intervention of the sympathetic axis, patients with a different approach than the classic or paravertebral technique, and patients with low survival rate were excluded. The Student t test was used to measure the significant difference between Visual Analog Scale (VAS) and morphine equivalent daily dose. The Cochran-Mantel-Haenszel test and the Gamma test were used to measure the association between the initial Karnofsky and blockade success. RESULTS: The study included a total of 180 patients. The success rate was 59.4% at 1 month, 55.5% at 3 months, and 48.8% at 6 months. There was a sustained and significant VAS reduction that was 49.55% at 3 months. A significant reduction in opioid consumption of 12.55% was found at 3 months. There was no significant statistical evidence related to either opioid consumption or the functionality of the patient before the blockade as an influential variable in the success of the procedure. LIMITATIONS: Retrospective study, developed in a single center. CONCLUSIONS: Although opioids remain the cornerstone of cancer pain treatment, they produce many deleterious side effects. The superior hypogastric plexus neurolysis represents a reproducible and effective alternative in the management of pain in this group of patients. KEY WORDS: Pelvic pain, neoplasms, chemical neurolysis, pain management, cancer pain, palliative care, analgesia, nerve block.

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Abstract Primary dysmenorrhea is defined asmenstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of themenstrual cycle. It hasmajor implications for quality of life, such as limitation of daily activities and psychological stress, being one of themain causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, nonpharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.

Resumo Dismenorreia primária é definida como dormenstrual na ausência de patologia pélvica. Caracteriza-se pelo excesso de produção de prostaglandinas pelo endométrio que provocam hipercontractilidade uterina, resultando em isquemia e hipoxia do músculo uterino e, subsequentemente, dor. É a patologia ginecológica mais comum em mulheres em idade fértil e uma das causas mais frequentes de dor pélvica; contudo, é subdiagnosticada, subtratada, e até desvalorizada pelas próprias mulheres, que a aceitam como parte do ciclo menstrual. A dismenorreia tem grandes implicações na qualidade de vida, como limitação das atividades diárias e estresse psicológico, sendo uma das principais causas de absentismo escolar e laboral. O seu diagnóstico é essencialmente clínico, baseando-se na história clínica e num exame físico sem alterações. É importante excluir causas secundárias de dismenorreia. O tratamento pode ter diferentes abordagens (farmacológica, não farmacológica e cirúrgica), sendo que a primeira linha de tratamento consiste na utilização de anti-inflamatórios não esteroides (AINEs) e, em casos de mulheres que desejem contracepção, no uso de anticoncepcionais hormonais. Tratamentos alternativos, como a utilização de calor tópico, modificação do estilo de vida, estimulação elétrica nervosa transcutânea, suplementos alimentares, acupuntura e acupressão, podem ser uma opção nos casos de contraindicação da utilização dos tratamentos convencionais. O tratamento cirúrgico apenas se encontra indicado em casos raros de mulheres com dismenorreia grave e refratária aos tratamentos.

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CONTEXTO CLÍNICO: El síndrome de congestión pelviana (SCP) es un desorden de la circulación venosa pelviana que causa dolor pelviano en mujeres en edad fértil. Se produce por una dilatación de la vena ovárica y la vena iliaca interna con flujo sanguíneo lento (congestión venosa), fluyo retrógrado y reflujo venoso que son indicadores de incompetencia venosa pélvica. El dolor crónico pelviano (DCP) se define como dolor abdominal o pelviano continuo o intermitente, que puede o no, estar asociado a los ciclos menstruales cuya duración es al menos entre tres a seis meses. Se estima una prevalencia entre 2,1% a 24% en mujeres entre 18 a 50 años.2 El DCP secundário a síndrome de congestión pelviana se caracteriza por agravarse tras largosperiodos de bipedestación y por mejorar al acostarse. Suele presentarse post-coito y entre 2 a 20 % de los casos pueden presentar várices en la vulva, especialmente en mujeres que tuvieron hijos. 12El diagnóstico suele ser un hallazgo por ecografía doppler de mujeres con várices en miembros inferiores o bien incidental en el contexto del estudio de enfermedad inflamatoria pélvica, endometriosis, cistitis intersticial, dolor miofascial, neuralgia pélvica, y otras condiciones. TECNOLOGÍA: La embolización o escleroterapia de venas pelvianas consiste en introducir un catéter guiado por fluoroscospia a través de la vena femoral o vena yugular. Progresado el mismo hasta las venas dilatadas, se instila en el catéter una sustancia esclerosante (monómeros de cianoacrilato, detergentes como morruato sódico o tretradecilsulfato) o se colocan para la embolización pequeñas bobinas de metal (acero inoxidable o platino) cubiertas de sustancias que inducen la producción de coágulos sanguíneos. Ambos métodos tienen el objetivo de producir una esclerosis y/o trombosis de la vena. La vena dilatada ocluida deriva el flujo sanguíneo hacia otras venas pélvicas, disminuyendo los flujos turbulentos y el reflujo venoso. Esta técnica es realizada por un radiólogo intervencionista, con experiencia en la misma, y no requiere hospitalización. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de embolización o escleroterapia de venas pelvianas en síndrome de congestión pelviana. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentessistemas de salud. RESULTADOS: No se encontraron estudios que comparen la embolización o escleroterapia de venas de región pelviana versus la ligadura de venas pelvianas por laparoscopía o versus el tratamiento médico (analgesia y reemplazo hormonal). Se incluyeron tres RS, una GPC, una evaluación de tecnologia sanitaria, y cinco informes de políticas de cobertura de tecnología para esta indicación. CONCLUSIONES: No se encontraron estudios que comparen la embolización o escleroterapia de venas de región pelviana versus la ligadura de venas pelvianas por laparoscopia o versus el tratamiento médico (analgesia y reemplazo hormonal) en el tratamiento del síndrome de congestión pelviana. Evidencia de muy baja calidad no permite concluir acerca de la efectividad y seguridad de esta tecnología. No se encontraron guías de práctica clínica específicas que den recomendaciones sobre el tratamiento del síndrome de congestión pelviana, solo la guía sobre el tratamiento de enfermedad venosa crónica de la Sociedad Americana de Cirugía Vascular, que la menciona como alternativa terapéutica. La mayoría de los financiadores latinoamericanos, estadounidenses y europeos no cubren esta tecnología por considerarla experimental. Un solo financiador estadounidense da cobertura solo cuando el dolor crónico pelviano no responde al tratamiento médico y ante el diagnóstico confirmado por venografía o resonancia magnética nuclear. Se desconoce la costo efectividad de esta tecnología en la indicación evaluada en la Argentina

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The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

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Objetivo: Verificar a eficácia da TENS no tratamento de mulheres com vulvodínia localizada provocada. Métodos: Buscou-se, nas bases de dados SciELO, PEDro e PubMed, por estudos que utilizaram a TENS como tratamento da vulvodínia localizada provocada. Resultados: Dos 50 artigos recuperados, três foram analisados: dois ECRs e um estudo de coorte longitudinal não controlado. Conclusão: A TENS pode ser eficaz como uma opção de tratamento na melhora da dor vulvar, sendo uma opção de baixo custo, não invasivo e de fácil manejo; assim como outras terapias combinadas, parece ter um efeito positivo e benéfico no tratamento da vulvodínia localizada provocada. (AU)

Objective: To verify the efficacy of TENS in the treatment of women with localized provoked vulvodynia. Methods: Searched the databases SciELO, PEDro, PubMed, for studies that used TENS as a treatment of localized vulvodynia. Results: Of the 50 articles retrieved, 3 articles were analyzed: 2 RCTs, 1 uncontrolled longitudinal cohort study. Conclusion: The TENS can be effective as a treatment option in improving vulvar pain and is a low-cost, non-invasive and easy to use option, as well as other combined therapies, which appears to have a positive and beneficial effect in the treatment of localized provoked vulvodynia.(AU)

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