Chronic Pelvic Pain in Women

The number of studies on chronic and recurrent pain bears no relation to the frequency of these complaints in gynecologic practice, nor to the clinical and scientific problems that still need solving in this area. Several factors stand in the way of progress in this field, such as the strongly subjective nature of the complaints, the frequent lack of correlation between them and objective findings, and the complexity of the psychosomatic interac tions involved. Although progress in our knowledge has been much slower than we would have wished, and although we are well aware of these many gaps, it was considered useful to gather in a book what we think we have learned during 3 decades of active interest in pain patients and pain problems in gynecologic practice and 12 years of supervision of a pain clinic in the Department of Obstetrics and Gynecology of Leuven University. As there are many differences between acute pain - clinical as well as experi mental - on the one hand and chronic pain symptoms on the other, it was felt preferable to limit the scope of this book essentially to chronic and recurrent pain in gynecologic practice. When presented with a complaint of lower abdominal and/or low back pain, the gynecologist should constantly be on the lookout for nongynecologic causes, of which the most frequent will be either gastroenterologic or orthopedic and sometimes urologic. I have been fortunate in obtaining the collaboration of Dr.

Inhalt
1 Introduction.- 1.1 Frequency of Chronic Pain.- 1.2 Frequent Incorrect Diagnoses.- 1.3 Two-Staged Clinical Investigation of Chronic Pain Syndromes.- 2 Anatomy and Physiology of Gynecologic Pain.- 2.1 Innervation.- 2.2 Central Pathways and Modulating Influences.- 2.3 Sensitivity of the Genital Organs.- 3 General Characteristics of Chronic Pain of Gynecologic Origin.- 3.1 Most Frequent Localizations.- 3.2 Radiation or Spread of Pain.- 3.3 Time-Intensity Relationship During the Menstrual Cycle.- 3.4 Hyperalgesia of the Abdominal Wall and of Back in Chronic Pain Syndromes.- 3.5 Other Useful Data.- 4 Examination of Patients with Chronic Pain Syndromes.- 4.1 The Patient and Her Complaints.- 4.2 Clinical Examination and Some Special Explorations.- 4.3 Gynecologic Laparoscopy.- 4.4 Interpretation of Data: Some Causes of Diagnostic Errors.- 5 Psychological Aspects of the Pain Experience.- 5.1 General Considerations.- 5.2 Behavioral Patterns of Patients with Acute and Chronic Pain.- 5.3 Presentation of the Pain Complaint.- 6 Genital Prolapse and Retroversion of the Uterus.- 6.1 Genital Prolapse.- 6.2 Retroversion and Retroflexion of the Uterus.- 7 Parietal Pain.- 7.1 Possible Causes of Pain Arising in the Abdominal Wall.- 7.2 Meaning of Parietal Tenderness in Chronic Abdominal Pain Syndromes.- 7.3 Characteristics of Parietal Pain Due to Irritation of Peripheral Nerves of the Abdominal Wall.- 7.4 Some Examples of Parietal Pain in Gynecologic Practice.- 7.5 Some Examples of Abdominal Parietal Pain in Obstetric Practice.- 8 Dysmenorrhea.- 8.1 Incidence.- 8.2 Classification.- 8.3 Primary Dysmenorrhea.- 8.4 Secondary Dysmenorrhea.- 9 Midcycle Pain.- 9.1 Severe Form.- 9.2 Less Severe Forms.- 9.3 Pathogenesis.- 9.4 Treatment.- 10 Premenstrual Tension.- 10.1 Symptoms.- 10.2 Pathogenesis.- 10.3 Treatment.- 11 Endometriosis.- 11.1 Incidence.- 11.2 Diagnosis.- Spontaneous Pain.- 11.3 Various Pain Localizations in Endometriosis.- 11.4 Mechanism of Pain Due to Endometriosis.- 11.5 Acute Pain Syndromes Due to Endometriosis.- 11.6 Management of Endometriosis.- 12 Chronic Pelvic Inflammatory Disease.- 12.1 Chronic Parametritis Due to a Chronic Cervical Infection.- 12.2 Chronic Salpingo-Oophoritis.- 13 Ovarian Pain.- 13.1 Ovarian Cysts.- 13.2 Ovarian Remnant Syndrome.- 13.3 Residual Ovary Syndrome.- 13.4 Chronic Oophoritis and Perioophoritis.- 13.5 Ovarian Dyspareunia.- 13.6 Ovarian Tumors.- 13.7 Some Rare Causes of Ovarian Pain.- 14 Dyspareunia.- 14.1 Varieties of Dyspareunia.- 14.2 Superficial Dyspareunia.- 14.3 Vaginal Dyspareunia.- Psychogenic Dyspareunia.- 14.4 Deep Dyspareunia.- 14.5 Psychological Factors.- 15 Acute and Chronic Lower Abdominal Pain of Enterocolic Origin.- 15.1 Innervation and Visceral Sensations.- 15.2 General Considerations of Enterocolic Pain.- 15.3 Abdominal Pain Patterns.- 15.4 Enterocolic Disorders Causing Lower Abdominal Pain.- 16 Low Back Pain in Women.- 16.1 Introduction.- 16.2 Definition of Low Back Pain.- 16.3 Medicosocial Importance of Low Back Pain.- 16.4 Origin of Low Back Pain.- 16.5 Investigation of Low Back Pain.- 16.6 Etiology of Low Back Pain.- 16.7 General Rules of Treatment and Conduct for Patients with Back Complaints.- 17 Chronic Pelvic Pain of Urologic Origin.- 17.1 Introduction.- 17.2 Recurrent Cystourethritis.- 17.3 Intractable Suprapubic Pain Due to Infiltrating Bladder Tumors.- 17.4 Pelvic Kidney Ectopia.- 17.5 Nephroptosis.- 17.6 Ureteral Causes of Pelvic Pain.- 18 Chronic Pelvic Pain Without Obvious Pathology.- 18.1 Introduction.- 18.2 Description of the Syndrome.- 18.3 Prevalence.- 18.4 Pathogenesis.- 18.5 Therapeutic Strategy.- 19 Treatment of Pain Due to Gynecologic Tumors Localized in the Pelvis.- 19.1 Introduction.- 19.2 Treatment of Cancer Pain with Analgesic Drugs.- 19.3 Treatment of Cancer Pain with Nerve Blocks.- 19.4 Neurosurgical Treatment of Cancer Pain of Gynecologic Origin.- 19.5 Conclusion.- 20 Subject Index.