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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The activity of the oblique abdominal muscles was investigated with the trunk in unconstrained, symmetrical and static postures. Electromyographic recordings in six healthy subjects revealed that in all subjects the activity of both the internal and the external obliques is significantly higher in unconstrained standing than in supine posture. Activity of the internal oblique was higher than that of the external oblique abdominal. The sacrospinal, gluteus maximus and biceps femoris muscles showed practically no activity in unconstrained erect posture. During unconstrained sitting both oblique abdominals are active. In most subjects the activity of the oblique abdominals was significantly smaller when sitting on a soft car seat than when sitting on an office chair with a hard seat. The possibility is discussed that contraction of the oblique abdominals in unconstrained standing and sitting may help in stabilizing the basis of the spine and particularly the sacroiliac joints. During standing and sitting the oblique abdominal muscles apparently have a significant role in sustaining gravity loads. RELEVANCE: Back pain and pelvic pain are often experienced in prolonged standing and sitting postures. In these postures the oblique abdominals are shown to be active. The present study gains clinical significance by the studies showing relatively small oblique abdominal muscle strength in patients with low back pain. A soft seat may be helpful in treatment and prevention, because it substitutes oblique abdominal muscle activity.
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PMID:Oblique abdominal muscle activity in standing and in sitting on hard and soft seats. 1141 34

Primary dysmenorrhea is a syndrome characterized by painful uterine contractility caused by a hypersecretion of endometrial prostaglandins; non-steroidal anti-inflammatory drugs are the first choice for its treatment. However, in vivo and in vitro studies have demonstrated that myometrial cells are also targets of the relaxant effects of nitric oxide (NO). The aim of the present study was to determine the efficacy of glyceryl trinitrate (GTN), an NO donor, in the resolution of primary dysmenorrhea in comparison with diclofenac (DCF). A total of 24 patients with the diagnosis of severe primary dysmenorrhea were studied during two consecutive menstrual cycles. In an open, cross-over, controlled design, patients were randomized to receive either DCF per os or GTN patches the first days of menses, when menstrual cramps became unendurable. In the subsequent cycle the other treatment was used. Patients received up to 3 doses/day of 50 mg DCF or 2.5 mg/24 h transdermal GTN for the first 3 days of the cycle, according to their needs. The participants recorded menstrual symptoms and possible side-effects at different times (0, 30, 60, 120 minutes) after the first dose of medication on the first day of the cycle, with both drugs. The difference in pain intensity score (DPI) was the main outcome variable. Both treatments significantly reduced DPI by the 30th minute (GTN, -12.8 +/- 17.9; DCF, -18.9 +/- 16.6). However, DCF continued to be effective in reducing pelvic pain for two hours, whereas GTN scores remained more or less stable after 30 min and significantly higher than those for DFC (after one hour: GTN, -12.8 +/- 17.9; DFC, -18.9 +/- 16.6 and after two hours: GTN, -23.7 +/- 20.5; DFC, -59.7 +/- 17.9, p = 0.0001). Low back pain was also relieved by both drugs. Headache was significantly increased by GTN but not by DCF. Eight patients stopped using GTN because headache--attributed to its use--became intolerable. These findings indicate that GTN has a reduced efficacy and tolerability by comparison with DCF in the treatment of primary dysmenorrhea.
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PMID:A comparison of glyceryl trinitrate with diclofenac for the treatment of primary dysmenorrhea: an open, randomized, cross-over trial. 1191 80

We have retrospectively reviewed the clinical and radiological results in 204 consecutive adult patients who had surgical correction of 70 late post-traumatic pelvic nonunions and 134 malalignments. The deformed pelvises were subdivided into united (true), unstable, ununited, and partially stable malalignments with heterotopic bone. The principal complaints were of pain, pelvic instability, sitting imbalance, and apparent limb-length discrepancy. After surgery, 195 patients (96%) achieved a primary union and 144 (71%) had slight, intermittent or no pelvic pain, while pelvic instability was entirely eliminated. Overall, 131 patients (64.2%) were extremely satisfied, 58 (28.4%) were satisfied and 15 (7.4%) were unsatisfied. After reconstruction of the malaligned pelvises, 67 results (50%) were anatomical, 47 (35%) were satisfactory and 20 (15%) were unsatisfactory. For a pelvic nonunion with local osteopenia and malalignment, stabilisation of all three pelvic columns is recommended. True pelvic (united) malunions were the most satisfactorily realigned and had the fewest complications. Ununited and unstable malalignments, especially those with heterotopic bone, had the poorest corrections and the most neurological complications. A therapeutic alternative, by the local resection of a symptomatic bony prominence, and fixation in situ of a posterior pelvic nonunion, gives highly effective symptomatic relief with fewer complications. Despite this, many patients had persistent low back pain.
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PMID:Surgical reconstruction of late pelvic post-traumatic nonunion and malalignment. 1258 73

Pain is a common complaint of patients who visit a family physician, and its appropriate management is a medical mandate. The fundamental principles for pain management are: placing the patient at the center of care; adequately assessing and quantifying pain; treating pain adequately; maximizing function; accounting for culture and gender differences; identifying red and yellow flags early; understanding and differentiating tolerance, dependence and addiction; minimizing side effects; and being familiar with and using CAM therapies when good evidence of efficacy exists. The pharmacologic management of pain requires thorough knowledge of nonsteroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors, and opioids. A table of equianalgesic dosages is useful because patients may need to move from one opioid to another. Accompanying this article are papers discussing 5 common pain disorders seen by family physicians, including: neck pain, low back pain, joint pain, pelvic pain, and cancer/end of life pain. The family physician who learns these principles of pain management and the algorithms for these common pain disorders can serve patients well.
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PMID:Pain management by the family physician: the family practice pain education project. 1557 25

Abnormal biomechanical properties of the sacroiliac joints are believed to be related to low back and pelvic pain. Presently, physiotherapists judge the condition of the sacroiliac joints by function and provocation tests, and palpation. No objective measuring device is available. Research is ongoing to identify the biomechanical properties of the sacroiliac joints from the dynamic behaviour of the pelvic bones. A new concept based on ultrasound (US) for the measurement of bone vibration is under investigation. The objective of this study was to validate this concept on a physical model and to assess the applicability in vivo. A model consisting of a piezo shaker covered by a layer of US transmission gel (representing bone and soft tissue) has been used. A packet of US detection signals is directed onto the shaker and correlation-based processing is used to estimate the difference in time-of-flight of their echoes. These variations of time are used to compute the displacement of the shaker at each pulse reflection. To assess the validity of our US technique, we compared the obtained measurements with the readings of the built-in strain gauge sensor. The experimental procedure has been tested on a volunteer where low-frequency excitation was provided through the ilium and vibration detected on the sacrum and ilia. The results demonstrated that the correlation-based approach is capable of reproducing the piezo shaker displacements with high accuracy (+/- 7%). Vibration amplitudes from 0.25 microm to 3 microm could be measured. The US technique was able to detect bone vibration in vivo. In conclusion, the principle based on US waves can be used to develop a new measurement tool, instrumental in studying the relation between the biomechanical properties of the sacroiliac joints and low back pain.
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PMID:Low back pain, the stiffness of the sacroiliac joint: a new method using ultrasound. 1565 29

To describe the characteristics of pain experienced by patients with interstitial cystitis (IC) in terms of pain site, severity, and character, we performed a secondary analysis of data from the IC database (ICDB), which was a prospective, longitudinal, cohort study of IC patients. We analyzed the cross-sectional baseline data from 629 patients who had a completed baseline symptom questionnaire. Patients answered questions about whether they had pain or discomfort associated with urinary symptoms over the past 4 weeks and if so, about the location, characteristics, intensity, and frequency of their pain. Logistic regression examined associations between pain location and the presence of urinary symptoms. Analyses were performed using SAS version 8.2 (SAS Institute, Cary, NC, USA) and considered significant at the 5% level. Five hundred and eighty-nine (94%) patients with a mean age of 45 years (SD 14 years) reported baseline pain or discomfort associated with their urinary symptoms. The most common baseline pain site was lower abdominal (80%), with urethral (74%) and low back pain (65%) also commonly reported. The majority of patients described their pain as intermittent, regardless of the pain site. Most patients reported moderate pain intensity, across all pain sites. There was a statistically significant link between pain in the urethra, lower back, and lower abdomen, and urinary symptoms. Patients with IC report pain at several sites other than the bladder, possibly arising from the previously well-described myofascial abnormalities of pelvic floor and abdominal wall present in patients with IC and other chronic pelvic pain syndromes.
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PMID:What is the pain of interstitial cystitis like? 1599 91

Non-specific low back pain and peripartum pelvic pain have aetiologies that may feature the sacroiliac region. This region possesses many potential pain-generating structures sharing common sensory innervation which makes clinical differentiation of pathoanatomy difficult. This anatomical study explores the relationship between the long posterior sacroiliac ligament (LPSL) and the lateral branches of the dorsal sacral nerve plexus. Twenty-five sides of the pelvis from 16 cadavers were studied, three for histological analysis and 22 for gross anatomical dissection. We found that the LPSL is penetrated by the lateral branches of the dorsal sacral rami of predominantly S2 (96%, 21/22) and S3 (100%, 22/22), variably of S4 (59%, 13/22) and rarely of S1 (4%, 1/22). Some of the penetrating lateral branches give off nerve fibres that disappear within the ligament. These findings provide an anatomical basis for the notion that the LPSL is a potential pain generator in the posterior sacroiliac region.
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PMID:Lateral branches of dorsal sacral nerve plexus and the long posterior sacroiliac ligament. 1623 86

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.
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PMID:BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy. 1640 13

The aim of this study was to conduct a systematic review of the efficacy of specific stabilisation exercise for spinal and pelvic pain. Randomised clinical trials evaluating specific stabilisation exercise were identified and retrieved. Outcomes were disability, pain, return to work, number of episodes, global perceived effect, or health-related quality of life. A single trial reported that specific stabilisation exercise was more effective than no treatment but not more effective than spinal manipulative therapy for the management of cervicogenic headache and associated neck pain. Single trials reported that specific stabilisation exercise was effective for pelvic pain and for prevention of recurrence after an acute episode of low back pain but not to reduce pain or disability associated with acute low back pain. Pooled analyses revealed that, for chronic low back pain, specific stabilisation exercise was superior to usual medical care and education but not to manipulative therapy, and no additional effect was found when specific stabilisation exercise was added to a conventional physiotherapy program. A single trial reported that specific stabilisation exercise and a surgical procedure to reduce pain and disability in chronic low back pain were equally effective. The available evidence suggests that specific stabilisation exercise is effective in reducing pain and disability in chronic but not acute low back pain. Single trials indicate that specific stabilisation exercise can be helpful in the treatment of cervicogenic headache and associated neck pain, pelvic pain, and in reducing recurrence after acute low back pain.
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PMID:Specific stabilisation exercise for spinal and pelvic pain: a systematic review. 1676 45

Caudal block with a local anesthetic through the hiatus sacralis has been performed in patients with chronic low back pain, lower limb pain, anal pain, and pelvic pain due to spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, postherpetic neuralgia, peripheral vascular disease, complex regional pain syndrome and so on. We prepar- ed an information and consent sheet on caudal block in The University of Tokyo Hospital. In the information sheet, we included disease, purpose, methods, outcome, accidental complications of caudal block, other treatments, progress on unperformed case, questions and answers, influence of rejection, and doctor's name. We experienced some cases of boring pain, deterioration of low back pain and lower limb pain, headache, nausea, hypertension, hypotension, and tachycardia as accidental complications of caudal block. In describing some accidental complications, we included boring pain, high intracranial pressure, dural puncture, nerve injury, infection, hemorrhage, embolism, allergy, and heart, lung, brain, liver, and kidney failures. Further, we could refer to the accidental complications of epidural block. However, the rate of each accidental complication has not been known in detail. We should survey the outcome and accidental complication of caudal block prospectively in multiple facilities and provide the patients with useful information.
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PMID:[Information and consent sheet of caudal block in the University of Tokyo Hospital]. 1678 90


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