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A - MSRA Gynaecology [8] > [41] Chronic Pelvic Pain > Flashcards

[41] Chronic Pelvic Pain Flashcards

1
Q

What is chronic pelvic pain?

A

The symptom of intermittent or chronic pelvic pain the lower abdomen or pelvis, of at least 6 months duration and not associated with pregnancy

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2
Q

What is the prevalence of CPP in women aged 15-73?

A

38/1000

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3
Q

What are the gynaecological causes of chronic pelvic pain?

A
  • Adenomyosis
  • Endometriosis
  • Adhesions
  • Pelvic venous congestion
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4
Q

What disorders caused by adhesions exist that cause chronic pelvic pain?

A
  • Trapped ovary syndrome

- Ovarian remnant syndrome

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5
Q

What happens in trapped ovary syndrome?

A

After hysterectomy the ovary becomes trapped within dense adhesions at the pelvic side wall

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6
Q

What happens in ovarian remnant syndrome?

A

A small piece of ovarian tissue, not removed during oophorectomy, becomes embedded within adhesions

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7
Q

What are the features of the pain caused by pelvic venous congestion?

A
  • Worst premenstrually and after prolonged periods of standing and walking
  • Dyspareunia often also present
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8
Q

What are the gastrointestinal causes of chronic pelvic pain?

A
  • IBS
  • Constipation
  • Hernia
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9
Q

What are the urological causes of chronic pelvic pain?

A
  • Interstitial cystitis
  • Urethral syndrome
  • Calculi
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10
Q

What are the MSK causes of chronic pelvic pain?

A
  • Fibromyalgia

- Trigger points

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11
Q

What are the neurological causes of chronic pelvic pain?

A
  • Nerve entrapment

- Neuropathic pain

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12
Q

What questions need to be asked in the history in chronic pelvic pain?

A

As for pelvic pain, but also including;

  • Detailed history of pain
  • Sexual history and future fertility wishes
  • Patients beliefs, wishes, and concerns about the pain
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13
Q

What needs to be included in a detailed history about the pain in chronic pelvic pain?

A
  • Events surrounding its onset
  • Site
  • Nature
  • Radiation
  • Time course
  • Exacerbating and relieving factors
  • Cyclicity
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14
Q

What examinations may be done in chronic pelvic pain?

A
  • Abdominal
  • Internal
  • Rectal
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15
Q

What should be looked for on abdominal examination in chronic pelvic pain?

A

As for acute pelvic pain, but also altered sensation and trigger points

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16
Q

When might a speculum examination not be appropriate in chronic pelvic pain?

A
  • History of vaginismus
  • Pain secondary to difficult smear
  • Abuse
17
Q

What should be looked for on internal examination in chronic pelvic pain?

A
  • Tension/trigger points in pelvic floor
  • Adnexal tenderness/mass
  • Cervical tenderness
18
Q

When should a rectal examination be performed in chronic pelvic pain?

A

Only if indicated, e.g. strong suspicion of rectal endometriosis

19
Q

What should investigations be guided by in chronic pelvic pain?

A

History and examination findings

20
Q

Why may a pain diary be useful in chronic pelvic pain?

A

May help clinician and woman make connections which had not previously been noted

21
Q

What can be a useful diagnostic tool with clearly cyclical chronic pelvic pain?

A

Trial with GnRH analogue

22
Q

How can the results of a trail with GnRH analogue be useful in cyclical chronic pelvic pain?

A

Women requesting total abdominal hysterectomy with bilateral salpingo-oophrectomy can be reassured that it may be a successful treatment if their pain is relieved with a GnRHa, however if their pain persists, they should be counselled that TAH&BSO is unlikely to remove their pain, and other causes should be explored

23
Q

What does treatment for chronic pelvic pain need to address?

A

Perpetuating and causative factors

24
Q

In what setting is treatment for chronic pelvic pain best achieved?

A

Within MDT

25
Q

When is success for chronic pelvic pain more likely to be successful?

A

It it fits within the woman own belief system

26
Q

What should be used to obtain appropriate pain relief in chronic pelvic pain?

A

Analgesic ladder

27
Q

What approach to analgesia might prevent emergency admissions with chronic pelvic pain?

A

Pre-emptive analgesia for predictable cyclical exacerbations

28
Q

Describe the role of opiates in the management of chronic pelvic pain?

A

May be required for severe, acute exacerbations, but if needed regularly, referral to specialist pain clinic should be made

29
Q

What analgesic options may be useful in chronic pelvic pain?

A
  • Neuropathic treatments

- Topical capsicum on abdominal skin

30
Q

What neuropathic treatments may be useful for analgesia in chronic pelvic pain?

A
  • Amitriptyline
  • Gabapentin
  • Pregabalin
31
Q

What hormonal treatment options can be used in chronic pelvic pain?

A
  • COCP
  • Progestagens
  • Danazol
  • GnRH analogues
32
Q

How long can a GnRHa be combined safely with low-dose HRT?

A

At least 2 years

33
Q

What % of women attending chronic pelvic pain clinics have MSK disorders?

A

75%

34
Q

What can improve CPP associated with MSK disorders?

A

Physiotherapy

35
Q

What are often perpetuating factors for CPP?

A

Psychosocial and psychosexual issues

36
Q

What can exploring psychosocial and psychosexual issues in a non-threatening environment achieve?

A

Help improve pain experience and help develop pain management pain

37
Q

What treatments may be useful for CPP associated with negative psychological features?

A

More specific treatments, such as CBT

38
Q

Is surgery a first line investigation/treatment for CPP?

A

No, always second line

39
Q

Why is surgery not a first line investigation/treatment for CPP?

A

Because patients with chronic pelvic pain are more likely to develop post-op pain, and negative laparoscopies reinforce abnormal health beliefs and psychological traits

A - MSRA Gynaecology [8] (52 decks)

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