scholarly journals Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
John Jarrell ◽  
Maria Adele Giamberardino ◽  
Magali Robert ◽  
Maryam Nasr-Esfahani
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Trigger Points ◽  
Cross Sectional ◽  
Myofascial Trigger Points ◽  
Predictive Values ◽  
Pain Thresholds ◽  
Somatic Pain ◽  
Cutaneous Allodynia

Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.

Painful Myofascial Trigger Points and Pain Sites in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

2009 ◽  
Vol 182 (6) ◽  
pp. 2753-2758 ◽  
Author(s):  
Rodney U. Anderson ◽  
Timothy Sawyer ◽  
David Wise ◽  
Angie Morey ◽  
Brian H. Nathanson
Keyword(s):  
Pelvic Pain ◽  
Chronic Prostatitis ◽  
Chronic Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Trigger Points ◽  
Pelvic Pain Syndrome ◽  
Myofascial Trigger Points

scholarly journals A PROSPECTIVE CROSS SECTIONAL OBSERVATIONAL STUDY OF CHRONIC PELVIC PAIN IN ADOLESCENTS TRANSVAGINAL ULTRASOUND VERSUS LAPAROSCOPY

2021 ◽  
pp. 1-3
Author(s):  
Supriya Kumari ◽  
Surya Narayan ◽  
Kumudini Jha ◽  
Debarshi Jana
Keyword(s):  
Observational Study ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Transvaginal Ultrasound ◽  
Cross Sectional ◽  
Predictive Values ◽  
Medical College ◽  
Kappa Test ◽  
Laparoscopic Evaluation ◽  
Good Agreement

Background: Chronic pelvic pain (CPP)is cyclic or noncyclic, intermittent or constant discomfort in the pelvic region for at least 6 months. It is a common complaint in female adolescents that may be overlooked. Objective: To evaluate CPP in adolescents using transvaginal ultrasound (TVS) and laparoscopy. Study design: This is a prospective cross sectional observational study conducted at Obstetrics and Gynaecology Department of Darbhanga Medical College and Hospital, Laheriasarai, Bihar. A total of 100 adolescents with CPP were evaluated by TVS and laparoscopy and findings were analyzed. Results: The mean age of adolescents was 17 ± 3.5 the majority were parous (51%), rural (69%) and low social class (65 %). Diffuse pelvic pain was present in (62%), Dysmenorrheain (61%), deep abdominal and pelvic tenderness in (55% and 80% respectively). TVS was normal in (40%) andabnormalin (60%). Laparoscopic evaluation was normal in (29%)and abnormal in(71%) in the form of tubo- ovarian masses (19%),endometriosis (18%) ovarian cysts (9%), adenomyosis (8%), Adhesions (6%), PID and RVF uterus (4% for each), subserous fibroid and pelvic congestion (1% for each). sensitivity and specificity of TVS were (81.7% and 93.1% respectively). Positive and negative predictive values were 96.7% and 67.5% respectively. Kappa test between TVS and laparoscopy showed good agreement (kappa = 0.67). Conclusions: Good agreement was found between TVS and laparoscopy, however, laparoscopy is considered as a gold standard tool in evaluating adolescent CPP because of distinct advantages in terms of sensitivity and negative predictive value.

Female Pelvic Pain: Assessment

2020 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 13 figures, 5 tables and 60 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

Female Pelvic Pain: Assessment

2018 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 12 figures, 2 tables and 57 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

scholarly journals Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

2022 ◽  
Vol 12 (1) ◽  
pp. 101
Author(s):  
Augusto Pereira ◽  
Manuel Herrero-Trujillano ◽  
Gema Vaquero ◽  
Lucia Fuentes ◽  
Sofia Gonzalez ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Conventional Therapy ◽  
Chronic Pelvic Pain ◽  
Myofascial Pain ◽  
Visceral Pain ◽  
University Hospital ◽  
Common Symptom ◽  
Rectal Pain ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.

Pain thresholds in women with chronic pelvic pain

2014 ◽  
Vol 26 (4) ◽  
pp. 253-259 ◽  
Author(s):  
Maria A. Giamberardino ◽  
Claudio Tana ◽  
Raffaele Costantini
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Pain Thresholds

Patient with Chronic Pelvic Pain from Endometriosis

2016 ◽  
Author(s):  
Jianguo Cheng ◽  
Yoon-Jeong Cho
Keyword(s):  
Pelvic Pain ◽  
Hormonal Therapy ◽  
Chronic Pelvic Pain ◽  
Reproductive Tract ◽  
Visceral Pain ◽  
Surgical Removal ◽  
Antiinflammatory Drugs ◽  
Persistent Symptoms ◽  
Incomplete Removal ◽  
Management Procedures

Endometriosis, a chronic and progressive condition characterized by the presence of endometrial tissue outside the uterus, accounts for about one third of the cases of chronic pelvic pain in women. Pain in endometriosis may be due to nociceptive, inflammatory, and/or neu­ropathic mechanisms. The clinical presentation is often variable between patients, and diagnostic laparoscopy for visualization and biopsy of lesions is the gold standard for diagnosis. The treatment may consist of two elements: chronic pelvic pain itself as a diagnosis and endometriosis as a disease. Hormonal therapy is used to reduce the amount of estrogen and hence reduce symptoms such as pelvic pain and dysmenorrhea. In patients with severe endometriosis, surgical removal of lesions, adhesions, and cysts and restoration of pelvic anatomy may be preferred. Both hormonal and surgical treatments have been shown to be effective in decreasing pain symptoms associated with endometriosis. A variety of analgesics, including nonsteroidal antiinflammatory drugs, opioids, tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, and antiepileptic drugs, have been used to ameliorate pain in endometriosis, with varying degrees of success. In patients with persistent symptoms, interventional pain management procedures may be performed to target the visceral and somatic organs and their innervations. Infertility is the most common complication of endometriosis. Between 10 and 20% of women with endometriosis have recurrence of the disease regardless of the treatment they receive. The recurrence of pain may be due to remodeling of the central nervous system, the role of the reproductive tract in reactivating pain, and incomplete removal or recurrence of lesions. This review contains 2 tables and 52 references  Key words: chronic abdominal pain, chronic pelvic pain, dyschezia, dysmenorrhea, dyspareunia, endometrioma, endometriosis, hormonal therapy, infertility, retrograde menstruation, visceral pain 

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