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Chronic Pelvic Pain in Women

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  • 220 Seiten
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The number of studies on chronic and recurrent pain bears no relation to the frequency of these complaints in gynecologic practice... Weiterlesen
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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.


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.- 4.2.1 History of the Present Disorder.- 4.2.2 Somatic Examination.- 4.2.3 Some Special Explorations.- 4.3 Gynecologic Laparoscopy.- 4.3.1 Systematic Visual Exploration of the Pelvis.- 4.3.2 Indications.- 4.3.3 Contraindications.- 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.- 5.3.1 Verbal Presentation.- 5.3.2 Indications Suggesting Psychogenic Components in Pain Complaints.- 5.3.3 Main Psychopathologic Syndromes Inducing or Accompanying Gynecologic Pain Complaints.- 6 Genital Prolapse and Retroversion of the Uterus.- 6.1 Genital Prolapse.- 6.1.2 Pain Mechanisms.- 6.2 Retroversion and Retroflexion of the Uterus.- 6.2.1 Which Symptoms May Be Caused by Mobile Retroversion?.- 6.2.2 Treatment of Mobile Retroversion.- 6.2.3 Fixed Retroversion.- 7 Parietal Pain.- 7.1 Possible Causes of Pain Arising in the Abdominal Wall.- 7.1.1 Posterior Columns and Posterior Horns.- 7.1.2 Posterior Roots and Spinal Ganglia.- 7.1.3 Peripheral Nerves.- 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.- 7.4.1 Pain Due to Irritation of the Posterior Roots and Ganglia.- 7.4.2 Pain Due to Irritation of Peripheral Nerves.- 7.5 Some Examples of Abdominal Parietal Pain in Obstetric Practice.- 8 Dysmenorrhea.- 8.1 Incidence.- 8.2 Classification.- 8.3 Primary Dysmenorrhea.- 8.3.1 Clinical Characteristics.- 8.3.2 Pathophysiology.- 8.3.3 Pathogenesis of Primary Dysmenorrhea.- 8.3.4 Management.- 8.4 Secondary Dysmenorrhea.- 8.4.1 Endometriosis.- 8.4.2 Adenomyosis.- 8.4.3 Fibroids.- 8.4.4 Obstructive Dysmenorrhea.- 8.4.5 Psychogenic 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.- 10.1.1 Signs.- 10.1.2 Prevalence.- 10.1.3 Pathophysiology.- 10.2 Pathogenesis.- 10.2.1 Premenstrual Tension and Personality.- 10.2.2 Hyperestrogenism or Deficient Luteal Function?.- 10.2.3 Hyperaldosteronism?.- 10.2.4 Does Prolactin Play a Role?.- 10.3 Treatment.- 10.3.1 General Remarks.- 10.3.2 Drug Treatment.- 11 Endometriosis.- 11.1 Incidence.- 11.2 Diagnosis.- Spontaneous Pain.- 11.3 Various Pain Localizations in Endometriosis.- 11.3.1 Visceral Pain.- 11.3.2 Parietal Pain.- 11.3.3 Referred Pain of Visceral Origin; Somatic Pain Radiations.- 11.4 Mechanism of Pain Due to Endometriosis.- 11.4.1 Pain Mechanism.- 11.4.2 Why Do Some Lesions Remain Painless?.- 11.4.3 How to Know Whether a Pain Symptom Is Due to Endometriosis.- 11.5 Acute Pain Syndromes Due to Endometriosis.- 11.5.1 Intestinal Stenosis and Obstruction.- 11.5.2 Acute Pain Without Rupture of an Endometriotic Cyst.- 11.5.3 Acute Pain Syndromes Due to Rupture of an Endometriotic Cyst.- 11.5.4 Pseudoappendicitis.- 11.5.5 Pseudoinflammatory Variety.- 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.- 12.2.1 Tuberculous Salpingitis.- 12.2.2 Sequelae of Acute PID or "Chronic Salpingo-Oophoritis".- 12.2.3 Subacute and Recurrent Salpingo-Oophoritis.- 13 Ovarian Pain.- 13.1 Ovarian Cysts.- 13.1.1 Follicle Cysts.- 13.1.2 Lutein Cysts.- 13.1.3 Endometriotic Cysts.- 13.1.4 "Sclerocystic Ovaritis".- 13.1.5 Recurrent Functional 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.- 14.2.1 Tender Episiotomy Scars.- 14.2.2 Posterior Repair Scars.- 14.2.3 Senile Atrophy.- 14.2.4 Perineal Endometriosis.- 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.- 15.1.1 Innervation.- 15.1.2 Visceral Sensations.- 15.2 General Considerations of Enterocolic Pain.- 15.2.1 Visceral Pain.- 15.2.2 Somatic Pain.- 15.2.3 Referred Pain.- 15.2.4 Shifting Pain.- 15.3 Abdominal Pain Patterns.- 15.3.1 Location of Pain.- 15.3.2 Duration of Pain.- 15.3.3 Quality of Pain.- 15.4 Enterocolic Disorders Causing Lower Abdominal Pain.- 15.4.1 Irritable Bowel Syndrome.- 15.4.2 Infectious Diarrheas.- 15.4.3 Appendicitis.- 15.4.4 Diverticulitis.- 15.4.5 Inflammatory Bowel Disease.- 15.4.6 Obstruction.- 15.4.7 Tumors.- 15.4.8 Pelvic Abscess.- 15.4.9 Hernias.- 15.4.10 Intestinal Ischemia (Abdominal Angina).- 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.- 16.5.1 History.- 16.5.2 Physical Examination.- 16.5.3 Roentgenologic Investigation.- 16.5.4 Special Investigations.- 16.6 Etiology of Low Back Pain.- 16.6.1 Congenital Anomalies.- 16.6.2 Growth Disorders.- 16.6.3 Traumatic Lesions of the Vertebral Column.- 16.6.4 Inflammation.- 16.6.5 Tumors.- 16.6.6 Osteoporosis.- 16.6.7 Postdiskectomy Syndrome.- 16.6.8 Degenerative Changes in the Spine.- 16.6.9 Spinal Stenosis.- 16.6.10 Pathologic Changes in the Sacroiliac Joints.- 16.6.11 Coccygodynia.- 16.6.12 Pubic Symphysis 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.- 17.6.1 Congenital Ureteral Obstructions.- 17.6.2 Acquired Ureteral Obstructions.- 18 Chronic Pelvic Pain Without Obvious Pathology.- 18.1 Introduction.- 18.2 Description of the Syndrome.- 18.3 Prevalence.- 18.4 Pathogenesis.- 18.4.1 To What Extent Is CPPWOP Due to "Traumatic Laceration of Uterine Support"?.- 18.4.2 Role of Circulatory Disturbances in the Pathogenesis of CPPWOP.- 18.4.3 To What Extent Can the Syndrome Be Explained by Morphological or Functional Modifications in the Internal Genital Organs or in the Parametrium?.- 18.4.4 Psychological Characteristics of Women with CPPWOP.- 18.4.5 A Hypothesis Concerning the Pathogenesis of CPPWOP.- 18.5 Therapeutic Strategy.- 18.5.1 Establishing an Efficient Therapeutic Relationship.- 18.5.2 Psychological Evaluation and Treatment.- 18.5.3 Medical Treatment.- 18.5.4 Surgical Treatment.- 19 Treatment of Pain Due to Gynecologic Tumors Localized in the Pelvis.- 19.1 Introduction.- 19.2 Treatment of Cancer Pain with Analgesic Drugs.- 19.2.1 Pharmacologic Properties of Analgesic Drugs.- 19.2.2 Clinical Aspects of Cancer Pain.- 19.2.3 Therapeutic Use of Analgesic Drugs.- 19.2.4 Concomitant Medication.- 19.2.5 Mode of Administration.- 19.2.6 Side Effects.- 19.3 Treatment of Cancer Pain with Nerve Blocks.- 19.3.1 Midline Pain.- 19.3.2 Unilateral Pain.- 19.4 Neurosurgical Treatment of Cancer Pain of Gynecologic Origin.- 19.4.1 Lesion Techniques.- 19.4.2 Stimulation Techniques.- 19.5 Conclusion.- 20 Subject Index.


Titel: Chronic Pelvic Pain in Women
EAN: 9783642679704
ISBN: 3642679706
Format: Kartonierter Einband
Herausgeber: Springer Berlin Heidelberg
Genre: Medizin
Anzahl Seiten: 220
Gewicht: 389g
Größe: H244mm x B170mm x T12mm
Jahr: 2011
Auflage: Softcover reprint of the original 1st ed. 1981