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

It has been traditional to exclude patients with radiation-recurrent carcinoma of the uterine cervix or other pelvic neoplasms, incapacitating pelvic pain, postirradiation fistulas, hemorrhage, or malodorous draining tumor necrosis from pelvic exenteration if cure of the malignant disease is not achievable. This negative attitude is a direct result of the reported high morbidity, prohibitive mortality, and low salvage rate previously associated with pelvic exenteration, the only acceptable surgical approach to these diseases. A recent experience with eighteen patients who underwent pelvic exenteration for advanced primary or recurrent carcinoma of the cervix, urinary bladder, or rectum has led us to challenge several traditional concepts regarding this operative procedure. We have observed but one operative death and our morbidity has been minimal. This may reflect our belief that an aggressive pelvic lymphadenectomy in those patients with direct visceral involvement from radiation-recurrent carcinoma of the pelvic viscera is not advantageous since no significant survival has ever been documented for patients with pathologic visceral involvement and positive lymph nodes. In addition, significant morbidity has always been associated directly with pelvic lymphadenectomy in the irradiated pelvis, and elimination of this phase of the operation in selected patients with radiation-recurrent carcinoma is indicated. Moreover, the considerable decrease in morbidity and the minimal mortality observed have led us to adopt a very liberal attitude toward preoperative selection criteria, and we regularly now use pelvic exenteration not only for cure but as intentional palliation in selected patients. We strongly believe that elimination of pain, fistulas, pelvic sepsis, hemorrhage, and malodorous areas of tumor necrosis are important for improving the quality of life for both the patient and family.
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PMID:Pelvic exenteration as palliation of malignant disease. 5 24

Data analyzed from five comparative studies show a relationship between the technique of tubal occlusion and pain experienced by patients both at the time of the procedure and during the recovery period. During the procedure, the spring-loaded clip is the technique least likely and the tubal ring the technique most likely to be associated with pain. During the recovery period, both the spring-loaded clip and the tubal ring are associated with higher rates of abdominal or pelvic pain than is electrocoagulation. Differences in pain that occurred during the recovery period did not persist to the early follow-up visit.
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PMID:Incidence of pain among women undergoing laparoscopic sterilization by electrocoagulation, the spring-loaded clip, and the tubal ring. 15 12

One of the most significant factors necessitating IUD removal is pelvic pain, which includes insertional pain, intermenstrual cramps, often associated with spotting and bleeding, and increased dysmenorrhea. The larger and stiffer devices and those whose shape does not conform to that of the endometrial cavity produce localized endometrial ulceration and inflammation, which contribute to these symptoms. Endometrial prostaglandin release secondary to the presence of an intrauterine foreign body may also play an important role. In patients who have pelvic pain with an IUD it is of utmost importance to completely evaluate them and exclude other causes of pain, such as pelvic inflammatory disease, with and without abscess formation, and ectopic gestation.
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PMID:Pelvic pain and the IUD. 34 74

Primary dysmenorrhea is a difficult entity to treat, and therapy is usually directed at relieving symptoms. There is some indication that this disorder is caused by an increase in prostaglandin F2alpha. Therefore, logically the treatment may include antiprostaglandin agents. We have studied 32 women with the diagnosis of primary dysmenorrhea in a randomized double-blind fashion using a placebo and indomethacin. Both agents were taken three times a day over four cycles, and therapy was begun two days before the usual onset of pelvic pain. Only two of 16 patients in the placebo group were significantly improved in the four-month treatment cycles while all 16 in the treatment group showed some improvement, 11 having cessation of pain. In the six months following the study period, all patients were given indomethacin. The original treatment group did not change significantly. However, all in the placebo group when switched to indomethacin had some relief, 12 of the 16 showing complete cessation of pain. Gastric irritation was the main side effect and was present in 18% of the treatment group and 12% in the placebo group. Indomethacin appears to effectively relieve primary dysmenorrhea and does not appear to be associated with a high incidence of side effects.
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PMID:Primary dysmenorrhea treated with indomethacin. 37 24

The importance of recognizing uterine penetration by an IUD is emphasized by the following case report. 4 weeks after a spontaneous delivery, a 23-year-old woman was inserted with a Saf-T-Coil; at time of insertion, she experienced marked abdominal and pelvic pain. Pain persisted, accompanied with irregular vaginal bleeding, but there were no positive somatic findings. On examination, the threads of the IUD were properly visible, but an attempt was made to remove the device on the patient's request; it was unsuccessful. A flat film of the abdomen reported that the device was within the uterine cavity, and another attempt at IUD removal under anesthesia was unsuccessful. Hysterogram revealed the device to be extrauterine and appeared to perforate the uterus, lodged in the layers of the broad ligament. By exploratory laparotomy, the coil was found protruding through the uterine wall at the junction of the internal os and corpus. The coil was removed, and the laceration of the uterus was repaired. Fortunately, only loops of the coil were adherent to the small intestine, and no injury had occurred.
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PMID:Perforation of uterus with Saf-T-Coil. 57 Oct 33

A multifactorial approach was used by the authors to analyze data from 119 women with endometriosis and infertility. Conservative surgical procedures afforded a mean pregnancy rate of 37.7 per cent for those women with significant disease. Only 6.7 per cent became pregnant when the proposed surgery was declined. There was an inverse relationship in severity of endometriotic involvement and pregnancy rate. The mean pregnancy rate among 17 patients with minimal disease for whom surgery was discouraged was 64.7 per cent; all pregnancies occurred within the first 2 years of follow-up. Relief of pelvic pain was dramatic, especially following presacral neurectomy. Laparoscopic selection of cases further reinforces the importance of grading severity of endometriosis prior to embarking on restorative surgery. Presacral neurectomy, despite reinforcement of pain relief, did not appear to contribute significantly to the occurrence of pregnancy.
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PMID:Pelvic endometriosis: infertility and pelvic pain. 60 6

This paper has given a general discussion of the spectrum of pain complaints presented to the gynecologist. Specific information about pain sensation and localization has been reviewed together with the gynecologic causes of acute abdominal pain. Chronic pain has been classified as episodic or continuous, and the causes, mechanisms, diagnosis and treatment of episodic and chronic pelvic pain have been presented. The concluding remarks have outlined some diagnostic considerations for the patient with chronic pain. (The interested reader will find more extensive information on these subjects in the articles listed in the bibliography.).
Pain 1978 Dec
PMID:Pain in gynecologic practice. 74 Apr 1

This paper addresses the problem of measuring the subjective report of clinical pain. In recognition of the multidemensional nature of pain, there was 1st a questionnaire which measured 3 dimensions of pain (sensory, effective, evaluative) and then a rating scale. The content of this test was drawn from the results of a survey of 200 sufferers of pelvic pain. The 1st study consisted of the identification of commonly used adjectives describing pelvic pain and was aided by the cooperation of 221 women. 35 women attended family planning clinics and were then part of a survey to determine the amount of pain indicated by each word (through use of a 5-point scale). The aim of these 2 surveys was to arrive at 3 words describing different amounts of qualitatively similar pain sensation which could then be used in the card sort. The results are included in tabular form. The 2nd study evaluted the card sort method of pain assessment. 2 words on 2 cards which describe pain (1 above the other) are presented to the patient who must then sort the cards according to whether the top or bottom word on each card most closely resembles the pain being experienced. The objectives were: 1) to establish the relevance of words included in the test and the degree of consensus over meaning and 2) to acess the internal structure of the card sort to validate the groupings of triads into sensation, affective, and evaluative dimensions of pain. The card sort was administered 213 times and based on the high degree of consensus, it was taken to have sufficient reliability for purposes of pain assessment. Scores were subjected to factor analysis and 3 emerged. The 1st accounted for 42% of the common variance and it seems that this 1 tapped the overall reaction to the pain experience; the 2nd accounted for 11% of the common variance and represents the sensory qualities of pain; and the 3rd factor accounted for 10% of the common variance and described the temporal quality of pain. There is strong evidence for viewing pain as a multidimensional experience for which commonly used assessment methods are inadequate. High internal consistency was found to exist for the test as a whole although it was somewhat lower for the sensory triads. The validity of the test was also found to be high and there was support for the distinction between sensation and the reaction or evaluation of these. The card sort could be a useful index in clinical research trials for pain; it is a method not limited to gynecological pain and it has demonstrated clinical utility and face validity.
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PMID:A card sort method of pain assessment. 75 Jun 60

The authors -- about a series of 124 cancerous patients treated during the 12 last years with open spino-thalamic cordotomy for intractable pain -- have tried to evaluate effectiveness of the operation with regard to its levels in relation to the site of pain. Patients suffering median or bilateral perineo-pelvic pain, isolated or associated with algias in one or both legs (group I: 50%) underwent a bilateral C8-C6 cordotomy in one stage. Patients with the same perineo-pelvic cancers but suffering only unilateral pain (group II : 31,8%) and patients with painful cancers in the leg (group III : 3,2%), were operated on with a C7 controlateral cordotomy. Patients suffering widespread unilateral pain in the chest, isolated or associated with algias in the arm, for instance from lung or breast cancers (group IV : 15%) underwent a controlateral C2 cordotomy. There was 3,2% mortality and one paraplegia. A useful early effect(i.e. complete or partial relief) was obtained : in 85% cases (60% and 25%) for the 1st group, in only 51% (36% and 15%) for the 2nd, and in 87% (56% and 31%) for the 4th. Relief was complete in each of the 4 cases of the 3rd group. In the 2nd group 39% of patients were completely relieved of their initial unilateral pain, but complained of an early post-operative pain on the other side. This secondary pain was supposed existing prior to the operation, but masked because of its lesser intensity. The useful results at the time of death, after a 6 month mean survival (from 1 month to 4 years), were 63,75% in the 1st group, 33% in the 2nd, 100% in the 3rd and 72% in the 4th. The high rate of poor results with unilateral cervical cordotomy in the perineo-pelvic cancers with apparently unilateral pain, led us since then to systematically perform for them a bilateral cordotomy. Thus, our general management for pain of malignant origin is now as follows: C8-C6 bilateral cordotomy for all the perineo-pelvic cancers whatever uni- or bilateral the site of pain may be; C7 controlateral cordotomy for the painful cancers of the leg; and C2 controlateral cordotomy for hemithoracic and/or arm pain, when related to very extended lung or breast cancers. We prefer complete posterior rhizotomy for limited cancers of the thoracic wall, and selective posterior rhizotomy through the scope, from -- the brachial plexus roots down to T4 -- for pain as from the PANCOAST-TOBIAS syndromes, or in case of painful involvements of the upper limb roots. For cervico-facial cancers we generally use combined sections of the sensory cranial nerves in the posterior fossa and of the cervical posterior roots.
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PMID:[Spino-thalamic cordotomy in cancerous pain. Results of a series of 124 patients operated on by the direct posterior approach]. 107 Nov 36

Prior to an abdominal operation, 125 patients were asked if they regularly had headache during the menstrual period together with or without pain in the lower pelvic region. Pelvic pain patients with endometriosis externa reported headache significantly more often than those without endometriosis. Headache proved to be almost as common a symptom as lower pelvic pain in patients with endometriosis.
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PMID:Headache as a symptom of endometriosis externa. 119 Jun 95


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