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

The various investigative procedures used in clinical, laboratory, and imaging evaluations for the patient presenting with chronic pelvic pain are discussed and categorized as mandatory, recommended, or optional procedures. These categories primarily serve to rule out underlying pathology because there is no diagnostic test for chronic prostatitis/chronic pelvic pain syndrome (CPPS). Mandatory category investigations should be performed in all patients with CPPS, and those procedures categorized as recommended or optional are generally prompted by specific findings in the history or physical examination, or by poor response to standard therapies.
Urology 2002 Dec
PMID:Clinical evaluation of the man with chronic prostatitis/chronic pelvic pain syndrome. 1252 83

Treatment of nonbacterial chronic prostatitis/chronic pelvic pain syndrome continues to be a challenge for the treating physician. However, results from studies on the use of alpha-blockers seem to show some promise. Further studies on this class of drugs in the treatment of this condition are recommended.
Urology 2002 Dec
PMID:Role of alpha-blockers in the treatment of chronic prostatitis. 1252 87

Anti-inflammatory medications have been used for the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), given that inflammation and pain are traditionally associated with this condition. The National Institutes of Health (NIH) classification divides category III into (1) category IIIA--patients with white blood cells (WBCs) in their expressed prostatic secretions, post-prostate massage urine (voided bladder urine-3 [VB3]) or semen; and (2) category IIIB--those without WBCs. However, recent studies indicate that the ability of WBC count alone to distinguish men with symptoms from those without appears limited. Other markers of inflammation, such as cytokines, may correlate better with clinical findings. The mechanisms of inflammation continue to be investigated, including contributions from reactive oxygen species, autoimmune response, neurogenic inflammation, and even endocrine dysfunction. There have been few controlled studies of anti-inflammatory therapy for chronic prostatitis. In the only randomized double-blind placebo-controlled trial, the NIH-Chronic Prostatitis Symptom Index (CPSI) total, domain, and pain scores significantly decreased from baseline in all groups, but the difference was not statistically significant. Other medications that have some theoretic anti-inflammatory properties have shown promising early results. Further study of currently available anti-inflammatory medications may be warranted, especially in longer trials, which may allow resolution of the significant placebo effect commonly seen in the short term in men with CPPS. Further discussion is needed to either validate, modify, or abolish the distinction between category IIIA and IIIB in the NIH classification.
Urology 2002 Dec
PMID:Inflammation and anti-inflammatory therapy in chronic prostatitis. 1252 89

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating condition, traditionally treated with antimicrobials, nonsteroidal anti-inflammatory drugs, and alpha-blockers. Pelvic floor tension myalgia is hypothesized to be a contributing factor in CPPS. Biofeedback training for CPPS is based on the principle that maximum muscle contraction prompts maximum muscle relaxation. Similar chronic pain conditions have been treated successfully with biofeedback-assisted techniques of neuromuscular reeducation. Preliminary study by our group has shown biofeedback, pelvic floor reeducation, and bladder training to be helpful in the treatment of CP/CPPS. Overall, 8 of 11 patients had improvement in either pain scores or their chronic prostatitis pain index scores. With no cure for CP/CPPS available, biofeedback and pelvic floor reeducation merit further evaluation in the treatment of this condition.
Urology 2002 Dec
PMID:Bladder training biofeedback and pelvic floor myalgia. 1252 95

Reflex sympathetic dystrophy (RSD) is a complex and poorly-understood condition characterized by: (a) pain and altered sensation; (b) motor disturbance and soft tissue change; (c) vasomotor and autonomic changes; and (d) psychosocial disturbance. Neurological symptoms typically do not conform to any particular pattern of nerve damage. Many different names have been ascribed to this condition and most recently the term 'complex regional pain syndrome' has been coined to emphasize the complex interaction of somatic, psychological and behavioural factors. Diagnostic criteria have been proposed by the International Association for the Study of Pain, but are still subject to debate. This review article describes the clinical features which may present as part of the condition, and the patho-physiology and pre-disposing factors so far identified. The evidence for effectiveness of different interventions is presented and a treatment approach outlined for inter-disciplinary management. While RSD is traditionally associated with pain in the extremities, the possibility is raised that the same process may underlie chronic pain syndromes affecting more central structures, such as testicular or pelvic pain.
Disabil Rehabil 2002 Dec 15
PMID:Reflex sympathetic dystrophy--a complex regional pain syndrome. 1252 47

Lymphadenectomy for pelvic cancer can lead to complications, particularly lymphocele. We report a case of pelvic lymphocele, which occurred in a patient who underwent surgery for stage IIa cervical carcinoma after preoperative radiotherapy. The intervention consisted in colpohysterectomy, with lymphadenectomy without peritonisation. Five months later she developed dysuria and pelvic pain. Ultrasound and computed tomography showed a pelvic lymphocele complicated by renal insufficiency. Kidney function was re-established after intraperitoneal marsupialisation. One year later the patient was in good clinical condition with no disorder of kidney function.
J Gynecol Obstet Biol Reprod (Paris) 2002 Dec
PMID:[Pelvic lymphocele: report of a case and review of the literature]. 1259 99

Ultrasound of the adolescent female pelvis is the imaging method of choice for most medical problems presenting with symptoms and signs referable to this area. Recognizing the transition from child to mature female and its manifestations are crucial in directing the workup and interpreting the sonographic findings. A description of the normal anatomy and physiology of the pelvic organs is followed by a discussion of the clinical and imaging findings in primary and secondary amenorrhea, pelvic pain, and pelvic masses.
Ultrasound Q 2002 Dec
PMID:Ultrasonography of the adolescent female pelvis. 1297 98

Hysterosalpingography was performed on 175 patients who had gynecological symptoms but negative pelvic findings, in order to test a new method of introducing the contrast medium into the uterus and tubes and to record the incidence of pathology revealed. In 132 patients, an attempt was made to secure a No. 14 Foley catheter in the uterus for introducing the contrast medium. This method was successful in 124 patients and can be recommended as being simple, less painful and more efficient than older methods. Of 156 patients with the complaints of infertility (68), dysmenorrhea (31), pelvic pain (29) or menstrual disorder (28), hysterosalpingography revealed significant abnormality in 58; most of these (47) had chronic salpingitis. One flare-up of pelvic inflammation occurred but no other complications were observed. It was concluded that hysterosalpingography is now sufficiently safe and reliable to merit wider utilization in gynecological diagnosis.
Can Med Assoc J 1963 Dec 07
PMID:THE USE OF HYSTEROSALPINGOGRAPHY IN THE DIAGNOSIS OF INFERTILITY AND OTHER GYNECOLOGICAL CONDITIONS. 1408 22

The aims of the present study were to determine the influence of pregnancy on somatosensory responses in women with or without pelvic/lumbosacral pain. Thirty pregnant women participated and were divided into pain (n = 12) and nonpain (n = 18) groups on the basis of pain complaints and positive pain-provoking tests associated with pelvic or lumbosacral pain during the current pregnancy. In the pain group, 9 reported initial pain in trimester 1, 2 in trimester 2, and 1 in trimester 3. Quantitative sensory testing with pressure pain threshold (PPT), heat pain threshold (HPT), and tactile threshold (TT) was performed once during each of the 3 trimesters at referred pain sites (sacrum, back, and pubis) and no pain control sites (thigh, arm, and sternum). All subjects in the pain group reported back pain, and 91% also had pain at the sacrum and pubis. The pain group exhibited significantly greater pain sensitivity than the nonpain group. The HPT and PPT were higher in trimester 3 as compared to trimesters 1 and 2 (P < .012). The increase in thresholds, or hypoalgesia, was generalized and present at both referred pain and control sites in the pain group. In the nonpain group hypoalgesia was localized to the presumed referred pain sites at the back and sacrum. There were no significant variations in the TT in any trimester. The study demonstrates for the first time that hypoalgesia in late pregnancy is generalized in women with pelvic pain and localized in women without pelvic pain. This suggests that the descending noxious inhibitory system is activated in late pregnancy and is probably more intense and generally activated in women with pelvic pain and only segmentally activated in women without pain.
J Pain 2002 Dec
PMID:Antenatal women with or without pelvic pain can be characterized by generalized or segmental hypoalgesia in late pregnancy. 1462 31

John Huffman, a founder of the subspecialty of pediatric and adolescent gynecology in North America, first related the diagnosis of endometriosis to thelarche. Subsequently, endometriosis was diagnosed in early puberty between thelarche and menarche. Based on solid evidence, we suggest that the theory of embryonic mullerian rests be added to currently accepted theories of pathogenesis of endometriosis. This article argues for recognition of embryonic mullerian rests as the pathogenesis of some cases of endometriosis not explained by accepted theories. Along with Huffman, we propose that thelarche be recognized as a developmental benchmark, after which endometriosis is included in the differential diagnosis of chronic pelvic pain. Thus, in an effort to refocus research and patient care to early adolescence, this review is limited to endometriosis occurring in young women from thelarche to their sixteenth birthday. Relating endometriosis to thelarche has fundamental implications for pathogenesis, early diagnosis, prognosis, treatment, education, and long-term care of adolescents.
J Pediatr Adolesc Gynecol 2003 Dec
PMID:Endometriosis from thelarche to midteens: pathogenesis and prognosis, prevention and pedagogy. 1464 54


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