oxytocin and Pelvic-Pain

With over four million deliveries annually in the United States alone and a constant increase in cesarean delivery rate, childbirth is likely to have a huge impact on the occurrence of acute and possibly chronic postpartum pain. Recent awareness that chronic pain may occur after childbirth has prompted clinicians and researchers to investigate this topic. Current evidence points towards a relatively low incidence of chronic pain after cesarean delivery, with rates ranging between 1% and 18%. To provide a potential mechanistic explanation for the relatively low occurrence of chronic pain after cesarean delivery compared with that after other types of surgery, it has been proposed that endogenous secretion of oxytocin may confer specific protection. Clinical interventions to reduce the incidence and severity of chronic post-surgical pain have not been consistently effective. Likely explanations are that the drugs that have been investigated were truly ineffective or that the effect was too modest because with a low incidence of chronic pain, studies were likely to be underpowered and failed to demonstrate an effect. In addition, since not all women require preventive therapies, preoperative testing that may identify women vulnerable to pain may be highly beneficial. Further research is needed to identify valid models that predict persistent pain to allow targeted interventions to women most likely to benefit from more tailored anti-hyperalgesic therapies.

Topics: Acute Pain; Adrenergic alpha-Agonists; Adult; Amines; Analgesics; Anesthetics, Dissociative; Cesarean Section; Chronic Pain; Clonidine; Cyclohexanecarboxylic Acids; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Injections, Spinal; Ketamine; Magnesium Sulfate; Nerve Block; Oxytocin; Pain, Postoperative; Parturition; Pelvic Pain; Peritoneum; Pregabalin; Pregnancy; Risk Factors; Uterus

This article explicates a theory that oxytocin, a sexually dimorphic neurotransmitter and paracrine hormone, is a plausible mechanism linking early relational trauma with posttraumatic self disorders (e.g., dissociation, somatization, and interpersonal sensitivity), posttraumatic stress disorder, and pelvic visceral dysregulation disorders (e.g., irritable bowel syndrome, chronic pelvic pain, interstitial cystitis, and hyperemesis gravidarum). This posttraumatic oxytocin dysregulation disorders theory is consistent with the historical and contemporary literature. It integrates attention to psychological and physical comorbidities and could account for the increased incidence of these disorders among females. Specific propositions are explored in data from studies of traumatic stress and women's health.

Topics: Cystitis, Interstitial; Dissociative Disorders; Female; Humans; Hyperemesis Gravidarum; Interpersonal Relations; Irritable Bowel Syndrome; Models, Psychological; Models, Theoretical; Oxytocin; Pelvic Pain; Pregnancy; Pregnancy Complications; Psychophysiologic Disorders; Somatoform Disorders; Stress Disorders, Post-Traumatic

To investigate the effect of intranasal oxytocin on chronic pelvic pain in a randomized, double-blind, within-subject crossover trial. Aims included: (1) determine intranasal oxytocin's effect on pain intensity and pain interference relative to placebo; (2) assess feasibility and acceptability.. Women with chronic pelvic pain were recruited from chronic pain and gynecology clinics between September 2017 and December 2018. Pain was recorded at pre-trial screening, and while administering intranasal oxytocin and placebo. Pain and pain-related interference were measured using the Brief Pain Inventory - Short Form. Feasibility and acceptability were measured using validated measures and interviews.. Twenty-one women were randomized with sufficient data available from 12 to permit analyses. Relative to placebo, a 2-week course of oxytocin administration resulted in improvement in pain severity with no effect on pain-related interference. This effect was driven by four women who demonstrated a minimal clinically significant improvement in pain following intranasal oxytocin (no women met this threshold for placebo). Adherence to dosing was excellent and occurrence of adverse effects did not differ between oxytocin and placebo.. Intranasal oxytocin may represent an adjuvant analgesic that could result in a minimal clinically significant improvement in pain among one in three women with chronic pelvic pain. Registration: ClinicalTrials.gov (Registration# NCT02888574).

Topics: Administration, Intranasal; Adult; Double-Blind Method; Feasibility Studies; Female; Humans; Oxytocin; Pain Measurement; Pelvic Pain; Surveys and Questionnaires; Treatment Outcome

This protocol presents the rationale and design for a trial evaluating the efficacy of intranasal oxytocin in improving pain and function among women with chronic pelvic musculoskeletal pain. Oxytocin is a neuropeptide traditionally recognised for involvement in labour, delivery and lactation. Novel evidence suggests that oxytocin decreases pain sensitivity in humans. While oxytocin administration has been reported to lower pain sensitivity among patients experiencing chronic back pain, headache, constipation and colon pain, no research has evaluated the association between intranasal oxytocin and chronic pelvic musculoskeletal pain. The association between oxytocin and pain may differ in women with chronic pelvic musculoskeletal pain relative to other chronic pain conditions because of the abundance of oxytocin receptors in the uterus.. This is a prospective, randomised, placebo-controlled, double-blind, within-participants crossover trial. 50 women with chronic pelvic musculoskeletal pain will be recruited through a local chronic pain centre and gynaecology clinics. Women will complete baseline measures and be randomised to an experimental or control condition that involve 2 weeks of self-administering twice-daily doses of 24 IU intranasal oxytocin or placebo, respectively. Women will then undergo a 2-week washout period before crossing over to receive the condition that they had not yet received. The primary outcome will be pain and function measured using the Brief Pain Inventory-Short Form. Secondary outcomes include emotional function, sleep disturbance and global impression of change. This trial will provide data on the 14-day safety and side-effect profile of intranasal oxytocin self-administered as an adjuvant treatment for chronic pelvic musculoskeletal pain.. This trial was granted approval from Health Canada and the University of Calgary Conjoint Health Research Ethics Board, and is registered online at ClinicalTrials.gov (#NCT02888574). Results will be disseminated to healthcare professionals through peer-reviewed publications and to the general public through press releases.. NCT02888574; Pre-results.

Topics: Administration, Intranasal; Adult; Canada; Chronic Pain; Cross-Over Studies; Double-Blind Method; Female; Humans; Musculoskeletal Pain; Oxytocin; Pain Threshold; Pelvic Pain; Prospective Studies; Research Design; Self Report

The myoma pseudocapsule (MP) is a fibro-vascular network rich of neurotransmitters, as a neurovascular bundle, surrounding fibroid and separating myoma from myometrium. We investigated the distribution of the opioid neuropeptides, as enkephalin (ENK) and oxytocin (OXT), in the nerve fibers within MP and their possible influence in human reproduction in 57 women. An histological and immunofluorescent staining of OXT and ENK was performed on nerve fibers of MP samples from the fundus, corpus and isthmian-cervical regions, with a successive morphometric quantification of OXT and ENK. None of the nerve fibers in the uterine fundus and corpus MPs contained ENK and the nerve fibers in the isthmian-cervical region demonstrated an ENK value of up to 94 ± 0.7 CU. A comparatively lower number of OXT-positive nerve fibers were found in the fundal MP (6.3 ± 0.8 CU). OXT-positive nerve fibers with OXT were marginally increased in corporal MP (15.0 ± 1.4 CU) and were substantially higher in the isthmian-cervical region MP (72.1 ± 5.1 CU) (p < 0.01). The distribution of OXY neurofibers showed a slight into the uterine corpus, while are highly present into the cervico-isthmic area, with influence on reproductive system and sexual disorders manifesting after surgical procedures on the cervix.

Topics: Adult; Cervix Uteri; Enkephalins; Female; Humans; Hysterectomy; Immunohistochemistry; Leiomyomatosis; Menorrhagia; Neoplasm Proteins; Neovascularization, Pathologic; Nerve Fibers; Oxytocin; Pelvic Pain; Uterine Neoplasms; Uterus

To study the complications and compare the success rate and abortion time between the live and the dead fetuses in second-trimester pregnancy termination with intracervicovaginal misoprostol.. A prospective comparative study.. A total of 89 pregnant women between 14 and 28 weeks of gestation with obstetric, medical, or genetic reasons for termination of pregnancy were recruited to receive 200 micrograms misoprostol inserted intracervicovaginally every 12 hours.. The rates of successful abortions within 12, 24 and 48 hours in live fetuses were 15.1%, 54.7% and 92.5%, respectively, while in dead fetuses were 50.0%, 83.3% and 97.2%, respectively. The success rates within 12 and 24 hours in live-fetus group were significantly lower than those of the dead-fetus group 9p = 0.0009 and p = 0.01, respectively). The mean abortion time of the live-fetus group (27.1 hours) was significantly more than that of the dead-fetus group (15 hours, p = 0.001). No serious complications occurred in terms of hemorrhage, febrile morbidity diarrhea, nausea and vomiting.. Intracervicovaginal misoprostol is an effective and safe method for second-trimester pregnancy termination. The success rate is higher and the abortion time is less in dead-fetus pregnancy than those in the live-fetus pregnancy.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Analgesia; Cohort Studies; Female; Fetal Death; Fetus; Gels; Humans; Misoprostol; Oxytocin; Pelvic Pain; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Time Factors

Genital endometriosis (GE) is a widespread gynecological disease which requires its further pathogenesis investigation and search for new effective treatments. The known data of oxytocin receptor presence in endometrioid heterotopy smooth muscle cells give some grounds to assume oxytocin participation in the pathogenesis of endometriosis. The present study objective was to evaluate oxytocin level in peripheral blood (PB) in patients with endometriosis associated pain syndrome and to estimate the efficacy of oxytocin receptor inhibitors (IOXTR) administration based on animal endometriosis model.. The basic group comprised 61 patients with endometriosis associated pain syndrome, while 21 patients formed the control group. VAS, MPQ, and BBS objective tests were applied for pain syndrome evaluation. Oxytocin level in PB was measured by immunoenzyme method. After confirmation of endometriosis experimental model formation in rats and further randomization, a daily IOXTR intra-abdominal injection was performed in a dose of 0.35 mg/kg/24 h in the basic group (. Oxytocin level in PB was authentically higher in patients with GE compared to the control: 51.45 (35.54-62.76) pg/mL and 27.64 (23.23-34.12) pg/mL, respectively (. The obtained results confirm the oxytocin role in the pathogenesis of endometrioid associated pain syndrome. The high efficacy of IOXTR administration based on animal model of surgically induced endometriosis allows viewing this method as a perspective therapy.

Topics: Adolescent; Adult; Animals; Case-Control Studies; Disease Models, Animal; Drug Evaluation, Preclinical; Endometriosis; Female; Humans; Middle Aged; Molecular Targeted Therapy; Oxytocin; Pelvic Pain; Peritoneal Diseases; Rats; Rats, Wistar; Receptors, Oxytocin; Syndrome; Vasotocin; Young Adult

The aim of the study was to expand the understanding of pathogenesis of adenomyosis-associated pelvic pain.. We studied 30 (n = 30) biopsy samples obtained after hysterectomy in women with diffuse adenomyosis of grade II-III, accompanied by severe pain syndrome, who did not receive hormonal therapy. The morphologic comparison group comprised 30 (n = 30) biopsy samples obtained from women with adenomyosis, without pain syndrome, operated on for abnormal uterine bleeding, who also did not receive hormone therapy.. The total density of immunological OTR labeling in the adenomyotic lesion foci was 73.7 ± 1.8%, and in the morphological control group it was 35.2 ± 1.4% (p <0.05), which indicates a significant effect of oxytocin as a ureterotonic peptide. Processes of local neurogenesis and growth of nerve fibers was established due to an increase in the expression of the nervous system growth factor NGF in the myometrium stroma, in comparison with biopsy samples of morphological control.

Topics: Adenomyosis; Adult; Case-Control Studies; Cohort Studies; Endometrium; Female; Humans; Myometrium; Nerve Growth Factor; Oxytocin; Pelvic Pain; Receptors, Oxytocin; Russia