Negative laparoscopy unveiled

2018 ◽  
Vol 10 (1) ◽  
pp. 18-21 ◽  
Author(s):  
John Jarrell ◽  
Lars Arendt-Nielsen
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Clinic Visit ◽  
Observer Error ◽  
Acute Pelvic Pain ◽  
Pain Sensitization ◽  
Student’S T ◽  
Nociceptive Input ◽  
Pain Testing

Introduction: Studies indicate a variable proportion of laparoscopies done for the management of non-acute pelvic pain that do not identify visible pathology and are called negative laparoscopies. Possible explanations have included undetected endometriosis, observer error, and/or neural tissues in the endometrium acting as nociceptive input. The goal was to compare demographic and pain testing measures between women with negative laparoscopies and confirmed endometriosis in a cohort of women presenting with chronic pelvic pain. Methods: Women with chronic pelvic pain (n = 255) provided written consent for the study prior to entry. Data were collected at the time of clinic visit and entered contemporaneously into SPSS. Pain sensitization was identified as the presence of cutaneous allodynia. Clinical, pain, and pain sensitization variables were compared using Student’s t-test. Results: The frequency of negative laparoscopy was 13.7% (35 cases) and that of confirmed endometriosis was 27.1% (69 cases). There were no differences between women with a negative laparoscopy and women with confirmed endometriosis in clinical, dysmenorrhea, or pain testing measurements. Conclusion: The data suggest in the absence of endometriotic tissue in the pelvis, chronic visceral pain may result from a uterine origin and result in a generalized pattern of pain and pain sensitization.

scholarly journals Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy

2022 ◽  
Vol 12 (1) ◽  
pp. 101
Author(s):  
Augusto Pereira ◽  
Manuel Herrero-Trujillano ◽  
Gema Vaquero ◽  
Lucia Fuentes ◽  
Sofia Gonzalez ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Conventional Therapy ◽  
Chronic Pelvic Pain ◽  
Myofascial Pain ◽  
Visceral Pain ◽  
University Hospital ◽  
Common Symptom ◽  
Rectal Pain ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.

Patient with Chronic Pelvic Pain from Endometriosis

2016 ◽  
Author(s):  
Jianguo Cheng ◽  
Yoon-Jeong Cho
Keyword(s):  
Pelvic Pain ◽  
Hormonal Therapy ◽  
Chronic Pelvic Pain ◽  
Reproductive Tract ◽  
Visceral Pain ◽  
Surgical Removal ◽  
Antiinflammatory Drugs ◽  
Persistent Symptoms ◽  
Incomplete Removal ◽  
Management Procedures

Endometriosis, a chronic and progressive condition characterized by the presence of endometrial tissue outside the uterus, accounts for about one third of the cases of chronic pelvic pain in women. Pain in endometriosis may be due to nociceptive, inflammatory, and/or neu­ropathic mechanisms. The clinical presentation is often variable between patients, and diagnostic laparoscopy for visualization and biopsy of lesions is the gold standard for diagnosis. The treatment may consist of two elements: chronic pelvic pain itself as a diagnosis and endometriosis as a disease. Hormonal therapy is used to reduce the amount of estrogen and hence reduce symptoms such as pelvic pain and dysmenorrhea. In patients with severe endometriosis, surgical removal of lesions, adhesions, and cysts and restoration of pelvic anatomy may be preferred. Both hormonal and surgical treatments have been shown to be effective in decreasing pain symptoms associated with endometriosis. A variety of analgesics, including nonsteroidal antiinflammatory drugs, opioids, tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, and antiepileptic drugs, have been used to ameliorate pain in endometriosis, with varying degrees of success. In patients with persistent symptoms, interventional pain management procedures may be performed to target the visceral and somatic organs and their innervations. Infertility is the most common complication of endometriosis. Between 10 and 20% of women with endometriosis have recurrence of the disease regardless of the treatment they receive. The recurrence of pain may be due to remodeling of the central nervous system, the role of the reproductive tract in reactivating pain, and incomplete removal or recurrence of lesions. This review contains 2 tables and 52 references  Key words: chronic abdominal pain, chronic pelvic pain, dyschezia, dysmenorrhea, dyspareunia, endometrioma, endometriosis, hormonal therapy, infertility, retrograde menstruation, visceral pain 

scholarly journals Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
John Jarrell ◽  
Maria Adele Giamberardino ◽  
Magali Robert ◽  
Maryam Nasr-Esfahani
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Trigger Points ◽  
Cross Sectional ◽  
Myofascial Trigger Points ◽  
Predictive Values ◽  
Pain Thresholds ◽  
Somatic Pain ◽  
Cutaneous Allodynia

Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.

Female Pelvic Pain: Assessment

2020 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 13 figures, 5 tables and 60 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

Pelvic neuropathic pain (differential diagnosis)

2021 ◽  
Vol 86 (4) ◽  
pp. 279-283
Author(s):  
Tomáš Fučík ◽  
◽  
Jaromír Mašata
Keyword(s):  
Differential Diagnosis ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Diagnostic Algorithm ◽  
International School ◽  
Functional Disorders ◽  
Review Of Literature ◽  
Acute Pelvic Pain ◽  
Time To Diagnosis ◽  
Common Etiology

Summary: Objective: General practitioners, surgeons, neurologists, urologists and gynecologists all encounter patients suffering from neurogenic pelvic pain. Correct management demands knowledge from all above mentioned specialties. The primary goal is to help patients suffering from chronic or acute pelvic pain coupled with functional disorders like dysuria, urgency, dyspareunia, mobility disorders orhypoesthesia. Neurogenic defects are not the most common etiology for either of listed symptoms. However, after exclusion of the more common ones and failure to respond to basic therapeutic methods such as physiotherapy or analgotheraphy doctors tend to mark the illness as idiopathic and incurable. The goal of this review is to show the most common nosological units and a robust diagnostic algorithm to describe the type and level of the damage. Methods: Review of literature using databases Pubmed, Science direct, Medline and sources of the international school of neuropelveology. Conclusion: Over a lifetime, one in seven women will suffer from chronic pelvic pain. Outside of the cases where a clear postoperative etiology is established, the time to make a correct dia gnosis is often long for the unspecific and varied symptomatology. Neuropelveological diagnostic algorithm is demonstrably efficient in shortening the time to diagnosis and more importantly to the treatment.

Pain Sensitization in Male Chronic Pelvic Pain Syndrome: Why Are Symptoms so Difficult to Treat?

2003 ◽  
Vol 170 (3) ◽  
pp. 823-827 ◽  
Author(s):  
CLAIRE C. YANG ◽  
JAY C. LEE ◽  
BRENDA G. KROMM ◽  
MARCIA A. CIOL ◽  
RICHARD E. BERGER
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Pain Sensitization

Spinal Cord Stimulation for Visceral Pain: Present Approaches and Future Strategies

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2298-2309
Author(s):  
Royce W Woodroffe ◽  
Amy C Pearson ◽  
Amy M Pearlman ◽  
Matthew A Howard ◽  
Haring J W Nauta ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pelvic Pain ◽  
Spinal Cord Stimulation ◽  
Chronic Pelvic Pain ◽  
Potential Role ◽  
Visceral Pain ◽  
The United States ◽  
Off Label ◽  
Pain Pathways ◽  
Implantation Techniques

Abstract Introduction The introduction of successful neuromodulation strategies for managing chronic visceral pain lag behind what is now treatment of choice in refractory chronic back and extremity pain for many providers in the United States and Europe. Changes in public policy and monetary support to identify nonopioid treatments for chronic pain have sparked interest in alternative options. In this review, we discuss the scope of spinal cord stimulation (SCS) for visceral pain, its limitations, and the potential role for new intradural devices of the type that we are developing in our laboratories, which may be able to overcome existing challenges. Methods A review of the available literature relevant to this topic was performed, with particular focus on the pertinent neuroanatomy and uses of spinal cord stimulation systems in the treatment of malignant and nonmalignant gastrointestinal, genitourinary, and chronic pelvic pain. Results To date, there have been multiple off-label reports testing SCS for refractory gastrointestinal and genitourinary conditions. Though some findings have been favorable for these organs and systems, there is insufficient evidence to make this practice routine. The unique configuration and layout of the pelvic pain pathways may not be ideally treated using traditional SCS implantation techniques, and intradural stimulation may be a viable alternative. Conclusions Despite the prevalence of visceral pain, the application of neuromodulation therapies, a standard approach for other painful conditions, has received far too little attention, despite promising outcomes from uncontrolled trials. Detailed descriptions of visceral pain pathways may offer several clues that could be used to implement devices tailored to this unique anatomy.

Female Pelvic Pain: Assessment

2018 ◽  
Author(s):  
Mario Castellanos ◽  
Louise P King
Keyword(s):  
Irritable Bowel Syndrome ◽  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Visceral Pain ◽  
Pelvic Floor Dysfunction ◽  
Pudendal Neuralgia ◽  
Somatic Pain ◽  
Irritable Bowel ◽  
Over Time

Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes. This review contains 12 figures, 2 tables and 57 references Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain

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