Abstracts from the International Pelvic Pain Society (IPPS) Annual Scientific Meeting on Pelvic Pain 2019

It is my pleasure to inform you that the 22nd International Pelvic Pain Society (IPPS) Annual Scientific Meeting on Pelvic Pain was a success. The 2019 program provided participants with an expanded understanding of chronic pelvic pain evaluation, management, research and innovative therapies. I am thrilled to announce that this year the meeting was attended by a record number of clinicians, researchers and other members of the pain community. The meeting featured a variety of multidisciplinary abstracts, and for the first time, abstract proceedings are being published in PAIN Reports. The abstracts presented here have undergone a rigorous peer review process whereby each abstract was evaluated by at least 2 members of the Scientific Program Committee. Abstracts were excluded if they were incomplete, if they had inadequate statistical analysis, if the data reported was a case report or series, if the data was incomplete or if the topic was not relevant to pain. In all 60 abstracts were submitted for presentation at the Annual Meeting, 55 were accepted for poster or oral presentation, and 50 were deemed suitable for publication in these proceedings. Despite being a prevalent health problem that has been shown to have significant negative consequences on patients, providers and the healthcare system, chronic pelvic and abdominal pain is often ignored, underdiagnosed, and undertreated. The primary mission of the IPPS is to serve as an educational resource for healthcare providers and persons who suffer with chronic pain. The society promotes multi-disciplinary and biopsychosocial approaches to the diagnosis and treatment of CPP as well as education, research and dissemination of research results. The challenge of improving care for persons suffering with chronic pelvic pain can only be overcome through collaboration between patients and teams of multidisciplinary providers. This collaboration is exemplified in the variety of the abstracts presented here. The IPPS thanks all providers and researchers who dedicate their lives and careers to the mission of improving the lives of people living with chronic pain. We thank the people who live with the experience of pain and yet participate in research and contribute to our improved understanding of chronic pain. This relentless effort and collaboration will continue throughout the year and we hope to come together again in 2020 at the 23rd Annual Scientific meeting in Denver, Colorado. Georgine Lamvu, MD, MPH Chair of the International Pelvic Pain Society Professor of Obstetrics and Gynecology University of Central Florida Director of the Fellowship in Minimally Invasive Gynecologic Surgery Orlando VA Medical Center Adolescents and young adults attitudes toward coping strategies for menstrual pain Laura A. Payne, PhDa, Laura C. Seidman, BSa, Katherine E. Allyn, BSb, Subhadra Evans, PhDc, Andrea J. Rapkin, MDd aMcLean Hospital/Harvard Medical School,bAlbert Einstein College of Medicine,cDeakin University,dDavid Geffen School of Medicine at UCLA Introduction: Painful menstruation without an identified cause, known as primary dysmenorrhea (PD), is the leading cause of school and work absences in reproductive age girls and women, with 20% to 25% of young women reporting significantly impaired functioning because of their symptoms. The aim of this study was to explore coping strategies used by adolescents and young adults (AYA) with PD who were not taking exogenous hormones in the hopes of informing the direction of future treatment approaches. Methods: Participants included 39 female AYA ages 16 to 24 with self-reported menstrual pain 4/10 on a 0 to 10 (0 = none, 10 = worst pain possible) numeric rating scale (M = 7.1, SD = 1.7). Participants were interviewed using a semi-structured interview guide; interviews were audio recorded, transcribed verbatim, and transcripts were checked for accuracy by the research team. Deductive, iterative thematic analysis was then conducted. Codes and themes were reviewed, and discrepancies were resolved with group consensus discussion. Results: Participants endorsed using coping strategies across the biopsychosocial spectrum, which aligned into 4 themes: (1) medication use; (2) physical strategies, including rest, sleep, change in body position, heating pad, food and drinks, etc.; (3) psychological strategies, including distraction, positive self-statements, and cognitive restructuring; and (4) social strategies, such as engaging a friend or family member. In addition, a number of sub-themes emerged related to effectiveness of coping mechanisms. While participants frequently reported that their coping strategies worked, they simultaneously reported having no control over the pain. Others reported that the only control they had was by using medication. Many also expressed an attitude of reluctance toward using medication. Conclusions: This study contributes to our understanding of attitudes toward coping strategies used by AYA for menstrual pain, which may help identify targets for future interventions aimed at decreasing pain and improving functioning for this recurring and disabling condition. Source of Financial Support: This study was supported by National Institutes of Health NICHD grant K23HD077042 (PI: Laura A. Payne) and NCATS University of California Los Angeles Clinical and Translational Science Institute grant KL2TR000122 (PI: Laura A. Payne). Disclosures/Conflicts of Interest: None. Central Sensitization Inventory in endometriosis-associated pain Natasha L. Orr, MSca, Kate Wahl, BSca, Heather Noga, MAb, Christina Williams, MDa, Catherine Allaire, MDCMa, Mohamed A. Bedaiwy, MD, PhDa, Paul J. Yong, MD, PhDa aUniversity of British Columbia,bWomen's Health Research Institute Introduction: Endometriosis-associated pain may be due to disease-specific factors (ie, invasiveness of disease) and/or other factors, such as central sensitization. The aim of this study was to analyze the association between the Central Sensitization Inventory (CSI) and pelvic pain measures. Methods: Included were women aged 18 to 50 years with endometriosis (current nodule on palpation or ultrasound; or visualized endometrioma on ultrasound; or previous surgical diagnosis), who were new or re-referred to the center between January 1, 2018 and December 31, 2018. Bivariate associations were tested between the CSI and the pain measures. Results: We analyzed data from 335 women with endometriosis. The mean age of this cohort was 36.0 ± 7.0 years. Forty-five percent (151/335) had a no/low CSI score and 55% (184/335) had a high CSI score, respectively. A high CSI was associated with more severe dysmenorrhea, dyschezia, deep dyspareunia, superficial dyspareunia, and chronic pelvic pain on a 11-point NRS (P = 0.002, P < 0.001, P < 0.001, P < 0.001, P < 0.001, respectively). For the EPHect questions regarding dysmenorrhea, high CSI was significantly associated with pelvic pain at its worst during last period, in the last 12 months, and throughout life (P < 0.001; P < 0.001; P = 0.004; respectively). High CSI was also associated with general pelvic/lower abdominal pain at its worst in the last 3 months and at its worst ever (P < 0.001 and P = 0.003). For sexual pain, high CSI was associated with a history of ever having pelvic pain during or in the 24 hours following vaginal sexual intercourse/penetration (P < 0.001). Conclusions: The Central Sensitization Inventory (CSI) was associated with more severe dysmenorrhea, dyschezia, dyspareunia, and chronic pelvic pain, as well as specific features of these types of pelvic pain as characterized by the EPHect data standards. Further analysis is needed to characterize the potential role of the CSI in phenotyping endometriosis-associated pain. Source of Financial Support: This work was supported by a Canadian Institutes of Health Research (CIHR) Operating Grant [MOP142273], the Womens Health Research Institute, and the BC Womens Hospital and Health Centre Foundation. Disclosures/Conflicts of Interest: Drs Allaire and Bedaiwy are consultants for Abbvie and Allergan. Altered pelvic floor muscle function in gynecological cancer survivors suffering from dyspareunia: a case-control study Marie-Pierre Cyr, MPT, MSca, Chantale Dumoulin, PT, PhDb, Paul Bessette, MDa, Annick Pina, MD, FRCSC, MScc, Walter H. Gotlieb, MD, PhDd, Mélanie Morin, PT, PhDa,e aUniversity of Sherbrooke; Research Center, Centre Hospitalier Universitaire de Sherbrooke,bUniversity of Montreal; Research Center of the Institut Universitaire de Gériatrie de Montréal,cUniversity of Montreal; Research Center, Centre Hospitalier de lUniversité de Montréal,dMcGill University; Lady Davis Institute, Jewish General Hospital,eSchool of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke Introduction: Gynecological cancer is one of the most prevalent cancers affecting women. Oncological treatments including surgery, radiation therapy and chemotherapy are suggested to yield alterations of the PFMs and vaginal tissues. These changes may contribute to the development of debilitating conditions such as dyspareunia, which affects more than half of gynecological cancer survivors. In women with no history of cancer, such as women with vestibulodynia, alterations in PFM function have been identified as playing a key role in the etiology of pain during sexual intercourse. Furthermore, previous studies in this younger population demonstrated the efficacy of physiotherapy treatment to reduce dyspareunia by improving PFM function. However, to date, no study has investigated PFM function in relation to dyspareunia in gynecological cancer survivors. A comprehensive and objective assessment of the alterations in PFM function will enable a better understanding of dyspareunia in this understudied population, which in turn, will help guide the development of adapted and effective physiotherapy treatment. Methods: Gynecological cancer survivors were included in the study if they reported vulvovaginal pain at an intensity of 5/10 on a numerical rating scale, for at least 80% of sexual intercourse attempts, for more than 3 months. They also had to have completed all scheduled oncological treatments at least 3 months before participating in the study. A standardized gynecological examination was performed by a gynecological oncologist to confirm each participants eligibility. Asymptomatic women were included if they had undergone a total hysterectomy for benign conditions more than 3 months prior and reported no pain during sexual intercourse. All women attended one evaluation session conducted by an experienced physiotherapist to assess PFM function. After verifying data normality using Shapiro-Wilk test and visual inspection of distribution, Student's t tests were used to compare the 2 groups (0.05). Results: Twenty-two gynecological cancer survivors with dyspareunia (endometrial cancer = 17, cervical cancer = 5) participated in this study. All of them (100%) had surgery (total hysterectomy and bilateral salpingo-oophorectomy = 21, total hysterectomy = 1), 11 (50%) had brachytherapy, 7 (31.8%) had external beam radiation therapy, and 7 (31.8%) had chemotherapy. They were compared to 33 asymptomatic women (total hysterectomy and bilateral salpingo-oophorectomy = 15, total hysterectomy and unilateral salpingo-oophorectomy = 2, total hysterectomy = 16). Baseline characteristics were similar between both groups in terms of age, body mass index and number of vaginal childbirths (P 0.261). Gynecological cancer survivors with dyspareunia demonstrated significantly higher PFM tone (1.46 ± 0.69 vs 1.02 ± 0.43 N, P = 0.012), lower flexibility (23.25 ± 8.94 vs 35.36 ± 5.49 mm, P 0.001), lower number of rapid contractions performed (6.0 ± 1.7 vs 7.4 ± 2.1, P = 0.010), which is suggestive of an altered coordination, and lower endurance (1711.50 ± 902.50 vs 2155.55 ± 671.50%*s, P = 0.009) compared to asymptomatic women. However, no significant difference was found between the 2 groups for PFM maximal strength (P = 0.292). Conclusions: Our findings showed that gynecological cancer survivors suffering from dyspareunia had altered PFM function, notably higher PFM tone and lower flexibility, coordination and endurance, compared to asymptomatic women who underwent a total hysterectomy for benign conditions. These results provide strong basis to guide the development of treatment protocols focusing on these alterations involved in dyspareunia in cancer survivors. Source of Financial Support: Quebec Network for Research on Aging, Ordre professionnel de la physiothérapie du Québec, Fonds de recherche du Québec Santé. Disclosures/Conflicts of Interest: None. Widespread pain is associated with poorer psychological health in women with chronic pelvic pain presumed secondary to endometriosis Danielle Perro, BMSca, Miriam Sazbob, Lydia Coxon, BAa, Jennifer Brawn, WIN, NDCN, Danielle Hewitt, BSc, MScc, Christian Becker, MDa, Krina Zondervan, BA, MSc, DPhila, Katy Vincent, BSc, DPhil, MBBS, MRCOGa aUniversity of Oxford,bLinköping University,cUniversity of Liverpool Introduction: Endometriosis is a chronic inflammatory disease that affects about 10% of women of reproductive age. Of those that are symptomatic, many present with pain in the pelvic region; dysmenorrhea (painful periods), dyspareunia (pain during sexual intercourse), and non-cyclical pain. In addition to pelvic pain, many women experience complex pain profiles that extend into other regions of the body. Previous research has demonstrated that women with interstitial cystitis/bladder pain syndrome who also experience pain in multiple other body sites have poorer psychological health compared to those women whose pain is localized to their pelvis.1 We aimed to determine if the same relationship exists for women with pelvic pain symptoms consistent with endometriosis rather than those focused on the bladder. Additionally, we aimed to determine if more widespread pain was related to self-reported comorbidities and poorer reproductive outcomes. Widespread pain is associated with systemic inflammation, which has been shown to play a role in the pathogenesis of conditions comorbid to endometriosis, in addition to adverse reproductive outcomes.2 Our hypothesis was that in women with chronic pelvic pain (CPP) and confirmed or suspected endometriosis, the presence of widespread pain would be associated with poorer psychological health, comorbid conditions and adverse reproductive outcomes compared to those with more localized pain. Methods: Local ethical approval was obtained prior to recruitment. Women with CPP were enrolled into one of 2 cohorts: EndoPain1: strong suspicion of endometriosis; EndoPain2: previous surgical diagnosis of endometriosis. Baseline questionnaires were completed prior to surgery and included Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Pain Catastrophizing Scale (PCS) and a body map that described the location of their pain. Participants were categorized into groups according to how many body regions were affected by pain. Two different categorizations were performed: (1) as in the previous study the cohort was divided into 3 groups: pelvic pain only, intermediate (1–2 additional regions affected), or widespread (3–7 regions affected); (2) the cohort was divided into 4 groups: pelvic pain only, isolated (1 additional region affected), intermediate (2 additional regions affected), or widespread (3–7 additional regions affected). Data were computed using SPSS. The KolmogorovSmirnov test was used to test normality and as all variables were non-normally distributed in at least one group, the Kruskal-Wallis test was used to identify differences between the subgroups. Results: Fifty-seven participants were recruited and of these 56 met criteria to be included in study analyses. Eighty-two percent of women (n = 46) reported pain in at least one region outside the pelvis and 52% (n = 29) in 2 or more regions. The cohort was best divided into 4 groups (pelvic pain only n = 10; isolated n = 17; intermediate n = 11; widespread n = 18). As predicted, those with more widespread pain had significantly higher PCS (2(3) = 10.130, P = 0.017) and BDI scores (2(3) = 9.465, P = 0.024). However, there was no difference in state or trait anxiety scores between the groups (2(3) = 5.731, P = 0.125; 2(3) = 5.305, P = 0.151 respectively). Although not formally tested, these data suggested that the presence of widespread pain is associated with; increasing incidence of comorbidities, additional pain conditions as well as psychological and systemic disorders, reduced incidence of live births and increased prevalence of negative reproductive outcomes. Conclusions: Our data suggests that a majority of women experiencing CPP consistent with a diagnosis of endometriosis also have pain outside the pelvis. In line with previous work in bladder pain syndrome, we observed a significant relationship between widespread pain and poorer psychological health. Interestingly, poorer reproductive outcomes and increasing reports of comorbid conditions were reported in women with more widespread pain profiles. In order to optimize clinical outcomes, it is important that psychological wellbeing is addressed. Use of the body map to determine the widespreadness of women's pain may be a valuable tool for clinicians to identify patients with widespread pain who may require a multi-modal approach to pain management rather than focusing solely on their pelvis. Source of Financial Support: EndoPain1 was funded by grants from The Academy of Medical Sciences and The University of Oxford Medical Research Fund; EndoPain2 was funded by an Investigator Initiated Award from Bayer HealthCare Ltd. Disclosures/Conflicts of Interest: None. Differing urologic parameters in chronic pelvic pain populations Crystal O'Haraa, Mingen Fenga, Pippa Merritt, PhDa, Katherine Sheridana, Gisela Chelimsky, MDa, Jeffrey Janata, PhDb, Frank Tu, MDc, Thomas Chelimsky, MDa, Jody Barbeau, PhDa aMedical College of Wisconsin,bCase Western Reserve University,cNorthshore University Introduction: The Uroflow is a reliable test that is conducted to measure the amount of urine voided and the speed and pattern of urination. Methods: Subjects return for on-site visits 5 times in 24 weeks, when a Uroflow reading is captured. Variables include maximum flow rate, average flow rate, voided volume, flow time, time to peak flow, voiding time and voiding pattern. We looked at the first 4 weeks of data (visits 1 and 2), both baseline on-site visits prior to the administration of placebo or metoprolol. Subjects also completed an at-home 24-hour voiding diary providing bladder pain ratings during each void via a preprogrammed smartphone as well as completing the GUPI. Analysis was performed using Kruskal-Wallis and Mann-Whitney-Wilcoxon tests on continuous variables. Continuous data are presented as median (interquartile < were Results: Of female are are and 12 are not the 3 groups = years = = P = baseline 1, parameters between and the other voided = = = mean flow = 16 = = and flow = = = had higher voided (P = mean flow (P = and flow (P = than the 3 parameters not between and and between and these differences not at 2, time, flow time, and time to flow not in both visits 1 and The data from the 24-hour voiding diary a in the total number of more in than the and groups in weeks 1, 2 and For in 1, void not = hours = = P = pelvic pain scores prior to and void were higher in than higher in than and not different between and in weeks 1, 2 and baseline 1, significant difference were in pain scores 0 to = 0 = = 10 scores 0 to 10 = 1 3 of life scores 0 to 12 = 0 = 7 = 7 and total scores 0 to = 2 = = to the other 2 groups had higher pain P < P < P = P = P < P < and total scores P < P < weeks 1, 2, and not report and there were no significant differences between and However, at and again had higher pain, and total scores compared to However, score was higher in than not different between and and higher in than Conclusions: As are voiding and have a lower mean and flow during the Uroflow compared to not as at their baseline This is confirmed in the score as to void more frequently and have more pain. However, it is both the and findings to in and in time, such that on differences between the 2 are more at other the pelvic floor in patients with not a pelvic examination at 2 to determine if this be additional data from visits 3 and 5 may help this as would analysis of results compared to the It was also that and to pelvic floor related the of these Source of Financial Support: and a Grant Disclosures/Conflicts of Interest: None. are altered in and are associated with the of regions Jennifer PhDa, PhDb, MD, PhDc, MD, PhDa, Andrea J. Rapkin, MDd College of Geffen School of Medicine at UCLA Introduction: which the of of and may be for that may be altered in including have been associated with and pain and are known to The aim of this research is to identify symptoms in Methods: of and vaginal obtained using vaginal during the 5 to 7 were in and women with The diagnosis of was identified during a clinical criteria for patients with included least months of pain at least 4 of 10 in during intercourse and other and findings on consistent with Pain was via muscle was tested with 2 of by prior to was performed using we report analysis results from vaginal = = and = = 29) from women who were not taking or systemic The a total of of known in and in vaginal t test was used to identify associated with that significantly < for all between and state was obtained on a in women with After in was used to obtained by the and for and was then computed using using and the was used to and of regions an (ie, and with group differences in Results: In the vaginal of compared to we observed significantly higher of vaginal involved in and vaginal of and In showed higher of and than of of these altered were associated with increased total pain and total muscle as well as the of = to P < to Conclusions: In the study we observed altered vaginal and of in the that with increased pain and muscle and the of regions involved in pain and studies have demonstrated an association between changes in the and inflammatory with central sensitization. alterations in observed in from group or vaginal and and Source of Financial Support: Disclosures/Conflicts of Interest: to of pelvic floor symptoms endometriosis surgery MDa, MDc, and Gynecology School of and Faculty of Health Sciences, of Obstetrics and School of and Health Sciences of Obstetrics and Medical University Introduction: Endometriosis is an inflammatory affecting many women and pain in the pelvic Pain are as pelvic floor deep dyspareunia, and also dysmenorrhea, and for endometriosis have focused on and surgery pain and in the pelvis may is a on the assessment of pelvic pain and pelvic floor endometriosis The aim of the study was to the pelvic floor symptoms in women endometriosis Methods: The Pelvic Inventory has shown to be and reliable for the to which pelvic floor of of 3 Pelvic Inventory of questions about the of the Inventory with questions of and the Inventory with questions about in urination. scale is from 0 to with higher scores The Pelvic Pain and and was and by as a to identify women with interstitial or bladder syndrome This is used by clinicians and has been used in studies because it to and symptoms associated with pelvic pain. This of 12 that are divided into 2 the and or of each is with an increasing The data were analyzed by using the statistical analysis Results: The enrolled participants were age ± and ± more than half were and more than half had completed high school or higher and was ± and ± In patients bilateral endometrioma was They reported that endometriosis had been All had undergone at