Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstetrician-gynecologists at St. James's University Hospital in Leeds, England, compared various cervical ripening agents in 64 18-39 year old women presenting for first trimester abortion. The women either received oral administration of a placebo or RU-486 or had a laminaria tent or gemeprost vaginal suppository inserted into the endocervical canal or the posterior fornix, respectively. All cervical ripening agents dilated the cervix better than the placebo (p .02). They also greatly diminished the force needed (50-65%) to dilate the cervix to 8 mm Hegar (p .001). The laminaria tent resulted in greater initial cervical dilatation than gemeprost or RU-486, regardless of parity (p .05), but the total force was not significantly different between the 3 groups. 71% of the women who received the gemeprost vaginal suppository had pelvic pain and regular painful uterine contractions. The pain was so intense in 33.3% of them (20% of all gemeprost patients) that health workers had to inject opiate analgesia intramuscularly. 81% of laminaria tent patients experienced menstrual type pains. A significantly lower percentage of RU-486 patients (33%) suffered mild pelvic discomfort than the gemeprost (p = .03) and laminaria tent groups (p = .001). None of the women in the placebo, laminaria tent, and RU-486 groups received analgesia. 40-41% of women in the 3 treatment groups experienced preoperative vaginal bleeding. Since RU-486 patients suffered minimal side effects and insertion of laminaria tents is inconvenient and potentially damaging (e.g. iatrogenic complications of fistulas, dumb belling, and tent fracture), the physicians concluded that RU-486 is the easiest cervical priming agent to administer and is as effective as the other agents.
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PMID:Should we use prostaglandins, tents or progesterone antagonists for cervical ripening before first trimester abortion? 145 95

Based on experience with 3100 tubal sterilizations and other pelviscopic operations the following conclusions are drawn: 1. Most endoscopic gynecologic operations can be performed as outpatient procedures by experienced gynecological surgeons without increased risk for patients. But not in all cases these operations can be done on an outpatient level a priori as by many american health insurance companies expected. 2. Most short operations don't need to be performed in general anaesthesia. Risks and costs can be reduced using local analgesia or "volonelgesie". 3. Such short operations can mostly be done with a single puncture laparoscope, more punctures for additional instruments should only be made if it is necessary. 4. Patients with chronic pelvic pain are able to give support in searching and finding painful organs under "volonelgesia". The treatment of these organs can be performed by injection of a local anaesthetic or in general anaesthesia. That necessitates cooperation between gynecologists, anaesthesiologists, nurses and patients which should be part of educational and training programs.
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PMID:[Ambulatory laparoscopy]. 183 16

Nine patients who had chronic perineal sinuses following proctectomy for inflammatory bowel disease underwent wide excision of the sinus and split-thickness skin grafting. All patients had persistent pain and discharge. All but one had undergone multiple surgical procedures previously. Fibrous tissue was excised from the sinus tract and the wound was grafted either immediately (six patients) or at a later date (three patients). Five patients had complete healing of the wound initially while four required further procedures. Eight patients have been followed up for an average of 4.6 years (range from 5 months to 12 years). Complete healing was achieved in seven patients; all are free of pain and can work or are unrestricted in their daily activities. One patient is improved but still requires analgesia and is disabled by the persistent pelvic pain.
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PMID:Management of chronic perineal sinuses by wide excision and split-thickness skin grafting. 389 66

Haemorrhage, probably related to hypervascularisation, is the commonest complication of uterine myomata and is difficult to treat. 16 patients, aged 34-48 years, with symptomatic uterine myomata, for which a major surgical procedure was planned after failure of medical treatment, were treated by selective free-flow arterial embolisation of the myomata with Ivalon particles. With a mean follow-up of 20 months (range 11-48) in the responders, symptoms resolved in 11 patients; menstrual cycles returned to normal in ten of these. Three patients had partial improvement. Two failures required surgery. In 14 cases embolisation caused pelvic pain, which required analgesia in all.
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PMID:Arterial embolisation to treat uterine myomata. 754 59

Pain during tubal sterilisation is thought to be due to either ischaemia or pressure at the site of impact of sterilising devices on the fallopian tubes. We have evaluated the effectiveness of an application of 2% lignocaine gel to Filshie clips to relieve postoperative pain. In a randomised double-blind placebo-controlled study, 80 healthy women undergoing tubal sterilisation under general anaesthesia at the County Hospital, Lincoln, UK, were allocated to be sterilised by Flishie clips covered with 2% lignocaine gel or K-Y gel as placebo. Pelvic pain was assessed, with a 100 mm visual analogue scale, at 1 hour, at hospital discharge, and time of first analgesia or any other time analgesia was demanded. The lignocaine-treated group had significantly longer time to first analgesia, less pain at 1 hour, less nausea and vomiting, and shorter recovery time. Fewer lignocaine-treated patients needed additional analgesia and they required fewer opioids. There was no case of failed sterilisation or adverse reaction to lignocaine. The application of local anaesthetic gel to Filshie clips is a safe, non-invasive, and effective method of relieving postoperative pain during laparoscopic tubal sterilisation.
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PMID:Local anaesthetic on Filshie clips for pain relief after tubal sterilisation: a randomised double-blind controlled trial. 747 63

This self-directed learning module highlights assessment and therapeutic options in the management of cancer pain, pelvic pain, and the pain problems of the elderly and children. It is part of the chapter on pain rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article delineates causes of cancer pain, discusses strategies for approaching each specialized population, and provides specific clinical examples to illustrate management issues, with emphasis on prevention. New advances include understanding the pain experience in children and elderly adults; investigation of psychosocial aspects of pelvic pain; and use of patient-controlled analgesia, opioids, and multimodality techniques for acute, perioperative, and chronic pain in these age groups.
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PMID:Pain rehabilitation. 3. Cancer pain, pelvic pain, and age-related considerations. 818 60

Eleven patients with cancer pain in a palliative care and chronic pain service required cessation of morphine due to unacceptable opioid side effects. In this retrospective study fentanyl was evaluated as a second-line subcutaneously infused opioid. Starting doses ranged from 100 to 1000 micrograms/24 h, and the duration of fentanyl infusion was 3-70 days. The clinically derived mean relative potency of fentanyl to morphine infusions was 68:1 (SD +/- 23; range: 15-100), and we now recommend cautious dose conversion at an approximate equivalence of 150-200 micrograms fentanyl for 10 mg morphine in non-opioid naive chronic cancer pain patients. All patients demonstrated an improvement in the adverse effect(s) for which the change in opioid was undertaken. Adequate pain relief was achieved in all but 1 patient with mixed nociceptive and neuropathic pelvic pain for whom an epidural infusion of a local anaesthetic/opioid mixture was required. Fentanyl was changed to the more potent synthetic opioid sufentanil in 2 patients for whom the fentanyl dose necessitated too large a volume for the portable syringe driver in use. The clinically derived sufentanil to fentanyl relative potencies were 24:1 and 16:1, respectively. This achieved good analgesia and maintained the favourable side-effect profile seen with fentanyl. Subcutaneous infusion appears to be a safe and viable route of fentanyl delivery, and provided effective analgesia with a low incidence of adverse effects in this small selected group of patients who were intolerant of subcutaneous morphine. We suggest a trial of subcutaneous fentanyl for selected patients who have intractable adverse effects on morphine, and it is now the second-line infusable opioid in our service. Further prospective evaluation of the role of these two synthetic mu opioid agonists in palliative care practice is warranted, as part of an evolving picture of variation in opioid side-effect profile seen with different drugs within the class.
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PMID:Subcutaneous fentanyl and sufentanil infusion substitution for morphine intolerance in cancer pain management. 862 93

The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 +/- 5.2 and 9.5 +/- 4.8 min and 9.4 +/- 5.2 and 11.5 +/- 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2 h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy 14/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 85%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time.
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PMID:A comparison of patient tolerance of hysterosalpingo-contrast sonography (HyCoSy) with Echovist-200 and X-ray hysterosalpingography for outpatient investigation of infertile women. 870 14

Twenty patients with chronic pain who previously had obtained analgesia from epidural clonidine and lignocaine agreed to participate in a double-blind crossover study of lumbar epidural clonidine (150 micrograms), lignocaine (40 mg) and the combination of clonidine (150 microgram) and lignocaine (40 mg), all drugs were given in a volume of 3 ml. There were 11 women and 9 men with a mean age 53 years (range: 23-78 years); 9 patients had low back and leg pain, 9 had neuropathic pain, 1 had pelvic pain and 1 Wegner's granulomatosis. Pain intensity and pain relief, as well as sensory and motor blockade, were assessed for 3 h following each injection. The combination was reported as the best pain relief by 12 of the 17 patients who completed all three arms of the study; 4 patients reported that clonidine was the best, 1 patient reported that none of the injections provided any analgesia and no patient reported that lignocaine was the best. SPID analysis revealed a significant difference between the combination and lignocaine (P < 0.05) but no other significant difference. TOTPAR analysis revealed no significant difference between any of the injections. All 3 injections produced evidence of neurological blockade; clonidine produced sensory blockade in 3 patients and motor blockade in 3 patients. Lignocaine produced sensory blockade in 6 patients and motor in 8 patients, while the combination produced evidence of neurological blockade in all 17 patients, sensory in 6 and motor in 11 patients. Overall there was no relationship between neurological blockade and analgesia. The reported side effects appeared to be related to clonidine. These data indicate that in these patients with chronic pain epidural clonidine had a supra-additive effect and behaved more like a co-analgesic than a pure analgesic.
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PMID:A double-blind randomised comparison of the effects of epidural clonidine, lignocaine and the combination of clonidine and lignocaine in patients with chronic pain. 874 Jun 12

The present report provides evidence that axons in the medial part of the posterior column at T10 convey ascending nociceptive signals from pelvic visceral organs. This evidence was obtained from human surgical case studies and histological verification of the lesion in one of these cases, along with neuroanatomical and neurophysiological findings in animal experiments. A restricted lesion in this area can virtually eliminate pelvic pain due to cancer. The results remain excellent even in cases in which somatic structures of the pelvic body wall are involved. Following this procedure, neurological testing reveals no additional neurological deficit. There is no analgesia to pinprick stimuli applied to the body surface, despite the relief of the visceral pain. Since it is reasonable to attribute the favorable results of limited midline myelotomies to the interruption of axons of visceral nociceptive projection neurons in the posterior column, we have performed experiments in rats to test this hypothesis. The results in rats indicate that the dorsal column does indeed include a nociceptive component that signals pelvic visceral pain. The pathway includes neurons of the postsynaptic dorsal column pathway at the L6-S1 segmental level, axons of these neurons in the fasciculus gracilis, and neurons of the nucleus gracilis and the ventral posterolateral nucleus of the thalamus.
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PMID:Is there a pathway in the posterior funiculus that signals visceral pain? 895 23


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