ABSTRACT
Chronic pelvic pain syndrome (CPPS) is generally defined as pain in the pelvic area that persisted for 3-6 months or longer. The pain can be constant or episodic and functionally disabling. Any dysfunction of the central nervous system can lead to central sensitization, which enhances and maintains pain as well as other symptoms that are mediated by the central nervous system. It occurs in subgroups of nearly every chronic pain condition and is characterized by multifocal pain and co-occurring somatic symptoms. Somatic symptom disorder (SSD) is defined as a condition in which having one or more somatic symptoms, such as excessive worries, pressure, and catastrophic events. These symptoms can be very disruptive to a patient's life and can cause significant distress. SSD cases with severe symptoms frequently undergo repeated medical investigations and the symptoms often lead patients to seek emergency medical treatment and consult with specialists repeatedly, which is a source of frustration for patients and clinicians. Here we report a case that Asian female with persistent CPPS with comorbid SSD, who got in trouble for up to 8 years. This case reminds clinicians to pay excessive attention to the diagnosis of CPPS with comorbid SSD after recovery from acute COVID-19, with hope of raising awareness in the identification of SSD and present new insight into appropriate treatment for each woman who suffers from it.
ABSTRACT
Chronic pelvic pain syndrome (CPPS) affects about 4-16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. Focal muscle vibration (FMV) has also been reported to relieve pelvic pain. The objective of this study was to assess the feasibility and effect of rTMS coupled with FMV to reduce pain in seven adult women with refractory CPPS. This pilot, open-labeled, prospective trial examined treatment by 5 Hz rTMS over SMA and 150 Hz FMV over the perineum, suprapubic, and sacrococcygeal areas, with one daily session for five consecutive days for three weeks. We assessed tolerance and subjective pain changes (as per visual analog scale, VAS) until one month post-treatment, with a primary endpoint at day 7. No patients experienced serious adverse effects or a significant increase in pain. Six out of seven patients experienced a VAS improvement of at least 10% at T7; three of these individuals experienced a VAS improvement of more than 30%. Overall, we found a significant VAS reduction of 15 points (95% CI 8.4-21.6) at T7 (t = 6.3, p = 0.001; ES = 2.3 (1.1-3.9)). Three of the women who demonstrated a significant VAS reduction at T7 retained such VAS improvement at T30. VAS decreased by six points (95% CI 1.3-10.7) at T30 (t = 3.1, p = 0.02; ES = 1.5 (0.2-2.6)). This coupled approach seems promising for pain management in adult women with refractory CPPS and paves the way for future randomized controlled trials.