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PubMed1994

Pain rehabilitation. 3. Cancer pain, pelvic pain, and age-related considerations.

This self-directed learning module highlights assessment and therapeutic options in the management of cancer pain, pelvic pain, and the pain problems of the elderly and children. It is part of the chapter on pain rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article delineates causes of cancer pain, discusses strategies for approaching each specialized population, and provides specific clinical examples to illustrate management issues, with emphasis on prevention. New advances include understanding the pain experience in children and elderly adults; investigation of psychosocial aspects of pelvic pain; and use of patient-controlled analgesia, opioids, and multimodality techniques for acute, perioperative, and chronic pain in these age groups.

Adult↗

PubMed2000

Use of the McGill Pain Questionnaire to compare women with vulvar pain, pelvic pain and headaches.

OBJECTIVE: To assess differences between women with three distinct types of chronic pain conditions using a modified McGill Pain Questionnaire. STUDY DESIGN: Data by self-administered questionnaire were collected on patients presenting to the University of Michigan Medical Center with chronic vulvar pain (144 patients), pelvic pain (198 patients) or headaches (130 patients). Data for analysis included: patient demographics, duration of pain and modified McGill Pain Questionnaire scores. Univariate and multivariate analyses were performed. RESULTS: Patients with vulvar pain had more formal education (P < .001), were more likely to be married (P < .001) and were less likely to be African American (P = .003) as compared to those with chronic pelvic pain and headaches. Chronic pelvic pain patients were younger than those in the other two groups (P = .002), and headache patients were likely to have had their chronic pain for a shorter duration than those with vulvar or pelvic pain (P < .001). Patients with vulvar pain had lower total scores on the McGill Pain Questionnaire as well as on the four subsets of variables: affective, sensory, cognitive and miscellaneous indexes (P < .001). They also chose fewer words to describe their symptoms from the 20-word lists (P < .001) and had lower average scores in each of the 20 categories as compared to the other two groups (P < .0001). Controlling for age, ethnicity and marital status did not alter this significance. CONCLUSION: Patients with vulvar pain were a unique groups when compared to other chronic pain populations. Evaluation of the demographics and McGill Pain Questionnaire scores confirmed the distinct qualities of women with vulvar pain.

Age Factors↗

PubMed1990

Pelvic pain--pelvic congestion or the irritable bowel syndrome?

Chronic unexplained pelvic pain in women may arise from either gynaecological or colonic causes. 35 women with pelvic congestion were interviewed with regard to their bowel habits and compared with a population with the irritable bowel syndrome. The results suggest that pelvic congestion and the irritable bowel syndrome are two distinctly different conditions, both of which may cause chronic lower abdominal pain in women.

Abdominal Pain↗

PubMed2003

Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease.

OBJECTIVE: To evaluate the morbidity from chronic pelvic pain after pelvic inflammatory disease (PID). METHODS: A total of 547 women were studied as part of the PID Evaluation and Clinical Health (PEACH) Study. Chronic pelvic pain was defined as pelvic pain reported at two or more consecutive interviews conducted every 3 to 4 months through 32 months and was graded as mild to moderate (low pain intensity) or moderate to severe (high pain intensity). Mean Medical Outcomes Study Short Form (SF-36) scores at 32 months were compared by chronic pelvic pain categories. RESULTS: The mean (+/- standard deviation) physical health composite scores and mental health composite scores from the SF-36 were progressively lower among women with increasing grade of chronic pelvic pain (physical health composite scores: no chronic pelvic pain = 87.3 +/- 10.7, mild to moderate chronic pelvic pain = 79.1 +/- 14.6, moderate to severe chronic pelvic pain = 73.6 +/- 16.0, P < .01; mental health composite scores: no chronic pelvic pain = 78.7 +/- 13.6, mild to moderate chronic pelvic pain = 69.1 +/- 15.8, moderate to severe chronic pelvic pain = 67.5 +/- 17.1, P < or = .01). Individual physical function, bodily pain, general health, vitality, social function, and mental health scores were also significantly lower among women with chronic pelvic pain and by increasing grade of pain intensity. CONCLUSION: Chronic pelvic pain after PID is associated with reduced physical and mental health.

Adolescent↗

PubMed2005

A life of pelvic pain.

Pelvic pain associated with menstruation, i.e., dysmenorrhea, is a chronic pelvic pain that not only interferes with a woman's wellbeing for a large part of her life but also often co-occurs with other chronic painful conditions such as interstitial cystitis and irritable bowel syndrome and others. Little has been known about mechanisms underlying these chronic pelvic pains. This paper reviews 37 years of research in my laboratory at Florida State University on such mechanisms. Our research, mostly on rats, has contributed to the following findings: (1) Female reproductive organs are innervated in a topographic fashion by afferents in the pelvic (vagina/cervix) and hypogastric (cervix/uterine horn) nerves. (2) The input contributes to uterine and vaginal perceptions (nociception) that are modified by reproductive status. (3) Throughout the CNS, neurons responsive to stimulation of the reproductive tract also respond to stimulation of skin and other internal organs, in a manner modifiable by reproductive status and peripheral pathophysiology. (4) This dynamic physiological convergence may reflect extensive anatomical divergence of and interconnections between pathways entering the CNS via gateways through the spinal cord, dorsal column nuclei, and solitary nucleus. (5) The convergence also indicates the existence of extensive cross-system, viscero-visceral interactions within the CNS, that, while organized for coherent bodily functioning, serves as a substrate by which pathophysiology in one organ can influence physiology and responses to pathophysiology in other organs. (6) Some cross-system effects observed so far include: (a) Bladder inflammation reduces the rate of uterine contractions and the effects of drugs on the uterus. (b) Colon inflammation produces signs of inflammation in the otherwise healthy bladder and uterus. (c) A surgical model of endometriosis produces vaginal hyperalgesia, exacerbates pain behaviors induced by a ureteral stone, and reduces volume voiding thresholds if the bladder. These cross-system effects, which likely involve CNS mechanisms, likely also underlie co-occurrence of painful clinical conditions. Research continues on details of these mechanisms and their relevance for clinical diagnosis and therapy. None of this work could have been done without collegial support of colleagues and technical staff at Florida State University.

Animals↗

PubMed1998

How should we approach the management of pelvic pain?

Pelvic pain is a common debilitating condition. Most investigations are invasive, expensive and usually negative. Although a positive diagnosis of endometriosis justifies a recognized treatment programme, the majority of women with negative investigations are left without a diagnosis and often accused of psychological abnormalities. The reasons for the negative investigations are just as likely to be due to the inadequate techniques of the operator as the lack of pathological signs. The early use of menstrual suppression with GnRH analogue allows pain relief sooner in the majority of sufferers and separates those with pain related to the menstrual cycle, from whatever cause, from those whose pain is not related to pelvic physiology and who would not benefit from further medication or operative therapy. The majority, who have obtained relief from the analogue therapy, then have time to discuss alternative long-term treatments without the feeling of desperation that chronic monthly pelvic pain can produce.

Endometriosis↗

PubMed1999

Pelvic pain.

Pelvic pain is a common symptom in the adolescent female. Acute pain may represent a life-threatening situation and torsion, ectopic pregnancy, and PID must be considered. For the young patient who presents with chronic pelvic pain, a multidisciplinary approach is essential to facilitate diagnosis and management. Whenever possible, organic disease such as endometriosis, adhesions, and obstructive malformations should be identified and treated as indicated. Developing a treatment team, recognizing psychosocial and environmental factors, and encouraging long-term relationships are critical components in the care of these patients and in the prevention of recurrent symptom formation and future disability.

Acute Disease↗

PubMed2005

Low back pain and pelvic pain during pregnancy: prevalence and risk factors.

STUDY DESIGN: Cross-sectional study. Women giving birth at one of two hospitals of northern Sweden from 1 January 2002 until 30 April 2002 were invited to fill in a questionnaire on their obstetric and gynecological history, actual pregnancy, and delivery. OBJECTIVE: The aim of this study was to investigate prevalence and risk factors for low back pain and pelvic pain (LBPP) during pregnancy. SUMMARY OF BACKGROUND DATA: Although low back pain and pelvic pain during pregnancy is a most common complication of pregnancy, its etiology is unknown and the pathophysiology is poorly understood. METHODS: The sample was analyzed by calculating the prevalence of LBPP during pregnancy. Univariate and multivariate logistic regression was performed to calculate odds ratio (OR) and its 95% confidence intervals (CI) where applicable. Parametric and nonparametric testing was used to establish differences between groups. RESULTS: The response rate was 83.2% (N = 891). The prevalence of LBPP during pregnancy was 72%. Most cases reported both anterior and posterior pain. Increasing parity, history of hypermobility, and reported periods of amenorrhea were risk factors for LBPP. Women with LBPP had significantly higher prepregnancy weight, end-pregnancy weight, and prepregnancy and end-pregnancy body mass index. Age at menarche and use of oral contraceptives were not associated with LBPP. Nonrespondents were of the same age and parity as respondents. CONCLUSIONS: A majority of pregnant women report LBPP. Parity, LBPP during a previous pregnancy, body mass index, a history of hypermobility, and amenorrhea are factors influencing the risk of developing LBPP during pregnancy.

Adult↗

PubMed1998

Reproductive disorders associated with pelvic pain.

Pelvic pain is common in adolescents and can result from a number of physiological and pathological etiologies, both gynecologic and nongynecologic in origin. The evaluation, diagnosis, and management of these conditions involve both medical and surgical approaches. In this review, the authors present a comprehensive approach to the care of adolescents with pelvic pain associated with dysmenorrhea, endometriosis, and obstruction of the genital tract.

Adolescent↗

PubMed2004

The role of ultrasound in the management of women with acute and chronic pelvic pain.

Pelvic pain (acute or chronic) is a common symptom in women of all ages. Ultrasonography is the least invasive investigative tool available to the clinician. Transvaginal probes produce high-resolution images of the pelvic organs, providing reliable and reproducible information without the need for a full bladder. Common gynaecological pathology involving the uterus, Fallopian tube and/or the ovary can be diagnosed with confidence. Non-gynaecological pathology involving the bowel can also be diagnosed with accuracy, and will often be seen in the acute gynaecological setting. Ultrasound can be used to triage patients into appropriate treatment protocols, enabling the clinician to avoid surgery in some cases and select the correct surgical approach in others. If the patient has a negative pregnancy test, no pelvic tenderness on bimanual examination and a normal scan, significant pathology is very unlikely.

Acute Disease↗

PubMed2005

Postpartum pelvic pain--the "pelvic joint syndrome": a follow-up study with special reference to diagnostic methods.

BACKGROUND: The etiology of pelvic joint syndrome (PJS) is not fully clarified. As a consequence, there is a lack of diagnostic methods to confirm the diagnosis, which today is mainly based on medical history. OBJECTIVE: The aim of this study was to examine women with PJS using various diagnostic methods. The hypothesis is that there are characteristics in this group of women that separate them from women who only suffer from pelvic pain during pregnancy and shortly after delivery, or healthy women. METHODS: Fifty-eight women participated in this follow-up study--twenty-one with PJS, 17 women who suffered from pelvic pain during pregnancy and shortly after delivery, and 20 controls with no history of pregnancy-induced pelvic pain. Clinical examination, gynecologic examination, psychological tests, spine X-ray, magnetic resonance imaging (MRI), blood samples, and urine dipsticks were performed. RESULTS: Clinical examination showed significant differences with regard to provocative tests and tenderness in the muscles and ligaments in the low back and the pelvis. Furthermore, psychological testing showed bad coping strategies when women with PJS were compared with those of the two control groups. However, no diagnostic method could explicitly differentiate between women with PJS and those of the two control groups. Thus, there was no significant difference in MRI, X-ray, blood or urine sample analysis. CONCLUSIONS: Women with PJS have positive provocative tests and ligament and muscular tenderness. Bad coping strategies might be an explanation why these women develop PJS.

Adult↗

PubMed2005

Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy.

AIMS: The aim of the study was to investigate physical activity prior to pregnancy, occupation, and treatment in women with low back pain and pelvic pain (LBPP) during pregnancy. METHODS: All women who gave birth at two hospitals in northern Sweden from 1 January 2002 to 30 April 2002 were invited to complete a questionnaire on their obstetric and gynaecological history, actual pregnancy, and delivery. The sample was analysed with calculation of odds ratios (OR) and their 95% confidence intervals (CI). Cox regression analyses were performed. Women with LBPP reporting a pain maximum of 7 or more on a visual analogue scale (0-10 cm) were considered to have "high pain score LBPP" (hps-LBPP). RESULTS: The response rate was 83% (n = 891). A higher number of years of regular leisure physical activity (RLPA) decreased the risk of LBPP during pregnancy. The risk of hps-LBPP was increased for women who characterized their occupation as "mainly active" (OR = 2.0, 95% CI: 1.1-3.5) and "physically demanding" (OR = 1.9, 95% CI: 1.1-3.2). Visiting a physician as a result of LBPP was reported by 46.2%, and the mean number of visits was 2.0. One-third of women with LBPP had received treatment, as had half of women with hps-LBPP. CONCLUSIONS: A higher number of years of previous RLPA decreases the risk of LBPP during pregnancy. Occupations described as "mainly active" and "physically demanding" are associated with increased risk of hps-LBPP during pregnancy.

Adolescent↗

PubMed2006

BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy.

Low back pain and pelvic pain (LBPP) is common during pregnancy and up to 40% of women still have symptoms half a year after delivery. The aim of the study was to investigate determinants and the prevalence of persistent LBPP after pregnancy in a Swedish cohort. In a previous study 891 women had responded to a questionnaire on risk factors and prevalence of LBPP during pregnancy. Altogether 72% (n=639) of the women had reported LBPP during pregnancy. These respondents were sent a second questionnaire at approximately 6 months after delivery. The response rate was 72.6% (n=464). Independent t-test and Pearson's chi-squared test were used to test the difference between the two groups. In response to the questionnaire, 43.1% of the women reported persistent LBPP 6 months after delivery. Women with persistent LBPP after pregnancy had had significantly earlier onset of pain during pregnancy, higher maternal age, higher body mass index (BMI), and assessed a higher level of pain due to LBPP during pregnancy and after pregnancy, and included a higher proportion of women with joint hyper-mobility. In summary, recurrent or continuous LBPP is prevalent after pregnancy. BMI as well as hyper-mobility are prominent determinants of persistent LBPP after pregnancy. Level and onset of pain during pregnancy were strong predictors of persistent LBPP.

Adult↗

PubMed2006

Perceived health, sick leave, psychosocial situation, and sexual life in women with low-back pain and pelvic pain during pregnancy.

BACKGROUND: Low-back pain and pelvic pain (LBPP) is a common problem during pregnancy. The aim of the study is to investigate perceived health, sick leave, psychosocial situation, and sexual life among women experiencing LBPP during pregnancy. METHODS: All women who gave birth at one of two hospitals in northern Sweden from 1 January 2002 to 30 April 2002 were invited to complete a questionnaire on their obstetric history, pregnancy, and delivery. Univariate and multivariate logistic regressions were performed in order to calculate odds ratio (OR) and its 95% confidence interval (CI) where applicable. Pearson's chi-square test was performed where applicable. RESULTS: Most women were married or cohabiting (98%), and reported a 'very good' or 'good' partner relationship (96%) and a satisfying sexual life before pregnancy (91%). Only a few women reported perceived health as 'quite poor' or 'poor' before pregnancy (2%); however, this proportion increased during pregnancy (13%). In general, satisfying sexual life declined during pregnancy, which was also the case for the assessment of perceived health during pregnancy. Women with LBPP during pregnancy had an increased risk of reporting poor health (OR = 3.05, 95% CI = 1.70-5.46). Overall, 68% of women had been on sick leave, and 22% had received maternity allowance. Women with LBPP reported sick leave in 72% of the participants. CONCLUSIONS: LBPP demonstrates a negative impact on perceived health and sexual life during pregnancy. A great majority of pregnant women were on sick leave at some time during pregnancy. These consequences make LBPP a major public health issue.

Alcohol Drinking↗

PubMed1979

Diagnosis and treatment of nonorganic pelvic pain.

Pelvic pain was a prominent complaint among one third of 3,000 gynecology clinic patients. In 1.1% no causative disease could be found, and these patients failed to respond to routine therapy. Twenty of these patients who were studied minutely revealed some psychologic disorder including hysteria, passive-aggressive behavior, sociopathy, depression, and alcoholism. A strong tendency toward psychophysiologic disturbances in other systems was practically universal. Supportive psychotherapy, progressive relaxation training, and insight therapy were used. The greatest barrier to treatment success was refusal of patients to accept the psychologic factors in their total illness.

Adult↗

PubMedDate not supplied

[Chronicle of functional pain: chronic pelvic pains].

Chronic pelvic pains are one of the most frequent complaints in our daily gynecological practice, motivating at least a quarter of our consultants. As it usually puts the practitioner ill at ease in a difficult situation, we will try to understand the meaning of those particular pains, thus defined: a duration outlasting 6 months and the absence or the ineffective suppression of any organic--somatic--substratum. But every alleged pain is real and true, and we must work on that. To validate such suffering, to accept such repetitive complaints, can also be a therapeutic medical approach, even if it is less gratifying for the gynecologist, and certainly less customary.

Chronic Disease↗

PubMed2006

Does caesarean section negatively influence the post-partum prognosis of low back pain and pelvic pain during pregnancy?

Low back and pelvic pain (LBPP) is prevalent during pregnancy and also post-partum. The aetiology is poorly understood. The aim of this study was to investigate possible associations between epidural or spinal anaesthesia and caesarean section (CS) with persistent LBPP half a year after pregnancy. In a previous questionnaire study (n=891) altogether 639 (72%) women had reported LBPP during pregnancy. We sent these respondents a second questionnaire at approximately 6 months post-delivery. The response rate was 72.6% (n=464). The respondents were divided into three groups reporting 'no pain', 'recurrent pain' and 'continuous pain' in relation to LBPP 6 months after delivery. Pearson's chi-square test was used to test the difference between groups and logistic regression analysis was performed. Forty percent of the respondents had received epidural anaesthesia (EDA) or spinal anaesthesia during delivery and 18.5% of women had been delivered by CS. Epidural or spinal anaesthesia was not associated with persistent LBPP. There was no significant difference in CS rates between different sub-groups. The risk of persistent LBPP was increased three- to fourfold in women delivered by elective CS compared with women delivered by emergency CS. Epidural or spinal anaesthesia was not associated with risk of persistent LBPP. Elective CS was associated with an increased risk of persistent LBPP. However, the results must be interpreted with caution because of a relatively small study sample.

Anesthesia, Epidural↗

PubMed1992

Pelvic pain without pelvic organs.

We report on 4 patients with persistent, severe pelvic pain unresponsive to removal of the bladder, uterus, ovaries and fallopian tubes. Of the patients 3 had a diagnosis of interstitial cystitis and 1 had voiding dysfunction. We conclude that severe pelvic pain may not be responsive to the elimination of pelvic organs and alternative organ-preserving therapies should be considered.

Adult↗