Abstracts from the International Pelvic Pain Society (IPPS) annual scientific meeting on pelvic pain 2023

Within network functional connectivity associations with menstrual pain, menstrual pain interference, and lifetime burden of menstrual pain in adolescent girls Payne, La, Seidman, Lb, Nickerson, La, Pizzagalli, Da, Kumar, Pa aMcLean Hospital/Harvard Medical School,bMcLean Hospital Introduction: Data demonstrating abnormalities in brain structure and functional connectivity have supported the notion that menstrual pain may be related to deficits in central pain processing. We aimed to investigate the role of the triple network model of brain networks implicated in psychiatric disorders in the encoding of the menstrual pain, pain interference, and lifetime burden of menstrual pain in adolescent girls. Methods: One hundred adolescent girls (ages 13–19) completed a 6-minute resting state fMRI and rated menstrual pain and menstrual pain interference. Lifetime burden of menstrual pain reflected the total number of painful menstrual periods. Thirty resting-state networks were estimated using an unsupervised machine learning method for group independent component analysis. Networks of interest included cingulo-opercular salience (SN), central executive (CEN), and default mode (DMN) networks. Dual regression was used to extract subject-specific network maps corresponding to each a priori network. FSL Randomise was used for the estimation of general linear models and inference to test associations between network connectivity and menstrual pain measures (P < 0.05 corrected). Results: Greater connectivity of SN with amygdala, CEN with lateral orbitofrontal cortex, and CEN with anterior insula was associated with higher menstrual pain. Higher pain interference was associated with greater connectivity between SN and widespread brain areas that share overlap with DMN and CEN. By contrast, higher lifetime burden was associated with reduced connectivity within DMN. Disclosure: Any of the authors act as a consultant, employee, or shareholder of an industry for: Bayer Healthcare, Mahana Therapeutics. Seasonal variation in emergency visits for pelvic and perineal pain: a novel approach using computer-generated synthetic data Chen, Ia, Latourneau, Ib, James, Db, Hickling, Db, Goddard, Ya, Kowalczewski, Ec, Choudhry, Ac aUniversity of Ottawa,bThe Ottawa Hospital,cOttawa Hospital Research Institute Introduction: Chronic pelvic pain is often associated with comorbid mood disorders, which are known to exhibit seasonal trends with increased exacerbation during fall and winter months. However, it is unclear whether such seasonal variations are seen in pelvic and perineal pain. Aim of this study was to determine whether there is seasonal variation in the frequency of emergency visits for pelvic pain using computer-generated synthetic data. Methods: A retrospective cohort study was conducted using computer-generated synthetic data (MDClone) for all emergency department (ED) visits at a tertiary care centre from April 1, 2013 to March 31, 2023. Synthetic data have been demonstrated to have statistical similarity to real data but without the associated privacy concerns. Female patients with pelvic and perineal pain (PPP) were identified using ICD-10 (R10.2). Frequencies of ED visits for PPP per 1,000 ED encounters were calculated, and fall (October–November) and winter (January–February) were compared with summer (June–July) using odds ratios [95% CI]. Results: The data included 301,754 emergency department visits over 10 years. Female pelvic pain accounted for 2,135 (7.08/1,000) of primary presenting concerns, representing 6.03/1,000 visits in summer, 7.79/1,000 in fall, and 7.94/1,000 in winter. Compared with summer, the odds of ED visit for pelvic pain were 1.29 [1.11–1.50] in fall and 1.32 [1.13–1.53] in winter. Disclosure: No. Low-dose naltrexone for chronic pelvic pain: a case series Sullender, Ra, Silverstein, Gb, Goodwin, Db, Mcclurg, Ab, Carey, Eb aUniversity of California at San Diego,bUniversity of North Carolina Introduction: Naltrexone is a reversible competitive antagonist at μ-opioid and κ-opioid receptors, approved for opioid and alcohol use disorders at doses of 50 to 150 mg daily. Low-dose naltrexone (LDN) may have utility treating chronic pain conditions through alternate pharmacodynamic pathways. Methods: We conducted a retrospective case series (January 2022–February 2023) of 15 patients with chronic pelvic pain (CPP), vulvodynia, endometriosis, and/or myofascial pain at a tertiary academic medical center. LDN was added as an adjunct in pain treatment after counselling, the use of which is experimental and off label by the Food and Drug Administration. Results: The primary outcome was continuation of LDN by subjective pain improvement. Patients tried an average of 11 interventions and experienced pain for a mean of 79 months before trying LDN. Eight of 15 patients (53%) continued taking LDN with a mean daily dose of 7.0 mg. Seven of 15 (47%) discontinued LDN at a mean dose of 4.3 mg. There was no relationship between the pain condition (CPP, vulvodynia, endometriosis, and/or myofascial pain) and perceived benefit. Six of 7 (86%) of those who discontinued LDN had a psychiatric diagnosis, compared with 4 of 8 (50%) who continued. Six of 7 (86%) who stopped LDN reported >2 chronic pain conditions, whereas 4 of 8 (50%) who continued LDN reported a single pain disorder. Disclosure: No. Patient characteristics associated with interest in pain psychology for management of chronic pelvic pain Ciesielski, Ka, Jiang, Ca, Kratz, Aa, As-Sanie, Sa, Till, Sa aUniversity of Michigan Introduction: Pain psychology is an evidence-based strategy often recommended as part of multimodal management of chronic pelvic pain. Little is known about patient perception regarding nonpharmacologic strategies, such as pain psychology. Methods: Retrospective cross-sectional study of new patients presenting to a chronic pelvic pain referral clinic. Patients complete a detailed questionnaire before their first visit, including questions regarding interest in various treatments (indicate “yes,” “not sure,” or “no”). Descriptive analyses were performed to compare patients according to interest in pain psychology. Results: Of 1,703 patients who completed questionnaires, 38.6% (n = 657) indicated interest (“yes”) in pain psychology, 29.1% (n = 495) indicated “not sure,” and 32.3% (n = 551) indicated “no.” Patients who indicated “yes” were younger, had seen more doctors for pelvic pain, had higher pain interference scores, and had more work absenteeism (all P < 0.001) compared with those who indicated “not sure” or “no.” Similarly, they had worse PROMIS physical function, depression, anxiety, sleep disturbance, fatigue, emotional support, and satisfaction with participation in social roles (all P < 0.001). They were more likely to have tried hormonal suppression, opioids, neuromodulating medications, and pelvic physical therapy (all P < 0.001). Patients who were interested in pain psychology were more likely to consider hormonal therapy, pelvic physical therapy, and neuromodulating medications for pelvic pain (all P < 0.001), whereas patients who were not interested (“no”) were more likely to be interested in surgery for pelvic pain (P < 0.001). Disclosure: No. Evaluating language processing artificial intelligence answers to patient-generated queries on chronic pelvic pain Zapata-Caballero, Ca, Galindo-Rodriguez, Na, Rodriguez-Lane, Rb, Granados-Martinez, Va aInstituto Nacional de Perinatologia,bInstituto Nacional de Perinatología Introduction: Language processing artificial intelligence (AI) focuses on understanding and generating human language. It can assist healthcare professionals answering medical questions and providing quick access to knowledge. Patients can also use it to try to understand disease processes. We evaluated the answers to patient-generated queries on chronic pelvic pain (CPP). Methods: Responses generated by ChatGPT (AI Lab OpenAI online chatbot) on causes, risk factors, diagnostic and treatment options, lifestyle changes, alternative therapies, common misconceptions, support groups, and resources for further reading on CPP were examined and assessed by a team of urogynecologists. Statements were evaluated and assigned a numerical score on a 15-point scale according to the criteria of accuracy, relevance, completeness, clarity, and consistency. Results: Scoring spanned from 9 to 14 on the rating scale. The highest scores were assigned to lifestyle interventions and misconceptions on pain (14/15). By contrast, inquiries about support groups (9/15) and resources for further reading (10/15) received lower scores due to nonexistent website links and inconsistent responses upon repetition. Clarity received the highest average rating (2.78 out of 3), followed by accuracy and relevance (2.67 out of 3). Consistency had the lowest rating (1.89 out of 3). Disclosure: No. The burden of comorbid central sensitization-based conditions on the health of patients with chronic pelvic pain Green, Ia, Stewart, Kb, Canning, Rb, Philpot, Lb aMayo Clinic Rochester,bMayo Clinic Introduction: Patients with chronic pelvic pain (CPP) often experience overlapping pain conditions, including those with a component of central sensitization. The goal of this study was to better understand the impact of central sensitization-based conditions (CSBC) on the health of patients with CPP. Methods: An electronic survey was emailed to1,033 patients seen in the CPP clinic from 2018 to 2022. Patients were excluded if not currently experiencing CPP, were younger than 18 years, pregnant, or did not have a research consent or email address on file. The survey assessed severity and duration of pelvic pain. Respondents were asked which of 10 CSBC they had been diagnosed with previously (eg. irritable bowel syndrome, migraine, fibromyalgia). They were asked to rate their overall and mental health. Demographic data were collected from the medical record. General linearized models adjusting for age were employed to understand the relationship in overall health and comorbid CSBC. Results: A total of 298 respondents completed the survey; 225 met inclusion criteria. The average age was 36 years, and the majority were White (94.7%). Most (77.8%) have been experiencing pain for more than 5 years. All respondents reported at least one CSBC—most reported 5 CSBC (range 1–10). Respondents with CPP and one CSBC reported a mean overall health of 4.1 (1 = poor, 5 = excellent). Each additional CSBC significantly decreased self-reported overall health (P < 0.0001). Disclosure: No. Opioid use 10 years after interdisciplinary pain program: are there long-lasting impacts? Laurenzana, La, Ye, Aa, Gagnon, Cb aShirley Ryan AbilityLab/Northwestern University,bShirley Ryan AbilityLab Introduction: Interdisciplinary pain management programs (IPMPs) can decrease opioid use at the time of program discharge, but long-term effects are study opioid use and 10 years after an on not on at are compared with long-term of Methods: outcome was opioid were pain rating scale Pain was to who completed a Retrospective was conducted to data. were completed to long-term outcome and data. Results: completed the with a mean age of years at and years at Of those on (n = on by program and at long-term the opioid cohort had in and < from program Of those not on (n = were on by program and at long-term the cohort had a in scores (P = Disclosure: No. in pelvic pain a and of and Green, aUniversity of of of and Introduction: on the of chronic pelvic pain (CPP) are it is not known whether to with and to between for the of CPP, and by Methods: was performed from 2018 to 2022. were included if they were a of on CPP. on CPP conditions, or treatments were data and the for A was performed to in the of CPP. A was used to and relevance of the in were used in a of used to Results: met inclusion criteria. were and as in the of CPP. that to CPP, the CPP on care and of were from all Disclosure: Any of the authors act as a consultant, employee, or shareholder of an industry for: in and characteristics Aa, Lb, aUniversity of Introduction: The of this study was to investigate between and characteristics with frequency of in Methods: from the on a data were collected using data were to in a series of met additional inclusion criteria and completed an of and and used Descriptive were for all Responses were by self-reported frequency of as painful between the groups were compared using for and for was P < Results: was reported by and reported did not significantly in years of or was between the groups for all including and number of Disclosure: this is by of the with industry support in study or Any of the authors act as a consultant, employee, or shareholder of an industry for: and in to pelvic and of in a model of Ka, Sa, aUniversity of of for Pain to Opioid Introduction: and However, and to chronic pelvic pain is Methods: We used a to 8 model of to test the that and increased in pelvic Results: evaluated the effects of the or on in or (n = (n = at time (n = but not (n = at the and time (P < a of at (n = that (P < in of at (n = 3), 10 (n = or (n = pelvic that at least 4 (P < on the that in the evaluated in the Compared with (n = 3), this increased in (n = P < Disclosure: No. approach for Introduction: and have been with of Most pain are not with and the for a alternative approach to Methods: The patient is in a the of the is used to the the and to the between the and the the is with using a A is to of the for a is at to duration of and The is to to to reduced of the of of is which the A total of 5 of for this Results: All patients and had a in a and had Disclosure: Any of the authors act as a consultant, employee, or shareholder of an industry for: and the a artificial networks Ca, Sa, Aa, of Introduction: are associated with the is regarding in was to determine whether there is a in the in using additional Methods: to 50 years with months of were compared with 8 without pelvic pain with questionnaires, physical and a with was assessed using the networks were generated to pain from the test was used to compare between the groups, and test or test was used to compare Results: age was years, were White and Higher of pain anxiety, depression, and P < 0.001) were in function, and pain was worse in compared with (P < The did not between the or the between the The model a in structure in with a of of and of Disclosure: No. of multimodal for the treatment of pelvic pain in a of of Medical Research of the de of and of de of The of Hospital and Hospital for of of of and of the de of and of de Introduction: various and with a in the management of pain However, a of the of in with chronic or pelvic pain to a or known is this study aimed to the of multimodal in with Methods: study is part of an for Eight electronic were for PPP in analyses on pain in multimodal as the performed study and data The of the was assessed with the scale. was Results: were in 7 examined interventions medical treatments medical as in 4 no interventions were Most of the had to Six of the 7 demonstrated effects of multimodal on at least one pain outcome compared with the The reported multimodal but did not Disclosure: No. in chronic pelvic pain Aa, Ec, Medical Introduction: use as the common for as during the and a of patients from pain during also known as were in this a physical therapy no study examined in pelvic pain and in The of the study the of the on pain and treatment satisfaction in chronic pelvic pain patients with Methods: pelvic pain patients by between 18 and 50 years were included in this The completed an treatment and and therapy for pelvic data were collected using at and The primary outcome was pain during evaluated with the rating scale and the Pain included patient of and Results: were from to on all such as and (P The study the in pain and in perceived by Disclosure: No. to pelvic physical therapy, a study Ra, Db, Introduction: physical therapy is a treatment for pelvic disorders often in with medical or with this therapy been to be and research to is Methods: was a research study of to years who were to by a at a single academic between and 2022. A was used with of therapy, and that to of were and using Results: at was General included factors, and to were time and an and of of the of the that they received about for their at the time of The majority who therapy All who that they it to The common for those who therapy was for of and about improvement. Disclosure: No. health physical therapy are in with Na, Rb, of Introduction: study to whether treatment used by pelvic health physical in the with in patients with chronic pelvic pain. Methods: A survey of through social and pelvic health One hundred to the which included questions regarding of 18 interventions used in pelvic on a 4 Results: and in pelvic health. had completed more than of pain The interventions used by the physical were pelvic = = = = and of = = The interventions were = = = = and = = were = = and pain = = Disclosure: No. health physical pain and in patients with chronic pelvic pain Ra, of Introduction: study the pain and self-reported of pelvic health physical patients with chronic pelvic pain. Methods: A survey was collected through and through social and pelvic health by the of The survey included the pain care scale the of Pain and the Pain and for Data were and for Results: The included There was a between of physical therapy = = P = those not = = P = and those with than of in pelvic health = = P = who were in with chronic pain. health who reported more than of significantly higher than those who did not regarding pain = = P = a more model = than the model = Greater pain score demonstrated a with greater = P = lower overall with a model = P = 0.001). Disclosure: No. Patient characteristics associated with interest in pelvic physical therapy for management of chronic pelvic pain Ciesielski, Ka, Jiang, Ca, Kratz, Aa, As-Sanie, Sa, Till, Sa aUniversity of Michigan Introduction: physical therapy is recommended as part of multimodal management of chronic pelvic pain. Little is known about patient regarding nonpharmacologic strategies, such as pelvic Methods: Retrospective cross-sectional study of new patients presenting to a chronic pelvic pain referral clinic. Patients complete a detailed questionnaire before their first visit, including questions regarding interest in various treatments (indicate interest as “yes,” “not sure,” or “no”). Descriptive analyses were performed to compare patients according to interest in pelvic Results: Of 1,703 patients who completed questionnaires, (n = indicated interest (“yes”) in pelvic indicated “not sure,” and (n = indicated “no.” Patients who indicated “yes” were younger (P < 0.001), had seen more doctors for pelvic pain (P < 0.001), likely to have (P = 0.001), and more likely to have tried (P < 0.001) or (P < 0.001) compared with those who indicated “not sure” or “no.” pelvic pain and chronic overlapping pain did not Patients who were interested in (“yes”) were more likely to consider hormonal therapy, pain psychology, and neuromodulating medications for pelvic pain (all P < 0.001), whereas patients who were not interested in (“no”) were more likely to be interested in surgery for pelvic pain (P < 0.001). Disclosure: No. of a functional method to in menstrual pain Ka, of Introduction: pain been to and in a of of processes. Methods: this aimed to a approach for and by from with menstrual pain and the frequency and duration of than 10 and anterior and and Results: had a of 4 per 10 with a duration of The for frequency was [95% and duration was [95% were and were 7 for the anterior [95% [95% anterior [95% and [95% were also frequency and were = P < between Disclosure: Any of the authors act as a consultant, employee, or shareholder of an industry for: and of the pain experience in with chronic pain: a cross-sectional survey of of of of and of of of of Introduction: of overlap between and chronic pain conditions, such as irritable bowel syndrome, and pain is is known regarding pain on the or of is to whether with chronic pain (CPP) experience pain on the of Methods: A cross-sectional survey conducted in 2022. The survey collected pain and including and interference assessed by pain analyses included and linear Results: Of respondents with CPP, reported There were no in age pelvic pain or duration of pelvic pain between with and without However, with reported higher pain severity pain interference and pain impact was associated with a higher number of overlapping pain conditions (P = with of overlapping pain conditions compared with of those without with had a higher frequency of (P < 0.001), chronic (P < 0.001), and (P = 0.001). The number of overlapping pain conditions was associated with higher pain interference, and of Disclosure: Any of the authors act as a consultant, employee, or shareholder of an industry for: is a for and of pelvic pain in Introduction: Chronic pelvic pain (CPP) is a common medical condition with a treatment due to that There is a the of and on pain. We aimed to investigate whether there is a in the and experience of pelvic pain in from a and Methods: The study patients who completed a of questions from Pain pelvic pain and of pain, and with pain, physical and were The pain questionnaire was used to pain. in the to Results: The mean age of the was years. We also a between the and of pelvic pain (P There was a between and pain scores (P < and physical also significantly the severity of pelvic pain (P Disclosure: Any of the authors act as a consultant, employee, or shareholder of an industry for: A chronic pelvic pain in a the experience Da, aUniversity of Hospital Introduction: There is a of data to be on chronic pelvic pain and management in Methods: We conducted a retrospective cohort study of patients to at the Hospital chronic pelvic pain clinic from to on diagnosis, and was from the that is time were using on the be as mean or test was used to compare test was used to compare pain We reported with the was at P < statistical was Results: The study that a chronic pelvic pain with additional in a (n = diagnostic patients to this the average number of performed were (range A for patients with an average of (range The of the study was the that an chronic pain management program pain scores and pain interference Disclosure: No. The of and on pain and of in with primary Hospital Introduction: by to be due to the of the is seen in and not have an is a recommended there is research on the effects of there are on the of that the brain and may be in and the study aimed to the of and on pain and of in Methods: study included the experimental group (n = and group (n = all did a for 4 the also did daily. Pain of all were with an before and after the they scale and before and after Results: study that the pain experienced by the during their decreased significantly in The decrease was more in the experimental group (P < scores decreased in groups, but the experimental group had a more decrease (P < of using the a in groups (P < not a from the with the (P Disclosure: Any of the authors act as a consultant, employee, or shareholder of an industry for:

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