Endometriosis

Joshua H. Tamayo‐Sarver, Rita K. Cydulka
In: Emergency Department Analgesia · 2008 · pp. 197–199 · doi:10.1017/cbo9780511544835.029 · W868775363
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

Oxaprozin improved function in non-septic bursitis, while oral corticosteroids offered early but not sustained benefit for shoulder bursitis; subacromial inflammation can be caused by protease inhibitors.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This chapter from Emergency Department Analgesia, in an evidence-based guide format, surveys emergency-department management considerations for pain associated with endometriosis, focusing on endocrine and anti-inflammatory treatments used for dysmenorrhea/endometriosis-type pain. It reports that NSAIDs are considered first-line therapy, with combined oral contraceptive pills (COCPs) generally recommended second-line, and cites a 2007 Cochrane review concluding COCPs are at least as effective as GnRH agonists. It further states that medroxyprogesterone acetate is comparable to danazol and that both can reduce pain scores versus placebo, and that depot medroxyprogesterone may relieve symptoms similarly to leuprolide; it notes that multiple endocrine therapies have generally equivalent pain relief in Cochrane findings. The chapter cautions that endocrine agents can cause menopausal, androgenic, and hepatic side effects (e.g., danazol), emphasizing the importance of ED physician communication and follow-up with longitudinal care providers. This paper is centrally about endometriosis—summarizing evidence for analgesic and endocrine therapies for endometriosis-associated pain in an emergency care context.

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Abstract

There are few rigorously conducted clinical trials assessing specific therapy for non-septic bursitis. First-line treatments of non-septic bursitis include NSAIDs, aspiration, and injection therapy with corticosteroids and local anesthetics. Patients receiving oxaprozin showed improved overall function scores on a variety of measures. Results for periarticular inflammation other than bursitis are similar to the findings for bursitis. For patients with shoulder bursitis, oral corticosteroids provide early improvement over placebo, but treatment benefit is lost after the first few weeks of therapy. Many corticosteroids have demonstrated effectiveness for injection of subacromial inflammation. For trochanteric bursitis, studies investigating intrabursal injection of corticosteroids have found efficacy similar to that reported for other bursal injection sites. One long-recognized medication-related etiology of subacromial inflammation is the use of protease inhibitors: indinavir and lamivudine. Given the obvious risks in altering these medication regimens, the ED provider should reduce dosages only after consultation with patients' physicians.
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Emergency Department Analgesia Buy print or eBook [Opens in a new window] An Evidence-Based Guide - Emergency Department Analgesia - Emergency Department Analgesia - Copyright page - Contents - Contributors - Foreword - Preface - Acknowledgments - Abbreviations - General considerations - Chief complaints and diagnoses - Abdominal aortic aneurysm - Aortic dissection - Arthritis - Biliary tract pain - Bites and stings – marine - Bites and stings – terrestrial - Breast pain - Burns - Bursitis and periarticular inflammation - Cancer and tumor pain - Cardiac chest pain - Chest wall trauma - Chronic low-back pain - Cluster headache - Corneal abrasion - Cystitis, urethritis, and prostatitis - Dysmenorrhea - Endometriosis - Esophageal spasm - Fibromyalgia - Gastritis and peptic ulcer disease - Gastroesophageal reflux disease - Hemorrhoids and perianal pain - Migraine and undifferentiated headache - Mucositis and stomatitis - Neck and back pain – mechanical strain - Neck and back pain – radicular syndromes - Neck and back pain – spinal spondylitic syndromes - Neuropathy – complex regional pain syndrome - Neuropathy – diabetic - Neuropathy – HIV related - Neuropathy – overview - Neuropathy – phantom limb pain - Ocular inflammation - Odontalgia - Orthopedic extremity trauma – sprains, strains, and fractures - Osteoporotic vertebral compression fracture - Otitis media and externa - Pancreatitis - Pharyngitis - Postdural puncture headache - Post-herpetic neuralgia - Renal colic - Sialolithiasis - Sickle cell crisis - Temporomandibular disorders - Tension-type headache - Trigeminal neuralgia - Undifferentiated abdominal pain - Tables from Chief complaints and diagnoses Published online by Cambridge University Press: 18 December 2009 Edited by Book contents - Emergency Department Analgesia - Emergency Department Analgesia - Copyright page - Contents - Contributors - Foreword - Preface - Acknowledgments - Abbreviations - General considerations - Chief complaints and diagnoses - Abdominal aortic aneurysm - Aortic dissection - Arthritis - Biliary tract pain - Bites and stings – marine - Bites and stings – terrestrial - Breast pain - Burns - Bursitis and periarticular inflammation - Cancer and tumor pain - Cardiac chest pain - Chest wall trauma - Chronic low-back pain - Cluster headache - Corneal abrasion - Cystitis, urethritis, and prostatitis - Dysmenorrhea - Endometriosis - Esophageal spasm - Fibromyalgia - Gastritis and peptic ulcer disease - Gastroesophageal reflux disease - Hemorrhoids and perianal pain - Migraine and undifferentiated headache - Mucositis and stomatitis - Neck and back pain – mechanical strain - Neck and back pain – radicular syndromes - Neck and back pain – spinal spondylitic syndromes - Neuropathy – complex regional pain syndrome - Neuropathy – diabetic - Neuropathy – HIV related - Neuropathy – overview - Neuropathy – phantom limb pain - Ocular inflammation - Odontalgia - Orthopedic extremity trauma – sprains, strains, and fractures - Osteoporotic vertebral compression fracture - Otitis media and externa - Pancreatitis - Pharyngitis - Postdural puncture headache - Post-herpetic neuralgia - Renal colic - Sialolithiasis - Sickle cell crisis - Temporomandibular disorders - Tension-type headache - Trigeminal neuralgia - Undifferentiated abdominal pain - Tables NSAIDs are widely considered as the first-line therapy for the pain associated with endometriosis. Combined oral contraceptive pills (COCPs) are generally recommended as the second-line therapy for endometriosis pain. A 2007 Cochrane review concluded that COCPs are at least as effective as gonadotropin-releasing hormone (GnRH) agonists. Medroxyprogesterone acetate is comparable to the androgen danazol, with both agents reducing pain scores by 50-74% compared with placebo. An SC form of depot medroxyprogesterone appears to relieve endometriosis as effectively as the proven approach of the GnRH agonist leuprolide acetate. Cochrane review has shown that there is generally equivalent pain relief achieved with multiple endocrine therapies for endometriosis. The myriad menopausal, androgenic, and hepatic side effects from some of the endocrine agents (e.g. danazol) used to treat endometriosis should serve to underline the importance of ED physician communication and follow-up arrangements with longitudinal care providers. - Type - Chapter - Information - Emergency Department AnalgesiaAn Evidence-Based Guide, pp. 197 - 199Publisher: Cambridge University PressPrint publication year: 2008 Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Endometriosis - - Book: Emergency Department Analgesia - Online publication: 18 December 2009 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Endometriosis - - Book: Emergency Department Analgesia - Online publication: 18 December 2009 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Endometriosis - - Book: Emergency Department Analgesia - Online publication: 18 December 2009

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endometriosis

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