PELVIC PAIN Flashcards
What is pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage (IASP).
What is organic pain?
Pain with an identifiable specific cause.
What is functional pain?
Pain without a clearly identifiable cause that is exacerbated by psychosocial factors.
What is the commonest site of pain in O&G?
The pelvis.
How is pelvic pain defined?
Pain confined to the pelvic location and severe enough to cause functional disability or lead to medical care.
How is pelvic pain classified based on duration?
Acute pelvic pain and chronic pelvic pain.
What is acute pelvic pain?
Pelvic pain of less than 6 months duration that significantly affects daily function and quality of life.
What is chronic pelvic pain?
Pelvic pain of more than 6 months duration that significantly affects daily function and quality of life.
What are some common gynecological causes of acute pelvic pain?
Pelvic inflammatory disease, endometritis, salpingitis, oophoritis, tubo-ovarian abscess, ectopic pregnancy, uterine fibroids, ovarian accidents, miscarriages, mittelschmerz, dysmenorrhea, adenomyosis.
How is chronic pelvic pain defined?
Pelvic pain lasting at least 6 months, not occurring exclusively with menstruation or intercourse, and not associated with pregnancy.
What percentage of women aged 18 to 50 have chronic pelvic pain?
15-20%.
What percentage of gynecological visits are due to chronic pelvic pain?
10-30%.
What percentage of hysterectomies are due to chronic pelvic pain?
12-19%.
What percentage of laparoscopy indications are due to chronic pelvic pain?
0.3
What are the major causes of chronic pelvic pain?
No apparent pathology (33%), endometriosis (33%), pelvic adhesions or chronic PID (25%), other causes (9%).
What are some gynecological causes of chronic pelvic pain?
Endometriosis, adhesions, chronic PID, pelvic congestion syndrome, recurrent hemorrhagic ovarian cysts, myomata uteri, uterine retroversion, adenomyosis, malignancy.
What are some genitourinary causes of chronic pelvic pain?
Chronic urinary retention, urethral syndrome, interstitial cystitis.
What are some gastrointestinal causes of chronic pelvic pain?
Penetrating neoplasms, irritable bowel syndrome, irritable bowel disease, partial small bowel obstruction, diverticulitis, hernia.
What are some neuromuscular causes of chronic pelvic pain?
Nerve entrapment syndrome, generalized myofascial pain syndrome, fibromyalgia.
What are some psychological causes of chronic pelvic pain?
Depression, PTSD, anxiety disorders, personality disorder.
What aspects should be covered in the history of pelvic pain?
Detailed, focused, pelvic review of systems, psychosocial review.
What are some important psychological factors to evaluate in chronic pelvic pain?
History of traumatic events, abuse, depression, anxiety, previous therapy/counseling, impact on daily life.
How is pain assessed in pelvic pain cases?
Subjective assessment using different rating scales.
What are some commonly used pain scales?
Verbal rating scales, Visual Analogue Scale (VAS),
Complex pain assessment: Brief Pain Inventory (BPI), McGill Pain Questionnaire.
What examinations are important in assessing pelvic pain?
General examination, musculoskeletal examination, detailed abdominal and pelvic examination.
What laboratory investigations are useful for pelvic pain?
FBC, ESR, E/U/Cr, urinalysis, urine M/C/S, ECS & HVS M/C/S.
What imaging modalities can be used for pelvic pain evaluation?
Transvaginal or abdominopelvic ultrasound, abdominopelvic CT, MRI, diagnostic laparoscopy.
What pharmacologic therapies are used in the management of pelvic pain?
Hormonal manipulation (ovulation suppression (OCP, DMPA, leuprolide), suppression of menses(DMPA, high dose intrauterine progestins)
).
Anti-inflammatory: NSAIDs
Analgesics: Non-narcotic (ASA, Acetominophen), Narcotic – use cautiously (tolerance, dependence)
SSRIs e.g. fluoxetine, paroxetine
TCAs e.g. amitriptylin, anti-epileptics e.g. carbamazepine
Especially for pain with neuropathic components
What are some surgical therapies for the management of pelvic pain?
Unilateral adnexectomy, hysterectomy + BSO, presacral neurectomy, LUNA, uterine suspension, lysis of adhesions, resection/ablation of endometriosis.
What are some anesthetic therapies used in pelvic pain management?
Acupuncture, nerve blocks, trigger point injections.
