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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The "dynias" are a group of chronic, focal pain syndromes with a predilection for the orocervical and urogenital regions. They include glossodynia, carotidynia, vulvodynia, orchidynia, prostatodynia, coccygodynia, and proctodynia. In some cases, the dynias occur secondarily, but more often, despite an exhaustive evaluation, no etiology is found and in these remaining cases, the cause of the pain remains enigmatic. The controversy that surrounds this group of disorders, which ranges from questioning their existence to suggesting that they are purely psychosomatic, is counterbalanced by an extensive literature attesting to their organicity. The approach to the patient begins with acknowledging that the symptom is well described, searching for a secondary cause, and performing a careful psychologic assessment. Treatment is empirical and patients can often be helped with medications used to treat neuropathic pain, all the while providing psychologic support and exercising caution toward invasive and irreversible therapeutic procedures.
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PMID:The dynias. 887 59

Pain syndromes of the urogenital and rectal area are well described but poorly understood and underrecognized focal pain syndromes. They include vulvodynia, orchialgia, urethral syndrome, penile pain, prostatodynia, coccygodynia, perineal pain, proctodynia and proctalgia fugax. The etiology of these focal pain syndromes is not known. A specific secondary cause can be identified in a minority of patients, but most often the examination and work-up remain unrevealing. Although these patients are often depressed, rarely are these pain syndromes the only manifestation of a psychiatric disease. This review article presents an overview of the neuroanatomy of the pelvis, which is a prerequisite to trying to understand the chronic pain syndromes in this region. We then discuss the clinical presentation, etiology and differential diagnosis of chronic pain syndromes of the urogenital and rectal area and review treatment options. The current knowledge of the psychological aspects of these pain syndromes is reviewed. Patients presenting with these pain syndromes are best assessed and treated using a multidisciplinary approach. Currently available treatment options are empirical only. Although cures are uncommon, some pain relief can be provided to almost all patients using a multidisciplinary approach including pain medications, local treatment regimens, physical therapy and psychological support, while exercising caution toward invasive and irreversible therapeutic procedures. Better knowledge of the underlying pathophysioloigical mechanisms of the urogenital and rectal pain syndromes is needed to allow investigators to develop treatment strategies, specifically targeted against the pathophysiological mechanism.
Pain 1997 Dec
PMID:The urogenital and rectal pain syndromes. 946 18

Several reports of coccygodynia have been confined to the causes, the methods of treatment, and the methods of radiological examination. As far as we know, there has been no previous study about the objective measurement of the coccyx. The purpose of this study was to find the possible cause of idiopathic coccygodynia by comparing the clinical and radiological differences between traumatic and idiopathic coccygodynia by innovative objective clinical and radiological measurements. Thirty-two patients with coccygodynia were evaluated retrospectively. We divided the patients into two groups. Group 1 consisted of 19 patients with traumatic coccygodynia and group 2 consisted of 13 patients with idiopathic coccygodynia. We reviewed medical records and checked age, sex distribution, symptoms, and treatment outcome in each group. We also reviewed coccyx AP and lateral views of plain radiological film and measured the number of coccyx segments and the intercoccygeal angle in each group. The intercoccygeal angle devised by the authors was defined as the angle between the first and last segment of the coccyx. We also checked the intercoccygeal angle in a normal control group, which consisted of 18 women and 2 men, to observe the reference value of the intercoccygeal angle. The outcome of treatment was assessed by a visual analogue scale based on the pain score. Statistical analysis was done with Mann-Whitney U test and Chi-square test. Group 1 consisted of 1 male and 18 female patients, while group 2 consisted of 2 male and 11 female patients. There were no statistically significant differences between the traumatic and idiopathic coccygodynia groups in terms of age (38.7 years versus 36.5 years), male/female sex ratio (1/18 versus 2/11), and the number of coccyx segments (2.9 versus 2.7). There were significant differences between the traumatic and idiopathic coccygodynia groups in terms of the pain score (pain on sitting: 82 versus 47, pain on defecation: 39 versus 87), the intercoccygeal angle (47.9 degree versus 72.2 degrees), and the satisfactory outcome of conservative treatment (47.4% versus 92.3%). The reference value of the intercoccygeal angle in the normal control group was 52.3 degrees, which was significantly different from that of the idiopathic group. In conclusion, the intercoccygeal angle of the idiopathic coccygodynia group was greater than that of the traumatic group and normal control group. Based on the results of this study, the increased intercoccygeal angle can be considered a possible cause of idiopathic coccygodynia. The intercoccygeal angle was a useful radiological measurement to evaluate the forward angulation deformity of the coccyx.
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PMID:Clinical and radiological differences between traumatic and idiopathic coccygodynia. 1041 31

Severe refractory coccydynia occasionally requires coccygectomy. Methods involved a retrospective chart review plus telephone follow-up of 15 patients who had coccygectomy. Pain was assessed by the numerical rating scale and function by Oswestry Low Back Disability Score. There were 13 (87%) patients (four men, nine women) available for follow-up at a mean of 43 months (range 19-74 months). Mean age was 45 years (range 24-72 years). All patients had coccygeal pain arising from the sacrococcygeal joint, but there were other lumbar disorders in 10 patients. There were two complications. The numerical rating scale improved from 7.3 to 3.6 (p < 0.001), and the Oswestry Low Back Disability Score improved from 55 to 36 (p < 0.001). Twelve patients would have the same surgery for the same result. Coccygectomy provides statistically and clinically significant improvement in patients with severe refractory sacrococcygeal joint pain. Many patients have other lumbar spine pathology.
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PMID:Coccygectomy for severe refractory sacrococcygeal joint pain. 1257 92

Coccygodynia (coccydynia, coccygalgia) or coccygeal pain is a well-known but rarely studied painful syndrome affecting the coccyx region. Its etiology is not well understood. Symptoms include development of pericoccygeal soft tissues, pelvic floor muscle spasms, referred pain from lumbar pathology, arachnoiditis of the lower sacral nerve roots, local post-traumatic lesions, and somatization. In spite of advances in the treatment of other pain conditions, coccygodynia remains in a position for which therapeutic options are not clearly designed. On the basis of an anatomic review, proposed pathogenesis of coccygodynia, and the number of treatment approaches that have been proposed, we propose an algorithm for therapeutic decision making in the treatment of this syndrome.
J Pain 2003 Jun
PMID:Coccygodynia: a proposal for an algorithm for treatment. 1462 95

Coccygodynia is pain in the region of the coccyx. In most cases, abnormal mobility is seen on dynamic standing and seated radiographs, although the cause of pain is unknown in other patients. Bone scans and magnetic resonance imaging may show inflammation and edema, but neither technique is as accurate as dynamic radiography. Treatment for patients with severe pain should begin with injection of local anesthetic and corticosteroid into the painful segment. Coccygeal massage and stretching of the levator ani muscle can help. Coccygectomy is done only when nonsurgical treatment fails, which is infrequent. Coccygectomy usually is successful in carefully selected patients, with the best results in those with radiographically demonstrated abnormalities of coccygeal mobility.
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PMID:Coccygodynia: evaluation and management. 1548 13

Anorectal and perineal pain has been described in association with a variety of organic conditions but can also occur under circumstances in which organic disorders are absent and pathophysiology is uncertain. The three most common functional disorders causing anorectal and perineal pain are levator ani syndrome, coccygodynia and proctalgia fugax; Alcock's canal syndrome is also responsible for pain in these areas. We review current concepts about these disorders and the approach to diagnosis and management, and offer a provocative interpretation of the role of psychological factors.
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PMID:Anorectal and perineal pain: new pathophysiological hypothesis. 1530 42

Chronic anoperineal pain may result from diverse causes; a precise and painstaking diagnostic approach is necessary to avoid inappropriate treatments which may aggravate the situation. Advances in imaging and neurophysiologic testing have improved the ability to diagnose and differentiate coccydynia, pudendal neuralgia, and the pyriformis muscle syndrome. Other etiologies including anismus, the descending perineum syndrome, and the levator ani syndrome are discussed as well as psychologic ans somatic interactions.
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PMID:[Chronic anoperineal pain: diagnosis and strategy for evaluation]. 1546 76

For definition of a pathogenesis ofposttraumatic coccygodynia, a study of morpho-functional changes of the structures of coccyx's area was organized. The preparations of coccyx, removed during operative intervention from 23 different-aged patients with manifestations of disease were analyzed by roentgen, histological technique and a submicroscopy. In a cartilaginous tissue from patients with posttraumatic coccygodynia, dystrophic changes of chondrocytes down to their atrophy, a destruction of the basic material with partial replacement of a fibrillar cartilaginous tissue with a hyaline cartilage were observed with a different degree of manifestation. Vessels and sacrococcygeal nervous plexus were subjected to pathological changes. Increased post-traumatic mobility, alterations in the process of ossification, deceleration of physiological joining of coccyx vertebras and sacrococcygeal joint alter biomechanical properties of coccyx at sitting. These alterations lead to the long-lasting traumatization with degenerative - dystrophic changes, reinforcement of pain syndrome and manifestation of dysfunctions of organs of pelvis.
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PMID:[Morphofunctional changes of coccyx area in posttraumatic coccygodynia]. 1573 68

Coccydynia can result from a varying number of causes, parturition being one of them. Although strains and sprains of the ligaments attached to the coccyx have been thought to be the usual cause for coccydynia occurring after childbirth, an intrapartum coccygeal fracture dislocation can result in the same. A 28-year-old female presented to the orthopaedic department 4 weeks after the birth of her first child with the complaint of coccygeal pain. Examination revealed marked local tenderness over the coccyx but no crepitus was felt. Radiographs established the diagnosis of fracture and posterior dislocation between the second and third coccygeal fragments. Conservative treatment in the form of rest, doughnut ring, local heat, and avoidance of direct pressure over the area resulted in considerable improvement over the next 4 weeks. Coccygeal fracture dislocation may result in introital dyspareunia and tension myalgia of the pelvic floor. Pain from this lesion may become recurrently symptomatic. The diagnosis must be established at the outset and appropriate treatment instituted to avoid these complications.
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PMID:Intrapartum coccygeal fracture, a cause for postpartum coccydynia: a case report. 1621 82


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