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

This report presents an attempt to assess quantitatively the extent of adenomyotic lesions in hysterectomy specimens from women with symptoms suggesting adenomyosis (n = 14) and from women operated on for other reasons (n = 12). The specimens were cut into 5 mm-thick slices in which adenomyotic lesions were localized and counted microscopically. Nineteen uteri contained from 1 to 890 lesions. The distribution of lesions was mostly focal and patchy. More than half of the cases with adenomyotic lesions would have remained unrecognized if only the slice from the axial plane had been examined. Seventy-two per cent of the lesions were found in the posterior wall. Leiomyomas were found in 68% of the uteri with adenomyotic lesions. As adenomyotic lesions were observed with equal frequency in patients with and without pelvic pain, and as the degree of adenomyotic involvement did not correlate with complaints of pain, the significance of adenomyotic lesions as a cause of gynecological symptoms may be questioned.
APMIS 1993 Dec
PMID:The extent and clinical significance of adenomyotic lesions in the uterine wall. A quantitative assessment. 811 Apr 46

A large proportion of women with chronic pelvic pain can be found to have gastrointestinal disorders, either pathologic or functional. The location of referred pain from the gastrointestinal tract overlaps that of the reproductive organs. An awareness of the differential diagnosis, a knowledge of the common presentations of gastrointestinal disorders, a thorough history that includes an appropriate discussion of gastrointestinal symptoms, and a relevant examination will ensure that gastrointestinal diagnoses are not overlooked.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Gastroenterologic causes of chronic pelvic pain. 811 83

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.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Relationship of pelvic infection and chronic pelvic pain. 811 85

Musculoskeletal dysfunctions often contribute to the signs and symptoms of chronic pelvic pain and in many cases may be the primary cause. The traditional team approach to chronic pelvic pain has not, however, routinely included a practitioner skilled in musculoskeletal examination and treatment. Characteristics of musculoskeletal pain are reviewed as are specific dysfunctions commonly found to produce lower abdominal and pelvic floor pain. A screening examination is presented to assist the gynecologic physician in identifying patients who may benefit from physical therapy.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Musculoskeletal origins of chronic pelvic pain. Diagnosis and treatment. 811 87

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.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Cyclic pelvic pain and dysmenorrhea. 811 89

The surgical procedures used for the treatment of chronic pelvic pain, their indications, and success rates are reviewed. A thorough preoperative evaluation is presented that will enable the physician to detect patients at high risk for surgical failure and those who will be more appropriately managed with nonsurgical treatment modalities.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Surgical management of chronic pelvic pain. 811 90

Women with chronic pelvic pain are frequently found to have histories of sexual victimization. The authors review the evidence supporting this association and examine related questions regarding the association of chronic pelvic pain with other forms of abuse as well as the relationship of sexual victimization with other physical sequelae. Practical strategies are offered for the office management of patients with both chronic pelvic pain and sexual trauma.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Sexual victimization and chronic pelvic pain. 811 92

In order to fully evaluate the woman with chronic pelvic pain, the clinician must consider the possibility of abdominal wall pain. A useful technique in both diagnosis and treatment may be trigger point injections.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Use of trigger point injections in chronic pelvic pain. 811 93

Anyone who has managed chronic pain patients well understands the need for patience and unconditional positive support for the patient. It is most imperative that the physician and the entire health care team continue to be optimistic in spite of repeated failures of different treatment regimens. It is important to keep the patient informed continually of the problems encountered and the different treatment regimens used (Fig. 8). To keep the patient motivated to seek eventual solutions to the problems is one of the key elements in chronic pelvic pain therapy for the pain specialist. Do not underestimate the power of patient involvement in her own disease process. Some of the most common errors made by physicians are the underestimation of the patient's interest and intelligence in understanding the medical aspects of the pain disorder, lack of communication with the patient in regard to new findings and the effect they have on the course of the patient's treatment, and the lack of outward expressions of sincerity and concern about an individual patient's condition.
Obstet Gynecol Clin North Am 1993 Dec
PMID:Management of chronic pelvic pain. 811 94

Recent comparative studies and developments in our understanding of the pathogenesis and pathophysiology of endometriosis have led to increasing doubts about whether it should always be considered a disease. Widespread use of laparoscopy for gynaecological investigation and treatment, recognition of non-pigmented lesions which are more active than classical implants, and the documentation of microscopic lesions in visually normal peritoneum, have all resulted in an increase in the frequency with which endometriosis is diagnosed. Recent studies suggest a prevalence of up to 80% in women complaining of infertility or pelvic pain, but also in up to 22% of fertile asymptomatic women undergoing sterilization. Perhaps it is a normal physiological variant, being present in such a high proportion of the population. Circumstantial evidence suggests this may be so, and the results with placebo treatment in controlled trials suggest that endometriosis is self-limiting and will regress or disappear spontaneously in 58% of women. The frequency and severity of symptoms which are often presumed to result from endometriosis do not correlate with the extent or site of lesions. Most women are pain-free. There is no dysmenorrhoea in up to 77%, no dyspareunia in up to 70%, and no pelvic pain at all in up to 61% of women with endometriosis. The pathophysiology of pain related to endometriosis is not understood. There is no medical or conservative surgical treatment that is wholly effective for symptom relief, and there is considerable placebo benefit. All treatments have risks or side-effects, and recurrent symptoms will develop in up to 45% of women within 5 years. For these reasons treatment should only be used where endometriosis fulfils the criteria of a disease, showing signs of progression with tissue damage or physiological disturbance. Asymptomatic endometriosis without tissue damage should not be considered a disease and should not be treated. Treatment of pain associated with minor endometriosis, or prophylactic treatment to prevent progression, must be regarded as empirical and not the specific requirement to control what is a questionable disease.
Baillieres Clin Obstet Gynaecol 1993 Dec
PMID:Is endometriosis a disease? 813 9


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