Chronic Pelvic Pain: Overview of Evaluation and Treatment

In: Chronic Pelvic Pain · 1998 · pp. 1–6 · doi:10.1007/978-1-4612-1752-7_1 · W1842024335
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This paper provides an overview of chronic pelvic pain, discussing its varied presentation, associated symptoms, and potential origins from different organ systems, often complicated by prior surgeries.

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This chapter provides an overview of the evaluation and treatment of chronic pelvic pain, describing how pelvic pain can vary widely in location (from diaphragm to knees) and associated symptoms (e.g., nausea, dizziness, migraine) and can originate from multiple systems including the reproductive system, nerves, bowel, bladder, neuromuscular structures, connective tissue, or psychological factors. It notes that patients may have prior chronic diseases such as pelvic inflammatory disease and endometriosis and that later-stage pain may involve an iatrogenic component from multiple surgeries, with pain patterns potentially cyclic/noncyclic and influenced by activity or diet. A major caveat is that the text functions as a general review rather than presenting original study data or specific comparative evidence for particular diagnostic or therapeutic approaches. Relevance to endometriosis: endometriosis is explicitly mentioned as part of the patient history of chronic abdominopelvic pain, though the chapter’s main focus is an overall evaluation and treatment framework for chronic pelvic pain.

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Abstract

The sensation of pain varies greatly among individuals, with one person’s nuisance being another individual’s agony.1 Patients present to the gynecologist with pain that can be located anywhere from the diaphragm to the knees. Furthermore, this pain may be complicated by the fact that it is associated with nausea, vomiting, diarrhea, dizziness, palpitations, syncope, and migraine headache. The latter types of dysfunction may be associated with aberrant prostanoid and/or sex steroid production. Pelvic pain may come from bone, the neuromuscular system, nerve compression or irritation, the bowel, the bladder, connective tissue, the reproductive system, or the psyche.2–4 The pain may be point specific or diffuse, it may be intermittent or continuous, cyclic or noncyclic, or related to activity and exercise, as well as diet. The patient who presents with chronic abdominopelvic pain may have a history of chronic disease, such as pelvic inflammatory disease, endometriosis, and has probably undergone multiple surgical procedures. Therefore, in the later stages, most abdominal pains have an iatrogenic underlying component that has been introduced into the situtation as a result of surgery.56 Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

References

Bonica JJ. General considerations of chronic pain. In Bonica JJ, ed. The management of pain. Lea & Febiger, Philadelphia, 1990, p 180. Kaplan C, Lipkin M Jr., Gordon GH. Somatization in primary care: patients with unexplained and vexing medical complaints. J Gen Int Med 1988; 3: 177. Katon W, Lin E, Von Korff M, et al. Somatization: a spectrum of severity. Am J Psychiatry 1991; 148: 34. Quill TE. Somatization: one of medicine’s blide spots. JAMA 1985; 254: 3075. Goldstein DP. Acute and chronic pelvic pain. Pediatr Clin North Am 1989; 36: 573. Steege JF, Stout AL, Somkuti SG. Chronic pelvic pain: toward an integrative model. J Psychosom Obstet Gynecol 1991, in press. Brownlee HJ, ed. Symposium on management of acute nonspecific diarrhea. Am J Med 1990; 88(6A): 1S. Johnason JF, Sonnenberg A, Koch TR. Clinical epidemiology of chronic constipation. J Clin Gastroenterol 1989; 11: 525. Wald A, Hinds JPJ, Caruana BJ. Psychological and physiological characteristics of patients with severe idiopathic constipation. Gastroenterology 1989; 97: 932. Freidman G. Treatment of the irritable syndrome. Gastroenteriol Clin North Am 1991; 20: 325. Klein KB. Controlled treatment trials in the irritable bowel syndrome. A critique. Gastroenterology 1988; 94: 232. Eddy DM. Screening for colorectal cancer. Ann Intern Med 1990; 113: 373. International Association for the Study of Pain. Classification of chronic pain: Description of chronic pain syndrome s and definitions of pain states. In Merskey H. ed. Pain 1986; (Suppl3): Sl. Editor information Editors and Affiliations Rights and permissions Copyright information © 1998 Springer Science+Business Media New York About this chapter Cite this chapter Blackwell, R.E. (1998). Chronic Pelvic Pain: Overview of Evaluation and Treatment. In: Blackwell, R.E., Olive, D.L. (eds) Chronic Pelvic Pain. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1752-7_1 Download citation DOI: https://doi.org/10.1007/978-1-4612-1752-7_1 Publisher Name: Springer, New York, NY Print ISBN: 978-1-4612-7265-6 Online ISBN: 978-1-4612-1752-7 eBook Packages: Springer Book Archive

Keywords

- Irritable Bowel Syndrome - Pelvic Pain - Pelvic Inflammatory Disease - Short Bowel Syndrome - Chronic Pelvic Pain These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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