#218 Chronic Pelvic Pain Flashcards
What is the definition of chronic pelvic pain according to ACOG and the ReVITALize data definitions initiative?
Pain symptoms perceived to originate from pelvic organs/structures typically lasting more than 6months. It is often associated with negative cognitive, behavioral, sexual and emotional consequences as well as with symptoms suggestive of lower urinary tract, sexual, bowel, pelvic floor, myofascial, or gynecological dysfunction.
What % of women living with or seeking care for chronic pelivc pain meet criteria for major depression?
12-33%
According to the WHO in 2006, what is the prevalence of noncyclical chronic pelvic pain?
2.1-24%. An updated review in 2014 with more stringent definition reports range 5.7-26.6%
According to the WHO in 2006, what is the prevalence of dyspareunia?
8-21.1%
According to the WHO in 2006, what is the prevalence of dysmenorrhea?
16.8-81%
What are common contributors to chronic pelvic pain that are unrelated to the female reproductive system?
Irritable bowel syndrome, interstitial cystitis or painful bladder syndrome, pelvic floor muscle tenderness, and depression
What is the estimated prevalence of conditions unrelated to female reproductive system (IBS, IC, etc) in women with chronic pelvic pain?
20-60%
True or false. Central sensitization plays an important role in perpetuating chronic pain syndromes?
True
What is central sensitization in regards to chronic pain?
Central sensitization occurs when peripheral pain provokes an exaggerated response by the interneurons, which amplifies the pain perception
What is allodynia?
Feel pain in response to innocuous stimuli
What is hyperalgesia?
Heightened response to painful stimuli
What are common gynecologic conditions associated with chronic pelvic pain?
Adenomyosis, adnexal mass, chronic PID/chronic endometritis, endometriosis, leiomyoma, ovarian remnant syndrome, pelvic adhesions, vestibulitis, vulvodynia
What are common GI conditions associated with chronic pelvic pain?
Celiac disease, colorectal cancer and cancer therapy, diverticular colitis, IBD, IBS
What are common urologic conditions associated with chronic pelvic pain?
bladder cancer and cancer therapy, chronic or complicated UTI, interstitial cystitis, painful bladder syndrome, urethral diverticulum
What are common neuromusculoskeletal conditions associated with chronic pelvic pain?
Fibromyalgia, myofascial syndromes (coccydynia, musculus levator ani syndrome), postural syndrome, abdominal wall syndromes (muscular injury, trigger point), neurologic (abdominal epilepsy, abdominal migraine, neuralgia, neuropathic pain)
What are common psychosocial conditions associated with chronic pelvic pain?
Abuse (physical, emotional, sexual), depressive disorder (MDD, dysthymia, substance-induced or medication-induced depressive d/o), anxiety disorders (GAD, panic d/o, social anxiety d/o, substance-induced), Somatic symptom d/o, substance use d/o
True or false: for chronic pelvic pain related to neuromusculoskeletal disorders, pain is reproducible on exam
True, with palpation of the affected muscle groups
What components of physical exam should be included when assessing a patient with chronic pelvic pain?
Palpation of the lower back, sacroiliac joints, pubic symphysis, as well as the abdomen and genitalia. Focal tenderness of the abdomen or pelvic floor can be found with a single digit examination or exam with cotton tipped swab
What is the FABER test (how to do it), and what is it used for?
Forced abduction external rotation of hip. Identifies hip, lumbar spine, or sacroiliac joint dysfunction or an iliopsoas spasm
What is a positive Carnett test result?
Tenderness that worsens or does not improve during an abdominal wall muscle contraction while examiner palpating abdomen
What is a negative Carnett test result?
Associated with visceral pain. Pain improves with abdominal muscle contraction during abdominal exam as muscle contraction allows abdominal wall to shield the viscera from examiner’s finger.
What referrals can be provided to a patient with myofascial and psychosocial causes and consequences of chronic pelvic pain and associated dyspareunia?
Pelvic floor physical therapy, sex therapy, or cognitive behavioral therapy, alone or in combination
True or false: SNRIs are recommended for patients with neuropathic chronic pelvic pain?
True
True or false: gabapentin and pregabalin are recommended for the treatment of neuropathic chronic pelvic pain?
True
True or false: treatment with neuropathic medications may improve the effectiveness of physical therapy and myofascial dysfunction by improving sensorineural tolerance of stimuli
True
What is the mechanism of action of gabapentin and pregabalin?
Calcium channel alpha 20delta ligand medications
True or false: opioids are an important tool for management of chronic pelvic pain?
False. Opioids are not recommended for the treatment of chronic pelvic pain.
With trigger point injections for chronic pelvic pain, what is substance is injected?
Saline, anesthetic, steroids, or opioids
For what etiologies of chronic pelvic pain are trigger point injections helpful for?
Hyperalgesic muscle cutaneous nerve entrapment or fascial trigger point. Pelvic floor muscle spasm refractor to pelvic floor PT and medications.
True or false: LSC uterosacral nerve ablation improves pain scores in patient with chronic pelvic pain
False
True or false: acupuncture reduces pain and opioid use in patients with chronic musculoskeletal pain
True
What is the role of laparoscopic lysis of adhesions in chronic pelvic pain?
The routine use of laparoscopic adhesiolysis is not recommended for the management of chronic pelvic pain. Lack of evidence of benefit. Not helpful for treatment of chronic pelvic pain after visceral gynecologic causes (such as endometriosis, adenomyosis, and adnexal disorders)
