Nongynecologic somatic pathology in women with chronic pelvic pain and negative laparoscopy.
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This study identified nongynecologic somatic pathology in 47% of women with chronic pelvic pain and negative laparoscopy, with myofascial pain being most common and 75% of those diagnosed showing long-term improvement.
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Abstract
One hundred eighty-three women with chronic pelvic pain were referred to a multidisciplinary chronic pelvic pain clinic after negative laparoscopy. One hundred twenty-two of them completed a thorough medical and psychologic evaluation and were followed for a minimum of six months after completion of therapy. Occult somatic pathology was diagnosed in 57 women (47%), including 19 in whom coexistent psychopathology was diagnosed. Myofascial pain was the most common somatic diagnosis, followed by atypical cyclic pain (dysmenorrhea or mittelschmerz); gastroenterologic, urologic and infectious diseases; and pelvic vascular congestion. No plausible somatic etiology was apparent in the remaining 65 (53%) of the 122 referrals. Nongynecologic somatic pathology accounted for 34 (29%) and gynecologic pathology for 23 (19%) of the referrals, only 6 (5%) of whom ultimately required hysterectomy. Women with a somatic diagnosis were found to be significantly older than the remainder of the referral population. Long-term symptomatic improvement or resolution of pain was obtained in 43 (75%) of the 57 patients with somatic diagnoses. Coexistent psychopathology was found to correlate with a poorer long-term prognosis. Our findings underscore the importance of a multidisciplinary approach to evaluating and treating chronic pelvic pain in women and confirm that hysterectomy is indicated in this setting only rarely.
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- History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain 2014
- Musculoskeletal Causes of Chronic Pelvic Pain 2013
- Systematic Review of Therapies for Noncyclic Chronic Pelvic Pain in Women 2012
- Physical therapy management of female chronic pelvic pain: Anatomic considerations 2012
- Chronic Pelvic Pain Unrelated to Endometriosis 2012
- Importance of Pelvic Muscle Tenderness Evaluation in Women with Chronic Pelvic Pain 2009
- Physical therapy evaluation of patients with chronic pelvic pain: a controlled study 2008
- Gynecological Pain, Endometriosis, Visceral Disease, and the Viscero-Somatic Connection 2008
- Impact of diagnostic laparoscopy on the management of chronic pelvic pain 2006
- Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process 2002
- Hernia and Chronic Pelvic Pain in Women 2001
- Chronic pelvic pain: clinical dilemma or clinician's nightmare 2000
- Clinical knots Chronic pelvic pain: clinical dilemma or clinician's nightmare 2000
- Dolor pélvico crónico: enfoque multidisciplinario 2000
- Clinical Outcome in Female Patients with Pelvic Pain and Normal Pelvic US Findings 2000
- Chronic Pelvic Pain as a Somatoform Disorder 1999
- Indications for Hysterectomy: Have They Changed 1997
- The role of laparoscopy in the evaluation of chronic pelvic pain: Pitfalls with a negative laparoscopy 1996
- Chronic Pelvic Pain: Prevalence, Health-Related Quality of Life, and Economic Correlates 1996
- The effectiveness of hysterectomy for chronic pelvic pain 1995
- Irritable Bowel Syndrome and Chronic Pelvic Pain 1994
- Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain 1994
- SURGICAL MANAGEMENT OF CHRONIC PELVIC PAIN 1993
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