Pelvic Pain Diagnosis and Management.

Pelvic Pain Diagnosis and Management. Fred M. Howard, MD, C. Paul Perry, MD, James E. Carter, MD, Ahmed M. El-Minawi, MD. Lippincott Williams & Wilkins. Philadelphia, PA, 2000, 528 pages, ISBN 0-7817-1724-8, $99.00. This is a comprehensive and heavily clinically oriented work on chronic pelvic pain (CPP). It is divided into three sections: Section I–Approach to the Patient with Chronic Pelvic Pain; Section II–Diagnoses and Treatment; and Section III–Chronic Pain. There are 57 chapters, covering history, examination, laboratory and imaging, as well as advanced diagnostic and treatment techniques. Subsections are divided into the reproductive system, gastrointestinal systems, urinary system, musculoskeletal system, systemic disease, metabolic disease, and other causes. The final section deals with the treatment of chronic pain as a diagnosis and the abuse factors in CPP. Most chapters deal with a definite diagnosis, such as adenomyosis, dyspareunia, ovarian remnant syndrome, constipation, colitis, fibromyalgia, porphyria, etc. About 40% of the book addresses gynecologic disease, and the remainder addresses other causes of pelvic pain. The book is very thorough and logical and discusses traditional and newer methods for the evaluation and treatment of CPP. References are numerous, some chapters having 100 or more cited. Illustrations, figures, and photos are black and white and superbly illustrate the points made. Each chapter offers a classical approach to the disease it describes as well as the opinions of the experienced clinicians who authored the book. Some of the diseases discussed–such as endosalpingiosis, ovarian retention syndrome, pelvic congestion syndrome, uterine malposition, etc.–are controversial as causes of CPP, but the authors clearly state this and discuss what is known about these entities. If the book has a weakness, it is that it is inclined too much toward the biological aspects of chronic pelvic pain and somewhat downplays the psychosociological perspectives. However, it clearly shows the magnitude of the problem, stating that at any given time most populations of women will have as many as 15% of their members classified as having chronic pelvic pain and that 33% of women have a history of chronic pelvic pain at some point. It states that nearly 40% of gynecologic diagnostic laparoscopies are done for CPP and that more than $2 billion annually is spent on direct and indirect costs for the treatment of CPP. In my opinion, this is the most comprehensive text available on CPP in women. For any clinician who wants to conscientiously evaluate and treat pelvic pain, this is the most useful reference he or she could own. I highly recommend it to obstetrician-gynecologists, health care providers concerned with women's health, and all trainees in this field. It is worth the investment of time and money to read and retain this book as a reference.