Fran Lowry

Children with juvenile idiopathic arthritis rate the intensity of their pain lower than their parents or their physicians do. They also rate their overall sense of well-being as being much higher, according to Dr. Pablo Garcia-Munitis, formerly of the Università di Genova (Italy) and now of the Hospital de Ninos “Superiora Sor Maria Ludovica,” La Plata, Argentina, and his associates.

The finding suggests that children may cope with their disease better than their parents realize, or that parents tend to be oversolicitous about their children's health problems, wrote Dr. Garcia-Munitis and his associates.

Observing the intensity of a child's pain plays an important role in determining therapy for children with juvenile idiopathic arthritis (JIA). Because the experience of pain is personal and subjective, children's self-reports are given preference whenever possible. Yet physicians usually rely on information obtained from the parents, most often from the mother. There is growing awareness that the sole use of parent proxy reports may fail to capture the fact that parents and children may differ in their perceptions of health, hence the need to understand the relationship between parent proxy reporting and patient self-reporting, said the researchers (Arthritis Rheum. 2006;55:177–83).

The researchers examined the level of agreement between children, parents, and physicians in rating JIA pain intensity. The study group comprised 94 children, aged 5–18 years, who attended an outpatient clinic accompanied by both parents.

The child, mother, and father independently rated the intensity of the child's present pain and of pain during the previous week according to a visual analog scale. They also completed the discomfort scale of the Childhood Health Assessment Questionnaire. Rather than being combined with the visual analog scale, the questionnaire was presented in a separate form to avoid possible confusion, the researchers said.

On average, the children rated their pain and disability as consistently lower, and their overall well-being as better, than did their mothers, fathers, and physicians. Mothers and fathers were similar in their mean ratings of their child's pain, disability, and well-being. Physicians gave the worst scores of all. With regard to the level of present pain, mothers and children had moderate agreement, whereas fathers and children and physicians and children had poor agreement. The parents and physicians had moderate agreement in rating present pain.

Children with juvenile idiopathic arthritis rate the intensity of their pain lower than their parents or their physicians do. They also rate their overall sense of well-being as being much higher, according to Dr. Pablo Garcia-Munitis, formerly of the Università di Genova (Italy) and now of the Hospital de Ninos “Superiora Sor Maria Ludovica,” La Plata, Argentina, and his associates.

The finding suggests that children may cope with their disease better than their parents realize, or that parents tend to be oversolicitous about their children's health problems, wrote Dr. Garcia-Munitis and his associates.

Observing the intensity of a child's pain plays an important role in determining therapy for children with juvenile idiopathic arthritis (JIA). Because the experience of pain is personal and subjective, children's self-reports are given preference whenever possible. Yet physicians usually rely on information obtained from the parents, most often from the mother. There is growing awareness that the sole use of parent proxy reports may fail to capture the fact that parents and children may differ in their perceptions of health, hence the need to understand the relationship between parent proxy reporting and patient self-reporting, said the researchers (Arthritis Rheum. 2006;55:177–83).

The researchers examined the level of agreement between children, parents, and physicians in rating JIA pain intensity. The study group comprised 94 children, aged 5–18 years, who attended an outpatient clinic accompanied by both parents.

The child, mother, and father independently rated the intensity of the child's present pain and of pain during the previous week according to a visual analog scale. They also completed the discomfort scale of the Childhood Health Assessment Questionnaire. Rather than being combined with the visual analog scale, the questionnaire was presented in a separate form to avoid possible confusion, the researchers said.

On average, the children rated their pain and disability as consistently lower, and their overall well-being as better, than did their mothers, fathers, and physicians. Mothers and fathers were similar in their mean ratings of their child's pain, disability, and well-being. Physicians gave the worst scores of all. With regard to the level of present pain, mothers and children had moderate agreement, whereas fathers and children and physicians and children had poor agreement. The parents and physicians had moderate agreement in rating present pain.

Children with juvenile idiopathic arthritis rate the intensity of their pain lower than their parents or their physicians do. They also rate their overall sense of well-being as being much higher, according to Dr. Pablo Garcia-Munitis, formerly of the Università di Genova (Italy) and now of the Hospital de Ninos “Superiora Sor Maria Ludovica,” La Plata, Argentina, and his associates.

The finding suggests that children may cope with their disease better than their parents realize, or that parents tend to be oversolicitous about their children's health problems, wrote Dr. Garcia-Munitis and his associates.

Observing the intensity of a child's pain plays an important role in determining therapy for children with juvenile idiopathic arthritis (JIA). Because the experience of pain is personal and subjective, children's self-reports are given preference whenever possible. Yet physicians usually rely on information obtained from the parents, most often from the mother. There is growing awareness that the sole use of parent proxy reports may fail to capture the fact that parents and children may differ in their perceptions of health, hence the need to understand the relationship between parent proxy reporting and patient self-reporting, said the researchers (Arthritis Rheum. 2006;55:177–83).

The researchers examined the level of agreement between children, parents, and physicians in rating JIA pain intensity. The study group comprised 94 children, aged 5–18 years, who attended an outpatient clinic accompanied by both parents.

The child, mother, and father independently rated the intensity of the child's present pain and of pain during the previous week according to a visual analog scale. They also completed the discomfort scale of the Childhood Health Assessment Questionnaire. Rather than being combined with the visual analog scale, the questionnaire was presented in a separate form to avoid possible confusion, the researchers said.

On average, the children rated their pain and disability as consistently lower, and their overall well-being as better, than did their mothers, fathers, and physicians. Mothers and fathers were similar in their mean ratings of their child's pain, disability, and well-being. Physicians gave the worst scores of all. With regard to the level of present pain, mothers and children had moderate agreement, whereas fathers and children and physicians and children had poor agreement. The parents and physicians had moderate agreement in rating present pain.

When it comes to rating the severity of their illness and assessing its effect on their quality of life, teens with juvenile idiopathic arthritis may not see eye to eye with their parents, reported K.L. Shaw, Ph.D., of the Institute of Child Health, University of Birmingham (England), and associates.

Perceptions between parent and teen are particularly discordant when the disease is of medium severity, but these become more in sync at either end of the disease spectrum, the researchers said (Arthritis Rheum. 2006;55:189–98).

In rheumatology, patients often are asked for their subjective assessment of their function, pain, and health-related quality of life (HRQOL). Adolescents are particularly well suited to self-assessment; their cognitive development is usually up to the task and self-assessment lets teens maintain their autonomy and privacy. Parents of teens who are not able or willing to self-report are asked to report on these subjective aspects of their child's disease, acting as a proxy for the adolescent. The unanswered question has been to what extent the findings from teen self-assessment and parent's assessment of the teen's health overlap, Dr. Shaw and associates said.

They examined agreement about pain, physical health, functional ability, and HRQOL between adolescents with juvenile idiopathic arthritis (JIA) and their parents using the Childhood Health Assessment Questionnaire with visual analog scales for pain and general well-being, and the Juvenile Arthritis Quality of Life Questionnaire. Agreement was determined using the Bland and Altman method.

The study population consisted of 303 adolescent-parent dyads. The children were divided into groups aged 11, 14, and 17 years, to reflect the various stages of adolescent development, Dr. Shaw and associates wrote.

They found a wide variation in agreement for the variables studied. For pain, agreement between adolescents and parents was better when the mean rating for pain was either low or high, and most discordant when the mean pain rating was at the middle of the scale.

Also, adolescents who showed agreement with their parents had statistically significant lower disease activity, fewer active or limited joints, lower pain, better general well-being, lower disability, and better HRQOL, when compared with the other groups. The findings were similar for general well-being, functional disability, and HRQOL.

Parents were as likely to underestimate pain and general well-being as they were to overestimate them, compared with their child's self-reports, leading the investigators to speculate that this tendency may have “more to do with psychological factors than clinical or demographic variables.”

There was also a greater proportion of disagreement in the 14-year-old age group with JIA that was not oligoarticular. This “may reflect the increasing desire for independence from parents that is characteristic of mid-adolescence and is potentially more challenging in the context of more extensive disease,” Dr. Shaw and associates wrote.

“When examined with respect to clinical definitions of agreement, only half of the parents assessed in this study would be considered acceptable proxies for their adolescent children,” according to Dr. Shaw and associates.

When it comes to rating the severity of their illness and assessing its effect on their quality of life, teens with juvenile idiopathic arthritis may not see eye to eye with their parents, reported K.L. Shaw, Ph.D., of the Institute of Child Health, University of Birmingham (England), and associates.

Perceptions between parent and teen are particularly discordant when the disease is of medium severity, but these become more in sync at either end of the disease spectrum, the researchers said (Arthritis Rheum. 2006;55:189–98).

In rheumatology, patients often are asked for their subjective assessment of their function, pain, and health-related quality of life (HRQOL). Adolescents are particularly well suited to self-assessment; their cognitive development is usually up to the task and self-assessment lets teens maintain their autonomy and privacy. Parents of teens who are not able or willing to self-report are asked to report on these subjective aspects of their child's disease, acting as a proxy for the adolescent. The unanswered question has been to what extent the findings from teen self-assessment and parent's assessment of the teen's health overlap, Dr. Shaw and associates said.

They examined agreement about pain, physical health, functional ability, and HRQOL between adolescents with juvenile idiopathic arthritis (JIA) and their parents using the Childhood Health Assessment Questionnaire with visual analog scales for pain and general well-being, and the Juvenile Arthritis Quality of Life Questionnaire. Agreement was determined using the Bland and Altman method.

The study population consisted of 303 adolescent-parent dyads. The children were divided into groups aged 11, 14, and 17 years, to reflect the various stages of adolescent development, Dr. Shaw and associates wrote.

They found a wide variation in agreement for the variables studied. For pain, agreement between adolescents and parents was better when the mean rating for pain was either low or high, and most discordant when the mean pain rating was at the middle of the scale.

Also, adolescents who showed agreement with their parents had statistically significant lower disease activity, fewer active or limited joints, lower pain, better general well-being, lower disability, and better HRQOL, when compared with the other groups. The findings were similar for general well-being, functional disability, and HRQOL.

Parents were as likely to underestimate pain and general well-being as they were to overestimate them, compared with their child's self-reports, leading the investigators to speculate that this tendency may have “more to do with psychological factors than clinical or demographic variables.”

There was also a greater proportion of disagreement in the 14-year-old age group with JIA that was not oligoarticular. This “may reflect the increasing desire for independence from parents that is characteristic of mid-adolescence and is potentially more challenging in the context of more extensive disease,” Dr. Shaw and associates wrote.

“When examined with respect to clinical definitions of agreement, only half of the parents assessed in this study would be considered acceptable proxies for their adolescent children,” according to Dr. Shaw and associates.

When it comes to rating the severity of their illness and assessing its effect on their quality of life, teens with juvenile idiopathic arthritis may not see eye to eye with their parents, reported K.L. Shaw, Ph.D., of the Institute of Child Health, University of Birmingham (England), and associates.

Perceptions between parent and teen are particularly discordant when the disease is of medium severity, but these become more in sync at either end of the disease spectrum, the researchers said (Arthritis Rheum. 2006;55:189–98).

In rheumatology, patients often are asked for their subjective assessment of their function, pain, and health-related quality of life (HRQOL). Adolescents are particularly well suited to self-assessment; their cognitive development is usually up to the task and self-assessment lets teens maintain their autonomy and privacy. Parents of teens who are not able or willing to self-report are asked to report on these subjective aspects of their child's disease, acting as a proxy for the adolescent. The unanswered question has been to what extent the findings from teen self-assessment and parent's assessment of the teen's health overlap, Dr. Shaw and associates said.

They examined agreement about pain, physical health, functional ability, and HRQOL between adolescents with juvenile idiopathic arthritis (JIA) and their parents using the Childhood Health Assessment Questionnaire with visual analog scales for pain and general well-being, and the Juvenile Arthritis Quality of Life Questionnaire. Agreement was determined using the Bland and Altman method.

The study population consisted of 303 adolescent-parent dyads. The children were divided into groups aged 11, 14, and 17 years, to reflect the various stages of adolescent development, Dr. Shaw and associates wrote.

They found a wide variation in agreement for the variables studied. For pain, agreement between adolescents and parents was better when the mean rating for pain was either low or high, and most discordant when the mean pain rating was at the middle of the scale.

Also, adolescents who showed agreement with their parents had statistically significant lower disease activity, fewer active or limited joints, lower pain, better general well-being, lower disability, and better HRQOL, when compared with the other groups. The findings were similar for general well-being, functional disability, and HRQOL.

Parents were as likely to underestimate pain and general well-being as they were to overestimate them, compared with their child's self-reports, leading the investigators to speculate that this tendency may have “more to do with psychological factors than clinical or demographic variables.”

There was also a greater proportion of disagreement in the 14-year-old age group with JIA that was not oligoarticular. This “may reflect the increasing desire for independence from parents that is characteristic of mid-adolescence and is potentially more challenging in the context of more extensive disease,” Dr. Shaw and associates wrote.

“When examined with respect to clinical definitions of agreement, only half of the parents assessed in this study would be considered acceptable proxies for their adolescent children,” according to Dr. Shaw and associates.

FORT LAUDERDALE, FLA. — Chronic sacral nerve stimulation with the implantable InterStim system bridges the gap between conservative treatment and highly invasive procedures such as urinary diversion, Dr. Gamal M. Ghoniem said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

InterStim uses a small device to deliver mild electrical pulses to the sacral nerves that influence the behavior of the bladder, sphincter, and pelvic floor muscles.

The therapy should be considered before ablative or reconstructive surgery when medical therapy has failed, said Dr. Ghoniem, head of the section of voiding dysfunction, female urology, and reconstruction at the Cleveland Clinic Florida in Weston.

In a multicenter study conducted in Europe and North America, the mean number of urinary incontinence (UI) episodes per day decreased from 10 to 2.6 in 250 patients who were implanted with the InterStim device. Patients had chronic symptoms of urge incontinence, urgency frequency, and urinary retention.

After successful completion of a nerve stimulation test, the study population was divided into a delayed group and an implant group. The delayed group members served as controls for 3 and 6 months, and then were implanted.

At 6 months after implantation with InterStim, 47% of the urge incontinence patients were dry, and an additional 28% were greatly improved.

These results were maintained at 12 and 18 months. Urgency/frequency patients had a significant 50% reduction in the number of voids per day, and 61% of the urinary retention patients were able to resume urination without catheterization.

Another 16% had a significant reduction in the number of catheterizations per day, Dr. Ghoniem reported.

The controls did not show any significant improvement in their condition during the observation period, he added.

No permanent injuries were reported. Adverse side effects included pain (15% of patients), infection (6.1%), transient electric shock (5.5%), adverse change in bowel function (3%), and suspected lead migration (8.4%). Nevertheless, the patient satisfaction rate was 84%, Dr. Ghoniem said.

Since this study, there have been several improvements in the technique of implantation and in the equipment used.

The previous technique necessitated an incision in the abdomen to place the control unit, whereas now it is placed over the gluteal region. This shortens the duration of the procedure by 30–54 minutes.

The leads are now placed percutaneously, whereas before, they were placed via incisions over the sacrum. As a result, the incidence of adverse events is considerably lower than reported in the earlier review, Dr. Ghoniem said.

Suitable patients benefit greatly from this therapy, said Dr. Ghoniem. “This disorder can make people very upset and anxious. They have had urinary incontinence for years. They've tried different medications, different doctors, and nothing works—they still go to the bathroom all day and all night and they are miserable. But once this changes for them, they are ecstatic.”

FORT LAUDERDALE, FLA. — Chronic sacral nerve stimulation with the implantable InterStim system bridges the gap between conservative treatment and highly invasive procedures such as urinary diversion, Dr. Gamal M. Ghoniem said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

InterStim uses a small device to deliver mild electrical pulses to the sacral nerves that influence the behavior of the bladder, sphincter, and pelvic floor muscles.

The therapy should be considered before ablative or reconstructive surgery when medical therapy has failed, said Dr. Ghoniem, head of the section of voiding dysfunction, female urology, and reconstruction at the Cleveland Clinic Florida in Weston.

In a multicenter study conducted in Europe and North America, the mean number of urinary incontinence (UI) episodes per day decreased from 10 to 2.6 in 250 patients who were implanted with the InterStim device. Patients had chronic symptoms of urge incontinence, urgency frequency, and urinary retention.

After successful completion of a nerve stimulation test, the study population was divided into a delayed group and an implant group. The delayed group members served as controls for 3 and 6 months, and then were implanted.

At 6 months after implantation with InterStim, 47% of the urge incontinence patients were dry, and an additional 28% were greatly improved.

These results were maintained at 12 and 18 months. Urgency/frequency patients had a significant 50% reduction in the number of voids per day, and 61% of the urinary retention patients were able to resume urination without catheterization.

Another 16% had a significant reduction in the number of catheterizations per day, Dr. Ghoniem reported.

The controls did not show any significant improvement in their condition during the observation period, he added.

No permanent injuries were reported. Adverse side effects included pain (15% of patients), infection (6.1%), transient electric shock (5.5%), adverse change in bowel function (3%), and suspected lead migration (8.4%). Nevertheless, the patient satisfaction rate was 84%, Dr. Ghoniem said.

Since this study, there have been several improvements in the technique of implantation and in the equipment used.

The previous technique necessitated an incision in the abdomen to place the control unit, whereas now it is placed over the gluteal region. This shortens the duration of the procedure by 30–54 minutes.

The leads are now placed percutaneously, whereas before, they were placed via incisions over the sacrum. As a result, the incidence of adverse events is considerably lower than reported in the earlier review, Dr. Ghoniem said.

Suitable patients benefit greatly from this therapy, said Dr. Ghoniem. “This disorder can make people very upset and anxious. They have had urinary incontinence for years. They've tried different medications, different doctors, and nothing works—they still go to the bathroom all day and all night and they are miserable. But once this changes for them, they are ecstatic.”

FORT LAUDERDALE, FLA. — Chronic sacral nerve stimulation with the implantable InterStim system bridges the gap between conservative treatment and highly invasive procedures such as urinary diversion, Dr. Gamal M. Ghoniem said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

InterStim uses a small device to deliver mild electrical pulses to the sacral nerves that influence the behavior of the bladder, sphincter, and pelvic floor muscles.

The therapy should be considered before ablative or reconstructive surgery when medical therapy has failed, said Dr. Ghoniem, head of the section of voiding dysfunction, female urology, and reconstruction at the Cleveland Clinic Florida in Weston.

In a multicenter study conducted in Europe and North America, the mean number of urinary incontinence (UI) episodes per day decreased from 10 to 2.6 in 250 patients who were implanted with the InterStim device. Patients had chronic symptoms of urge incontinence, urgency frequency, and urinary retention.

After successful completion of a nerve stimulation test, the study population was divided into a delayed group and an implant group. The delayed group members served as controls for 3 and 6 months, and then were implanted.

At 6 months after implantation with InterStim, 47% of the urge incontinence patients were dry, and an additional 28% were greatly improved.

These results were maintained at 12 and 18 months. Urgency/frequency patients had a significant 50% reduction in the number of voids per day, and 61% of the urinary retention patients were able to resume urination without catheterization.

Another 16% had a significant reduction in the number of catheterizations per day, Dr. Ghoniem reported.

The controls did not show any significant improvement in their condition during the observation period, he added.

No permanent injuries were reported. Adverse side effects included pain (15% of patients), infection (6.1%), transient electric shock (5.5%), adverse change in bowel function (3%), and suspected lead migration (8.4%). Nevertheless, the patient satisfaction rate was 84%, Dr. Ghoniem said.

Since this study, there have been several improvements in the technique of implantation and in the equipment used.

The previous technique necessitated an incision in the abdomen to place the control unit, whereas now it is placed over the gluteal region. This shortens the duration of the procedure by 30–54 minutes.

The leads are now placed percutaneously, whereas before, they were placed via incisions over the sacrum. As a result, the incidence of adverse events is considerably lower than reported in the earlier review, Dr. Ghoniem said.

Suitable patients benefit greatly from this therapy, said Dr. Ghoniem. “This disorder can make people very upset and anxious. They have had urinary incontinence for years. They've tried different medications, different doctors, and nothing works—they still go to the bathroom all day and all night and they are miserable. But once this changes for them, they are ecstatic.”

FORT LAUDERDALE, FLA. — The Colpexin sphere, an intravaginal device for women with advanced genital prolapse that supports the prolapse above the levator musculature and helps patients strengthen their pelvic floor muscles, can also serve as a test to objectively assess pelvic floor muscle contractility and strength, Dr. G. Willy Davila said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

An objective test of the pelvic floor musculature has long been needed, said Dr. Davila, chairman of the department of gynecology at the Cleveland Clinic in Weston, Fla. Until now, clinicians have had to rely on subjective methods, such as manual testing using the Brink classification system, which was first published in 1989.

“You can see from the date it was published that we really haven't done very much to improve our assessment of pelvic floor contractions,” Dr. Davila said.

For the Colpexin sphere pull test to objectively assess pelvic floor musculature strength and tone, a tensiometer is attached to the sphere and then the patient is asked to contract her pelvic floor muscles. The force required to extract the device while the woman is resisting its removal is then measured, explained Dr. Davila, who has received research funding from and is a consultant for Adamed Inc., the maker of the Colpexin sphere.

Early results with the Colpexin pull test show a significant improvement in contractile strength over a 16-week period in women with prolapse who performed Kegel exercises regularly with the sphere in place.

“This is the first time that we have had the ability to objectively evaluate pelvic floor strength and to measure improvement over time in our patients,” he said.

The Colpexin device, which was developed in Poland, has just won Food and Drug Administration approval and will be marketed within a few months, Dr. Davila said.

He stressed the importance of evaluating pelvic floor muscular function, both before therapeutic intervention for prolapse and as a way of measuring the intervention's success.

“We spend a lot of time and energy in urodynamics with very sophisticated equipment, yet we don't spend a lot of time and energy evaluating their muscular function in the pelvic floor, which is probably equally important,” he said.

EMILY BRANNAN, ILLUSTRATION

FORT LAUDERDALE, FLA. — The Colpexin sphere, an intravaginal device for women with advanced genital prolapse that supports the prolapse above the levator musculature and helps patients strengthen their pelvic floor muscles, can also serve as a test to objectively assess pelvic floor muscle contractility and strength, Dr. G. Willy Davila said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

An objective test of the pelvic floor musculature has long been needed, said Dr. Davila, chairman of the department of gynecology at the Cleveland Clinic in Weston, Fla. Until now, clinicians have had to rely on subjective methods, such as manual testing using the Brink classification system, which was first published in 1989.

“You can see from the date it was published that we really haven't done very much to improve our assessment of pelvic floor contractions,” Dr. Davila said.

For the Colpexin sphere pull test to objectively assess pelvic floor musculature strength and tone, a tensiometer is attached to the sphere and then the patient is asked to contract her pelvic floor muscles. The force required to extract the device while the woman is resisting its removal is then measured, explained Dr. Davila, who has received research funding from and is a consultant for Adamed Inc., the maker of the Colpexin sphere.

Early results with the Colpexin pull test show a significant improvement in contractile strength over a 16-week period in women with prolapse who performed Kegel exercises regularly with the sphere in place.

“This is the first time that we have had the ability to objectively evaluate pelvic floor strength and to measure improvement over time in our patients,” he said.

The Colpexin device, which was developed in Poland, has just won Food and Drug Administration approval and will be marketed within a few months, Dr. Davila said.

He stressed the importance of evaluating pelvic floor muscular function, both before therapeutic intervention for prolapse and as a way of measuring the intervention's success.

“We spend a lot of time and energy in urodynamics with very sophisticated equipment, yet we don't spend a lot of time and energy evaluating their muscular function in the pelvic floor, which is probably equally important,” he said.

EMILY BRANNAN, ILLUSTRATION

FORT LAUDERDALE, FLA. — The Colpexin sphere, an intravaginal device for women with advanced genital prolapse that supports the prolapse above the levator musculature and helps patients strengthen their pelvic floor muscles, can also serve as a test to objectively assess pelvic floor muscle contractility and strength, Dr. G. Willy Davila said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

An objective test of the pelvic floor musculature has long been needed, said Dr. Davila, chairman of the department of gynecology at the Cleveland Clinic in Weston, Fla. Until now, clinicians have had to rely on subjective methods, such as manual testing using the Brink classification system, which was first published in 1989.

“You can see from the date it was published that we really haven't done very much to improve our assessment of pelvic floor contractions,” Dr. Davila said.

For the Colpexin sphere pull test to objectively assess pelvic floor musculature strength and tone, a tensiometer is attached to the sphere and then the patient is asked to contract her pelvic floor muscles. The force required to extract the device while the woman is resisting its removal is then measured, explained Dr. Davila, who has received research funding from and is a consultant for Adamed Inc., the maker of the Colpexin sphere.

Early results with the Colpexin pull test show a significant improvement in contractile strength over a 16-week period in women with prolapse who performed Kegel exercises regularly with the sphere in place.

“This is the first time that we have had the ability to objectively evaluate pelvic floor strength and to measure improvement over time in our patients,” he said.

The Colpexin device, which was developed in Poland, has just won Food and Drug Administration approval and will be marketed within a few months, Dr. Davila said.

He stressed the importance of evaluating pelvic floor muscular function, both before therapeutic intervention for prolapse and as a way of measuring the intervention's success.

“We spend a lot of time and energy in urodynamics with very sophisticated equipment, yet we don't spend a lot of time and energy evaluating their muscular function in the pelvic floor, which is probably equally important,” he said.

EMILY BRANNAN, ILLUSTRATION

FORT LAUDERDALE, FLA. — The Colpexin sphere, an intravaginal device for women with advanced genital prolapse that supports the prolapse above the levator musculature and helps patients strengthen their pelvic floor muscles, can also serve as a test to objectively assess pelvic floor muscle contractility and strength, Dr. G. Willy Davila said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

An objective test of the pelvic floor musculature has long been needed, said Dr. Davila, chairman of the department of gynecology at the Cleveland Clinic in Weston, Fla. Until now, clinicians have had to rely on subjective methods, such as manual testing using the Brink classification system, which was first published in 1989. “You can see from the date it was published that we really haven't done very much to improve our assessment of pelvic floor contractions,” Dr. Davila said.

In using the Colpexin sphere pull test to objectively assess pelvic floor musculature strength and tone, a tensiometer is attached to the sphere and then the patient is asked to contract her pelvic floor muscles. The force required to extract the device while the woman is resisting its removal is then measured, explained Dr. Davila, who has received research funding from and is a consultant for Adamed Inc., the maker of the Colpexin sphere.

Early results with the Colpexin pull test show a significant improvement in contractile strength over a 16-week period in women with prolapse who performed Kegel exercises regularly with the sphere in place. “This is the first time that we have had the ability to objectively evaluate pelvic floor strength and to measure improvement over time in our patients,” he said. The Colpexin device, which was developed in Poland, has just won Food and Drug Administration approval and will be marketed within a few months, Dr. Davila said. He stressed the importance of evaluating pelvic floor muscular function, both before therapeutic intervention for prolapse and as a way of measuring the intervention's success. “We spend a lot of time and energy in urodynamics with very sophisticated equipment, yet we don't spend a lot of time and energy evaluating their muscular function in the pelvic floor, which is probably equally as important.”

We have the ability to evaluate pelvic floor strength and to measure improvement. DR. DAVILA

FORT LAUDERDALE, FLA. — The Colpexin sphere, an intravaginal device for women with advanced genital prolapse that supports the prolapse above the levator musculature and helps patients strengthen their pelvic floor muscles, can also serve as a test to objectively assess pelvic floor muscle contractility and strength, Dr. G. Willy Davila said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

An objective test of the pelvic floor musculature has long been needed, said Dr. Davila, chairman of the department of gynecology at the Cleveland Clinic in Weston, Fla. Until now, clinicians have had to rely on subjective methods, such as manual testing using the Brink classification system, which was first published in 1989. “You can see from the date it was published that we really haven't done very much to improve our assessment of pelvic floor contractions,” Dr. Davila said.

In using the Colpexin sphere pull test to objectively assess pelvic floor musculature strength and tone, a tensiometer is attached to the sphere and then the patient is asked to contract her pelvic floor muscles. The force required to extract the device while the woman is resisting its removal is then measured, explained Dr. Davila, who has received research funding from and is a consultant for Adamed Inc., the maker of the Colpexin sphere.

Early results with the Colpexin pull test show a significant improvement in contractile strength over a 16-week period in women with prolapse who performed Kegel exercises regularly with the sphere in place. “This is the first time that we have had the ability to objectively evaluate pelvic floor strength and to measure improvement over time in our patients,” he said. The Colpexin device, which was developed in Poland, has just won Food and Drug Administration approval and will be marketed within a few months, Dr. Davila said. He stressed the importance of evaluating pelvic floor muscular function, both before therapeutic intervention for prolapse and as a way of measuring the intervention's success. “We spend a lot of time and energy in urodynamics with very sophisticated equipment, yet we don't spend a lot of time and energy evaluating their muscular function in the pelvic floor, which is probably equally as important.”

We have the ability to evaluate pelvic floor strength and to measure improvement. DR. DAVILA

FORT LAUDERDALE, FLA. — The Colpexin sphere, an intravaginal device for women with advanced genital prolapse that supports the prolapse above the levator musculature and helps patients strengthen their pelvic floor muscles, can also serve as a test to objectively assess pelvic floor muscle contractility and strength, Dr. G. Willy Davila said at a symposium on pelvic floor disorders sponsored by the Cleveland Clinic Florida.

An objective test of the pelvic floor musculature has long been needed, said Dr. Davila, chairman of the department of gynecology at the Cleveland Clinic in Weston, Fla. Until now, clinicians have had to rely on subjective methods, such as manual testing using the Brink classification system, which was first published in 1989. “You can see from the date it was published that we really haven't done very much to improve our assessment of pelvic floor contractions,” Dr. Davila said.

In using the Colpexin sphere pull test to objectively assess pelvic floor musculature strength and tone, a tensiometer is attached to the sphere and then the patient is asked to contract her pelvic floor muscles. The force required to extract the device while the woman is resisting its removal is then measured, explained Dr. Davila, who has received research funding from and is a consultant for Adamed Inc., the maker of the Colpexin sphere.

Early results with the Colpexin pull test show a significant improvement in contractile strength over a 16-week period in women with prolapse who performed Kegel exercises regularly with the sphere in place. “This is the first time that we have had the ability to objectively evaluate pelvic floor strength and to measure improvement over time in our patients,” he said. The Colpexin device, which was developed in Poland, has just won Food and Drug Administration approval and will be marketed within a few months, Dr. Davila said. He stressed the importance of evaluating pelvic floor muscular function, both before therapeutic intervention for prolapse and as a way of measuring the intervention's success. “We spend a lot of time and energy in urodynamics with very sophisticated equipment, yet we don't spend a lot of time and energy evaluating their muscular function in the pelvic floor, which is probably equally as important.”

We have the ability to evaluate pelvic floor strength and to measure improvement. DR. DAVILA

ORLANDO — Women with chronic pelvic pain responded as well to medical treatment as they did to surgery, according to a prospective, observational cohort study of 370 patients that was carried out 1 year after treatment, Dr. Georgine Lamvu said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

About 15% of women report having chronic pelvic pain (CPP) in their lifetime. It is the primary indication for 12% of hysterectomies and 40% of laparoscopies and costs over $2 billion annually, said Dr. Lamvu of the University of North Carolina at Chapel Hill.

The mean pain level score, as assessed by the McGill Pain Questionnaire, was 30, or moderate to severe, in 49% of both medically and surgically treated women who were referred to the university's pelvic pain clinic for evaluation of continued CPP. Likewise, moderate to severe depression, as measured by the Beck Depression Inventory, was diagnosed in 22% of both groups.

Surgical treatment ranged from diagnostic laparoscopy to hysterectomy, and medical treatment consisted of pharmacotherapy, psychotherapy, and physical therapy.

One year later, the mean McGill Pain Questionnaire score had decreased from 30 to 23 in both groups.

In another study on CPP presented at the meeting, Jane Leserman, Ph.D., also of the University of North Carolina, reported that breaking CPP into diagnostic subtypes may be useful in guiding therapy.

A chart review and questionnaire of 306 consecutive patients who presented to the university's pelvic pain clinic found the following most common diagnostic subtypes:

▸ Diffuse abdominal pelvic pain (43%).

▸ Vulvovaginal pain (20%).

▸ Cyclic pain (10%).

▸ Neuropathic pain (9%).

▸ Nonlocal pain (7%).

▸ Trigger point pain (6%).

▸ Palpation of the uterus (6%).

Patients who had diffuse abdominal pelvic pain had worse physical functioning and more pain than did patients with vulvovaginal, cyclic, neuropathic, and fibroid pain. Those with vulvovaginal pain had the best physical functioning and the least pain, Dr. Leserman said.

Slightly less than half of the patients (48%) had been sexually or physically abused. The women also scored at or below the 25th percentile on mental and physical health measures, compared with the U.S. female population as a whole, Dr. Leserman said.

Endometriosis, which was present in 21% of the women, was not significantly related to any measure of mental or physical health status, Dr. Leserman said.

“It seems like the diagnostic subtypes were better predictors of health status than was endometriosis. Perhaps the degree of diffuseness of pain and the cyclic nature of pain may help guide us in the future in terms of treatment,” she said.

'It seems like the diagnostic subtypes were better predictors of health status than was endometriosis.' DR. LESERMAN

ORLANDO — Women with chronic pelvic pain responded as well to medical treatment as they did to surgery, according to a prospective, observational cohort study of 370 patients that was carried out 1 year after treatment, Dr. Georgine Lamvu said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

About 15% of women report having chronic pelvic pain (CPP) in their lifetime. It is the primary indication for 12% of hysterectomies and 40% of laparoscopies and costs over $2 billion annually, said Dr. Lamvu of the University of North Carolina at Chapel Hill.

The mean pain level score, as assessed by the McGill Pain Questionnaire, was 30, or moderate to severe, in 49% of both medically and surgically treated women who were referred to the university's pelvic pain clinic for evaluation of continued CPP. Likewise, moderate to severe depression, as measured by the Beck Depression Inventory, was diagnosed in 22% of both groups.

Surgical treatment ranged from diagnostic laparoscopy to hysterectomy, and medical treatment consisted of pharmacotherapy, psychotherapy, and physical therapy.

One year later, the mean McGill Pain Questionnaire score had decreased from 30 to 23 in both groups.

In another study on CPP presented at the meeting, Jane Leserman, Ph.D., also of the University of North Carolina, reported that breaking CPP into diagnostic subtypes may be useful in guiding therapy.

A chart review and questionnaire of 306 consecutive patients who presented to the university's pelvic pain clinic found the following most common diagnostic subtypes:

▸ Diffuse abdominal pelvic pain (43%).

▸ Vulvovaginal pain (20%).

▸ Cyclic pain (10%).

▸ Neuropathic pain (9%).

▸ Nonlocal pain (7%).

▸ Trigger point pain (6%).

▸ Palpation of the uterus (6%).

Patients who had diffuse abdominal pelvic pain had worse physical functioning and more pain than did patients with vulvovaginal, cyclic, neuropathic, and fibroid pain. Those with vulvovaginal pain had the best physical functioning and the least pain, Dr. Leserman said.

Slightly less than half of the patients (48%) had been sexually or physically abused. The women also scored at or below the 25th percentile on mental and physical health measures, compared with the U.S. female population as a whole, Dr. Leserman said.

Endometriosis, which was present in 21% of the women, was not significantly related to any measure of mental or physical health status, Dr. Leserman said.

“It seems like the diagnostic subtypes were better predictors of health status than was endometriosis. Perhaps the degree of diffuseness of pain and the cyclic nature of pain may help guide us in the future in terms of treatment,” she said.

'It seems like the diagnostic subtypes were better predictors of health status than was endometriosis.' DR. LESERMAN

ORLANDO — Women with chronic pelvic pain responded as well to medical treatment as they did to surgery, according to a prospective, observational cohort study of 370 patients that was carried out 1 year after treatment, Dr. Georgine Lamvu said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

About 15% of women report having chronic pelvic pain (CPP) in their lifetime. It is the primary indication for 12% of hysterectomies and 40% of laparoscopies and costs over $2 billion annually, said Dr. Lamvu of the University of North Carolina at Chapel Hill.

The mean pain level score, as assessed by the McGill Pain Questionnaire, was 30, or moderate to severe, in 49% of both medically and surgically treated women who were referred to the university's pelvic pain clinic for evaluation of continued CPP. Likewise, moderate to severe depression, as measured by the Beck Depression Inventory, was diagnosed in 22% of both groups.

Surgical treatment ranged from diagnostic laparoscopy to hysterectomy, and medical treatment consisted of pharmacotherapy, psychotherapy, and physical therapy.

One year later, the mean McGill Pain Questionnaire score had decreased from 30 to 23 in both groups.

In another study on CPP presented at the meeting, Jane Leserman, Ph.D., also of the University of North Carolina, reported that breaking CPP into diagnostic subtypes may be useful in guiding therapy.

A chart review and questionnaire of 306 consecutive patients who presented to the university's pelvic pain clinic found the following most common diagnostic subtypes:

▸ Diffuse abdominal pelvic pain (43%).

▸ Vulvovaginal pain (20%).

▸ Cyclic pain (10%).

▸ Neuropathic pain (9%).

▸ Nonlocal pain (7%).

▸ Trigger point pain (6%).

▸ Palpation of the uterus (6%).

Patients who had diffuse abdominal pelvic pain had worse physical functioning and more pain than did patients with vulvovaginal, cyclic, neuropathic, and fibroid pain. Those with vulvovaginal pain had the best physical functioning and the least pain, Dr. Leserman said.

Slightly less than half of the patients (48%) had been sexually or physically abused. The women also scored at or below the 25th percentile on mental and physical health measures, compared with the U.S. female population as a whole, Dr. Leserman said.

Endometriosis, which was present in 21% of the women, was not significantly related to any measure of mental or physical health status, Dr. Leserman said.

“It seems like the diagnostic subtypes were better predictors of health status than was endometriosis. Perhaps the degree of diffuseness of pain and the cyclic nature of pain may help guide us in the future in terms of treatment,” she said.

'It seems like the diagnostic subtypes were better predictors of health status than was endometriosis.' DR. LESERMAN

ORLANDO — Women with chronic pelvic pain responded as well to medical treatment as they did to surgery, according to a prospective, observational cohort study of 370 patients that was carried out 1 year after treatment, Dr. Georgine Lamvu said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

About 15% of women report having chronic pelvic pain (CPP) in their lifetime. It is the primary indication for 12% of hysterectomies and 40% of laparoscopies and costs over $2 billion annually, said Dr. Lamvu of the University of North Carolina at Chapel Hill.

The mean pain level score, as assessed by the McGill Pain Questionnaire, was 30, or moderate to severe, in 49% of both medically and surgically treated women who were referred to the university's pelvic pain clinic for evaluation of continued CPP.

Likewise, moderate to severe depression, as measured by the Beck Depression Inventory scale, was diagnosed in 22% of both groups.

Surgical treatment ranged from diagnostic laparoscopy to hysterectomy, and medical treatment consisted of pharmacotherapy, psychotherapy, and physical therapy.

One year later, the mean McGill Pain Questionnaire score had decreased from 30 to 23 in both groups. Overall, depression scores were unchanged in 48%, improved in 32%, and worsened in 20%. However, depression did not predict worse outcome, Dr. Lamvu said. “We were surprised, but that is what we found. Outcomes were similar with both treatment types.”

Dr. Lamvu said she is planning further studies that will focus on physician-patient relationships, which may influence outcomes for pain treatment in women with CPP. “There may actually be some biological reasons for the way women respond to pain management after they have had interactions with a physician, so we will be studying that next.”

In another study on CPP presented at the meeting, Jane Leserman, Ph.D., also of the University of North Carolina, reported that breaking CPP into diagnostic subtypes may be useful in guiding therapy.

A chart review and questionnaire of 306 consecutive patients who presented to the university's pelvic pain clinic found the following most common diagnostic subtypes:

▸ Diffuse abdominal pelvic pain (43%).

▸ Vulvovaginal pain (20%).

▸ Cyclic pain (10%).

▸ Neuropathic pain (9%).

▸ Nonlocal pain (7%).

▸ Trigger point pain (6%).

▸ Palpation of the uterus (6%).

Patients who had diffuse abdominal pelvic pain had worse physical functioning and more pain than did patients with vulvovaginal, cyclic, neuropathic, and fibroid pain.

Those with vulvovaginal pain had the best physical functioning and the least pain, Dr. Leserman said.

Slightly less than half of the patients (48%) reported having been sexually or physically abused.

The women also scored at or below the 25th percentile on mental and physical health measures compared with the U.S. female population as a whole, Dr. Leserman said.

Endometriosis, which was present in 21% of the women, was not found to be significantly related to any measure of mental or physical health status, Dr. Leserman said.

“It seems like the diagnostic subtypes were better predictors of health status than was endometriosis. Perhaps the degree of diffuseness of pain and the cyclic nature of pain may help guide us in the future in terms of treatment,” she said.

ORLANDO — Women with chronic pelvic pain responded as well to medical treatment as they did to surgery, according to a prospective, observational cohort study of 370 patients that was carried out 1 year after treatment, Dr. Georgine Lamvu said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

About 15% of women report having chronic pelvic pain (CPP) in their lifetime. It is the primary indication for 12% of hysterectomies and 40% of laparoscopies and costs over $2 billion annually, said Dr. Lamvu of the University of North Carolina at Chapel Hill.

The mean pain level score, as assessed by the McGill Pain Questionnaire, was 30, or moderate to severe, in 49% of both medically and surgically treated women who were referred to the university's pelvic pain clinic for evaluation of continued CPP.

Likewise, moderate to severe depression, as measured by the Beck Depression Inventory scale, was diagnosed in 22% of both groups.

Surgical treatment ranged from diagnostic laparoscopy to hysterectomy, and medical treatment consisted of pharmacotherapy, psychotherapy, and physical therapy.

One year later, the mean McGill Pain Questionnaire score had decreased from 30 to 23 in both groups. Overall, depression scores were unchanged in 48%, improved in 32%, and worsened in 20%. However, depression did not predict worse outcome, Dr. Lamvu said. “We were surprised, but that is what we found. Outcomes were similar with both treatment types.”

Dr. Lamvu said she is planning further studies that will focus on physician-patient relationships, which may influence outcomes for pain treatment in women with CPP. “There may actually be some biological reasons for the way women respond to pain management after they have had interactions with a physician, so we will be studying that next.”

In another study on CPP presented at the meeting, Jane Leserman, Ph.D., also of the University of North Carolina, reported that breaking CPP into diagnostic subtypes may be useful in guiding therapy.

A chart review and questionnaire of 306 consecutive patients who presented to the university's pelvic pain clinic found the following most common diagnostic subtypes:

▸ Diffuse abdominal pelvic pain (43%).

▸ Vulvovaginal pain (20%).

▸ Cyclic pain (10%).

▸ Neuropathic pain (9%).

▸ Nonlocal pain (7%).

▸ Trigger point pain (6%).

▸ Palpation of the uterus (6%).

Patients who had diffuse abdominal pelvic pain had worse physical functioning and more pain than did patients with vulvovaginal, cyclic, neuropathic, and fibroid pain.

Those with vulvovaginal pain had the best physical functioning and the least pain, Dr. Leserman said.

Slightly less than half of the patients (48%) reported having been sexually or physically abused.

The women also scored at or below the 25th percentile on mental and physical health measures compared with the U.S. female population as a whole, Dr. Leserman said.

Endometriosis, which was present in 21% of the women, was not found to be significantly related to any measure of mental or physical health status, Dr. Leserman said.

“It seems like the diagnostic subtypes were better predictors of health status than was endometriosis. Perhaps the degree of diffuseness of pain and the cyclic nature of pain may help guide us in the future in terms of treatment,” she said.

ORLANDO — Women with chronic pelvic pain responded as well to medical treatment as they did to surgery, according to a prospective, observational cohort study of 370 patients that was carried out 1 year after treatment, Dr. Georgine Lamvu said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.

About 15% of women report having chronic pelvic pain (CPP) in their lifetime. It is the primary indication for 12% of hysterectomies and 40% of laparoscopies and costs over $2 billion annually, said Dr. Lamvu of the University of North Carolina at Chapel Hill.

The mean pain level score, as assessed by the McGill Pain Questionnaire, was 30, or moderate to severe, in 49% of both medically and surgically treated women who were referred to the university's pelvic pain clinic for evaluation of continued CPP.

Likewise, moderate to severe depression, as measured by the Beck Depression Inventory scale, was diagnosed in 22% of both groups.

Surgical treatment ranged from diagnostic laparoscopy to hysterectomy, and medical treatment consisted of pharmacotherapy, psychotherapy, and physical therapy.

One year later, the mean McGill Pain Questionnaire score had decreased from 30 to 23 in both groups. Overall, depression scores were unchanged in 48%, improved in 32%, and worsened in 20%. However, depression did not predict worse outcome, Dr. Lamvu said. “We were surprised, but that is what we found. Outcomes were similar with both treatment types.”

Dr. Lamvu said she is planning further studies that will focus on physician-patient relationships, which may influence outcomes for pain treatment in women with CPP. “There may actually be some biological reasons for the way women respond to pain management after they have had interactions with a physician, so we will be studying that next.”

In another study on CPP presented at the meeting, Jane Leserman, Ph.D., also of the University of North Carolina, reported that breaking CPP into diagnostic subtypes may be useful in guiding therapy.

A chart review and questionnaire of 306 consecutive patients who presented to the university's pelvic pain clinic found the following most common diagnostic subtypes:

▸ Diffuse abdominal pelvic pain (43%).

▸ Vulvovaginal pain (20%).

▸ Cyclic pain (10%).

▸ Neuropathic pain (9%).

▸ Nonlocal pain (7%).

▸ Trigger point pain (6%).

▸ Palpation of the uterus (6%).

Patients who had diffuse abdominal pelvic pain had worse physical functioning and more pain than did patients with vulvovaginal, cyclic, neuropathic, and fibroid pain.

Those with vulvovaginal pain had the best physical functioning and the least pain, Dr. Leserman said.

Slightly less than half of the patients (48%) reported having been sexually or physically abused.

The women also scored at or below the 25th percentile on mental and physical health measures compared with the U.S. female population as a whole, Dr. Leserman said.

Endometriosis, which was present in 21% of the women, was not found to be significantly related to any measure of mental or physical health status, Dr. Leserman said.

“It seems like the diagnostic subtypes were better predictors of health status than was endometriosis. Perhaps the degree of diffuseness of pain and the cyclic nature of pain may help guide us in the future in terms of treatment,” she said.