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 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 6 months of VVD were compared with 8 controls without pelvic pain with validated questionnaires, physical examination, and a midvaginal swab analyzed with 16s rRNA sequencing. Vaginal microbiome diversity was assessed using the Shannon alpha diversity index. Artificial neural networks (ANN) were generated to predict pain status from the microbiome community. Mann–Whitney U test was used to compare continuous variables between the groups, and χ2 test or Fisher exact test was used to compare categorical variables. Results: Median age was 27.2 years, 70% were non-Hispanic White and mostly nulliparous. Higher rates of UTI, yeast infection, STI, other pain diagnoses, anxiety, depression, and levator ani tenderness (100% vs 0%, P < 0.001) were noted in VVD. Sexual function, disability, and pain catastrophizing was worse in VVD compared with controls (P < 0.05). The 16s rRNA sequencing analysis did not show significant differences between the Genus taxa or the Shannon diversity index between the groups. The ANN model detected a difference in microbiome community structure in VVD with a precision of 0.89, recall of 0.53, and f-score of 0.7. Disclosure: No. Effectiveness of multimodal physiotherapy approaches for the treatment of persistent pelvic pain in women: a systematic review Starzec-Proserpio, Ma, Frawley, Hb, Bø, Kc, Morin, Md aDepartment of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC,bMelbourne School of Health Sciences, The University of Melbourne, Melbourne; Allied Health Research, Royal Women's Hospital and Mercy Hospital for Women, Melbourne,cDepartment of Sports Medicine, Norwegian School of Sport Sciences, Oslo; Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog,dResearch Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC Introduction: Multimodal physiotherapy approaches integrate various therapies and modalities with a growing evidence base in the management of persistent pain conditions. However, a comprehensive synthesis of the existing literature of these conservative therapies in women with chronic or persistent pelvic pain (PPP), unrelated to a defined pathology or known disease, is lacking. Therefore, this study aimed to assess the effectiveness of multimodal physiotherapy approaches in women with these conditions. Methods: This study is part of an ongoing broader review investigating conservative (nonsurgical, nonpharmacological) therapies for PPP. Eight electronic databases were systematically searched for randomized-controlled trials (RCTs) targeting PPP in women. Preliminary analyses focused on pain outcomes in trials examining multimodal physiotherapy approaches as the main active treatment. Two reviewers performed study screening and data extraction. The quality of the evidence was assessed with the PEDro scale. This protocol was prospectively registered. Results: Multimodal physiotherapy approaches were investigated in 7 trials. Among them, 2 examined interventions delivered online. In 3 RCTs, medical treatments (pharmacotherapy, standard medical care) served as comparators, while in 4 trials, no active interventions were administered (leaflet, waitlist). Most of the studies had moderate to high methodological quality. Six of the 7 RCTs demonstrated statistically significant superior effects of multimodal physiotherapy on at least one measured pain outcome compared with the control. The remaining trial reported significant improvements following multimodal physiotherapy but did not present between-group comparisons. Disclosure: No. Telerehabilitation in chronic pelvic pain Buyuk, Aa, Doğan, Sb, Attar, Ec, Attar, Rc aAkdeniz University,bAkdeniz University Medical Faculty,cYeditepe University Introduction: Physical therapists use telerehabilitation as the common term for telehealth applications. Many physiotherapists worked as telehealth providers during the coronavirus pandemic and a large proportion of patients suffering from pain during sexual intercourse, also known as dyspareunia, were underestimated in this period. Following a telerehabilitation-based physical therapy (TBPT) treatment, no study thus far has examined changes reduction in pelvic pain and improvement in sexual outcomes. The objective of the study showed the efficacy of the TBPT on pain intensity and treatment satisfaction in chronic pelvic pain patients with dyspareunia. Methods: Forty-two pelvic pain patients affected by dyspareunia aged between 18 and 50 years were included in this study. The women completed an 8-week TBPT treatment comprising sex education, self-massage, and internal and external trigger point release therapy for pelvic floor muscles. Quantitative data were collected using validated questionnaires at baseline and posttreatment. The primary outcome was pain intensity during intercourse evaluated with the numeric rating scale (0–10) and the Pelvic Pain Impact Questionnaire (PPIQ). Secondary outcomes included patient global impression of improvement (PGI-I) and sexual function (Female Sexual Function Index). Results: Significant improvements were found from baseline to posttreatment on all quantitative outcomes, such as VAS, PPIQ, PGI-I, and FSFI (P ≤ 0.05). The study highlighted the reduction in pain and improvement in sexual functioning perceived by participants affects patients' impressions positively. Disclosure: No. Barriers to pelvic floor physical therapy, a qualitative study Thompson, Ra, Lewis, Db, Sridhar, Sb, Robinson, Jb aMedStar Health,bMedstar Health Introduction: Pelvic floor physical therapy (PFPT) is a common, noninvasive, low-risk, first-line treatment for pelvic floor disorders (PFDs) often offered in conjunction with medical or surgical treatments. Compliance with this therapy has been shown to be very poor and research addressing barriers to PFPT is lacking. Methods: This was a qualitative research study of female subjects aged 22 to 76 years who were referred to PFPT by a gynecologic subspecialist at a single academic institution between February and August 2022. A semistructured interview guide was used with topics surrounding provider counseling, prior knowledge of therapy, and factors that contributed to initiation of therapy. Interviews were transcribed and coded thematically using grounded theory. Results: Theoretical saturation occurred at 16 interviews. Average interview length was 20 minutes. General themes included knowledge, experiential factors, and feasibility/affordability. Barriers to PFPT were time and geographic constraints, difficulty obtaining an initial appointment, and lack of awareness of the therapy. Only half of the subjects felt that they received adequate information about PFPT for their provider at the time of referral. The majority who initiated therapy described prohibitive financial factors despite insurance coverage. All subjects who initiated PFPT stated that they would recommend it to others. The most common promoting factor for those who initiated therapy was motivation for relief of symptoms and optimism about improvement. Disclosure: No. Pelvic health physical therapy interventions: are we in alignment with current evidence? Hodges, Na, Greenwood, Rb, Lesh, SGc aMethodist University,bBowling Green State University,cUniversity of Charleston Introduction: This study aims to identify whether contemporary treatment strategies used by pelvic health physical therapists (PHPT) practicing in the United States align with current evidence in managing patients with chronic pelvic pain. Methods: A survey of PHPT through social media, professional membership, and pelvic health courses. One hundred twenty-seven practicing PHPT responded to the survey, which included questions regarding utilization of 18 interventions commonly used in pelvic rehabilitation on a Likert scale: 0 (never), 1 (rarely), 2 (sometimes), 3 (often), 4 (always). Results: Respondent's entry-level education degree included: 82 DPT (64.6%), 26 MPT 20.4%, and bachelor 15% (19). For continuing education, 38 providers (30%) obtained advanced credentialing in pelvic health. Nineteen providers (15%) had completed more than 40 hours of pain neuroscience education. The top 3 interventions used by the responding physical therapists were pelvic anatomy education (M = 3.86, SD = 0.449), breathing techniques (M = 3.79, SD = 0.612), and muscle stretching of surrounding tissues (M = 3.46, SD = 0.815). The bottom 3 interventions were graphesthesia (M = 0.50, SD = 0.907), 2-point discrimination (M = 0.61, SD = 0.891), and dry needling (M = 0.071, SD = 1.229). Other notable results were mindfulness (M = 3.24, SD = 0.888) and pain neuroscience education (M = 2.60, SD = 1.449). Disclosure: No. Pelvic health physical therapists pain knowledge and confidence in managing patients with chronic pelvic pain Greenwood, Ra, Lesh, Sb, Hodges, Nc aBowling Green State University,bUniversity of Charleston,cMethodist University Introduction: This study explores the current pain s