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

By the time that the pelvalgia patient seeks treatment, her chronic tension, anxiety, stress, and related somatic symptoms, which usually have moderated her fear of repeat assault or punishment by the aggressor-parent, has begun to disintegrate. The patient usually has little or no insight into the fact that her feelings of being trapped, helpless, and victimized in her marriage, job, or other interpersonal relationships can be symbols of the original sexual trauma. The depressed patient may be unaware that suicidal thoughts and actions, if present, are a reflection of her sense of helplessness, hopelessness, and victimization. Hence, CPP may be a symptom of a wide spectrum of disorders, both organic and psychological. While the patient is undergoing evaluation of pelvic pain, it is essential that clinicians remain aware that the patient's psychogenic symptoms are an attempt to reinforce a faltering ego. Additionally, it is important that they recognize that previous attempts at diagnosis and therapy of CPP and other somatic complaints usually have reinforced the belief that the symptoms are physically based and unrelated to any psychological factors. A number of prospective studies currently are underway to characterize further the relationships between complaints of chronic pelvic pain, personality functioning, and history of sexual trauma. Without data on very long-term follow-up, our understanding of the precise psychodevelopmental pathophysiology and long-term prognosis of CPP currently remains incomplete.
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PMID:Psychogenic chronic pelvic pain: diagnosis and management. 217 35

Experience with multidisciplinary management of CPP has demonstrated the importance of ruling out and of treating nongynecologic conditions such as myofascial syndrome, irritable bowel syndrome, urethral syndrome, and psychogenic pain in women with CPP and normal laparoscopies. Moreover, current data suggest that availability of a multidisciplinary pelvic pain clinic can reduce the frequency of hysterectomy for this disorder.
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PMID:Nonsurgical management of chronic pelvic pain: a multidisciplinary approach. 231 16

The approach to the patient with CPP with a history of PID remains a diagnostic challenge even for the experienced clinician. From the initial diagnosis of presumed PID to managing the pain that may result, using an approach that looks at all factors, not just antecedent PID, allows the practicing physician to avoid becoming too narrowly focused in his or her approach. A clinical starting point would assume all possibilities for pelvic pain and evaluate for each. Given the history of one or more episodes of PID, especially if documented with a prior laparoscopy, earlier investigation for adhesions could be justified in selected patients. If the pelvic examination further suggests a pelvic source, a laparoscopy performed early rather than late in the work-up would seem appropriate. The key to management of the patients who have CPP following PID is to use any and all available diagnostic and therapeutic modalities to identify the source(s) before assuming that the patient suffers only from the known sequelae of PID.
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PMID:Relationship of pelvic infection and chronic pelvic pain. 811 85

Primary dysmenorrhea, secondary dysmenorrhea, and cyclic pelvic pain syndromes represent a special subset of CPP. Although more common and no less debilitating, these conditions are better understood, more easily diagnosed, and more successfully treated than chronic pain states. It should be the expectation of both the physician and the patient that successful resolution of these complaints is possible.
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PMID:Cyclic pelvic pain and dysmenorrhea. 811 89

The purpose of our study was to examine the chronic pelvic pain syndrome (CPPS) and the chronic vulvar pain syndrome (CVPS) as two psychosomatic gynecological syndromes. Sociodemographic data were collected from 106 CPPS and 36 CVPS in-patients (under internal and external supervision). Sixty-eight CPPS and 24 CVPS patients were examined using psychological tests (Freiburg Personality Inventory (FBI) and Giessen Test (GT)) and compared with a control group of 34 healthy women. Descriptive statistics, the chi-square test, multi-variant analyses, and regression analyses were used for statistical evaluation. There was a significantly higher incidence of sexual abuse and severe psychological disturbances in the CPPS group (p < 0.03). Sexual abuse was found to be a significant predictor of the CPP syndrome. The CPPS and CVPS patients were significantly more depressed than the control group (p < 0.03). CPPS and CVPS are two distinct psychosomatic gynecological syndromes accompanied by different psychological disturbances.
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PMID:Chronic pelvic pain syndrome (CPPS) and chronic vulvar pain syndrome (CVPS): evaluation of psychosomatic aspects. 1049 57

Chronic pelvic pain often means for patients as well as for their physicians a dilemma concerning diagnosis and therapy: the common medical approach does often not fit for essential therapeutic needs, which should include somatic examination as well as psychosomatic (psychotherapeutic) concepts for escaping from further somatic chronification typical for CPP-patients. The study performed during 1995-98 with 220 patients of the Department of Obstetrics & Gynecology in collaboration with the Psychosomatic Department in the St. Johann's Hospital of Salzburg has shown results about laparoscopic/pelviscopic and psychosomatic interventions in patients with chronic pelvic pain. Evidence-based somatic medicine is not able to explain the discrepancy between pathomorphology and intensity of pain in CPP-patients. The specific dilemma in treating CPP-patients could be characterized as the following: Somatisation is often the one and only symptom presented by CPP-patients to gynecologists. It is the physician's task to stay in a relationship with the patient and treat her symptomatically on somatic symptoms. The relationship will provide the chance to introduce a psychosomatic approach and engage psychotherapeutic work on the reluctance of accepting a psychogenesis of CPP. Gynecologists lack psychosomatic knowledge and concepts for treatment and therefore often contribute to the chronification of CPP in patients approached only in somatic terms.
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PMID:[Chronic pelvic pain--a still too little appreciated disease picture]. 1056 20

Chronic pelvic pain is a frequent complaint in adolescent females. It is a complex disorder with multiple causes. The assessment must attempt to differentiate between gynaecological and non-gynaecological sources of pain. An understanding of the physical, cognitive and environmental factors associated with the pain are essential. Laparoscopy has been used in the assessment of CPP but a significant number of patients will have no obvious aetiology at the time of laparoscopy. For the young patient with CPP, a multidisciplinary approach may be essential to facilitate diagnosis and management. Although the symptoms may not always be curable, management that allows the young female to obtain normal or near normal function may be possible. This chapter focuses on the various causes of pelvic pain in the adolescent female with a focus on the assessment, diagnosis and treatment of the different causes.
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PMID:Adolescent pelvic pain. 1275 28

One of the most common gynaecological causes of chronic pelvic pain is endometriosis. A lack of correlation between laparoscopic findings and pelvic pain has been reported. As endometriotic lesions are under hormonal influence, the effects of the gonadotrophin-releasing hormone (GnRH) analogues cause shrinkage of the deposits, reducing symptoms caused by them. We carried out a longitudinal, interventional pilot study, examining the effect of leuprorelin acetate 3.75 mg (Prostap SR, Wyeth) on pelvic pain prospectively. Preliminary data shows a decrease in pain scores from before to after treatment which is statistically significant (P<0.0001) as well as a general improvement in other symptoms. Laparoscopy showed that symptom intensity is not always related to severity of endometriosis and the worst symptoms may not necessarily be due to pathology. Therefore, it is beneficial to treat women with CPP with GnRH analogues as first-line management to relieve painful symptoms, avoid surgical risks and save money.
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PMID:The effect of a gonadotrophin-releasing hormone analogue as first-line management in cyclical pelvic pain. 1467 84

Once thought to be a rare condition, PBS/IC is being increasingly recognized as an important cause of CPP. It can exist either as a solitary disorder or in conjunction with other gynecologic or urologic disorders. The true prevalence of PBS/IC is hard to determine because most patients remain undiagnosed, although it is now thought to occur in up to 7.5% of the general female population and in 38-85% of women who present with CPP. Because the bladder has been insufficiently considered as a component of pelvic pain, many patients with PBS/IC may be misdiagnosed and inappropriately treated for years. It is critical for all clinicians, and especially gynecologists, who are often the first physicians from whom a woman with CPP will seek treatment, to consider PBS/IC in their patients who complain of pelvic pain, particularly when it occurs with urinary symptoms. The hallmark features of PBS/IC are irritative voiding and CPP. A minority of patients have classic ulcers and most have glomerulations, although it is not always necessary to establish these features to make the diagnosis. With careful questioning, most patients, in fact, can be identified by symptomatology, a medical history and a physical examination. Cystoscopy may be useful to rule out other conditions or to evaluate microscopic hematuria, which may be found in these patients. PBS/IC should be correctly diagnosed as early in the disease course as possible in order to avoid debilitating detriments to the patients' QOL in multiple domains. When symptoms of PBS/IC are recognized early on, treatment can be initiated when it is most likely to have a successful outcome. Although evidence-based clinical practice guidelines for IC/PBS are not available, partly because there is a lack of consensus on the definition and etiology of IC, clinicians, both primary care providers and specialists, can be reassured that there are diagnostic and treatment options that are simple to administer and have been demonstrated to be safe and effective.
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PMID:Epidemiology and quality of life. 1667 17

A standardized test was developed to evaluate posture, movement, gait, sitting posture, and respiration of patients with psychosomatic disorders, based on the Mensendieck principles of observation and analysis of motor function. To validate the test and to make a comprehensive body examination of a defined group of patients, it was applied in a study of women with chronic pelvic pain (CPP, ICD10 F45.4). Fifteen women with CPP and 15 matched, healthy controls were examined. Test subjects were video recorded and scored by three experienced Mensendieck physical therapists, blinded with respect to the selection of subjects. Scores from 0 (for least functional movement) to 7 (optimal function) were assigned to each test person according to a test manual. High intraclass correlations (ICC1.1 [corrected] ranging from 0.82 to 0.97) were found among the testers. The standardized Mensendieck test (SMT) discriminated well between women with CPP and the controls (sensitivity 0.9, specificity 0.7, mean values). The CPP patients scored significantly lower than the controls in all subtests (p < 0.01). The largest difference in scores were found for gait (patients 2.70 +/- 0.11, vs. control, 5.60 +/- 0.09) and respiration (patients 2.88 +/- 0.14, vs. control, 5.63 +/- 0.10). The results indicate that, in the hands of experienced Mensendieck therapists, the SMT is a reliable tool, demonstrating a good discriminative validity. Furthermore, it may turn out to be a useful instrument in the evaluation of patients with somatoform disorders. It may also point toward a possible therapeutic treatment approach to patients with CPP.
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PMID:Reliability and validity of a standardized Mensendieck physiotherapy test (SMT). 1692 Jun 78


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