The Role of Laparoscopy in Chronic Pelvic Pain: Promise and Pitfalls

Howard, Fred M.

doi:10.1097/00006254-199306000-00001

Cited by 397 publications

(231 citation statements)

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“…[23][24][25][26][27][28][29][30] Recurrent pain, such as that associated with isolated dysmenorrhoea and dyspareunia, is often considered biologically distinct from chronic pain, although many women have overlapping symptoms. To investigate any differences in risk factors for different classes of chronic pelvic pain, we adopted an inclusive approach with a composite of chronic and recurrent pelvic pain.…”

Section: Methodsmentioning

confidence: 99%

“…1 It is the single most common indication for referral to gynaecology clinics, accounting for 20% of all outpatient appointments in secondary care. 2 An estimated £158m (€230m, $274m) is spent annually on the management of this condition in the NHS, 3 and $881.5m a year (£507m, €740m) on its outpatient management in the United States. 4 There is wide variation in clinical evaluation of women with chronic pelvic pain.…”

Section: Introductionmentioning

confidence: 99%

“…Diagnostic laparoscopy is often carried out after referral to a gynaecologist as an initial investigation to uncover pathological causes-for example, endometriosis or adhesions-but has negative results in over half of cases. 5 Moreover, the extent to which such conditions cause pain is uncertain as there is overlap with psychosocial factors in most cases. 6 7 Even laparoscopy may have beneficial effects through psychological mechanisms.…”

Section: Introductionmentioning

confidence: 99%

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Factors Predisposing Women to Chronic Pelvic Pain: Systematic Review

2006

Obstetrics & Gynecology

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Objective To evaluate factors predisposing women to chronic and recurrent pelvic pain. Design, data sources, and methods Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors. Results There were 122 studies (in 111 articles) of which 63 (in 64 286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18 601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12 040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche ( < 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain. Conclusion Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Predisposing Women to Chronic Pelvic Pain: Systematic Review

2006

Obstetrics & Gynecology

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“…There is no agreed definition of chronic pelvic pain and there is much controversy about what may cause it [154]. Some believe that peritoneal endometriosis and pelvic adhesions cause chronic pelvic pain [155].…”

Section: Chronic Pelvic Painmentioning

confidence: 99%

Imaging in gynecology

Valentin

2006

Best Practice & Research Clinical Obstetrics & Gynaecol

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This chapter summarizes the diagnostic performance (sensitivity, specificity, positive and negative likelihood ratios) of ultrasound, computer tomography, and magnetic resonance imaging in the diagnosis of various gynecological diseases and tumors. Positron emission tomography is not discussed. Imaging in infertility, in the diagnosis of Mullerian duct anomalies and in gynecological oncology (staging of gynecological cancers, diagnosis of recurrence of gynecological cancer, diagnosis of trophoblastic tumors) is not dealt with.Ultrasound is the first line imaging method for discrimination between viable intrauterine pregnancy, miscarriage and tubal pregnancy in women with bleeding and/or pain in early pregnancy, for discrimination between benign and malignant adnexal masses and for making a specific diagnosis in adnexal tumors (e.g., dermoid cyst, endometrioma, hemaorrhagic corpus luteum, ectetera), for diagnosing intracavitary uterine pathology in women with bleeding problems, and for confirming or refuting pelvic pathology in women with pelvic pain. Magnetic resonance imaging may have a role as a secondary test in the diagnosis of adenomyosis, 'deep endometriosis' (e.g., endometriosis in the rectovaginal septum or in the utero-sacral ligaments), and in the diagnosis of extremely rare types of ectopic pregnancy (e.g., in the spleen, liver or retroperitoneum).

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“…Em unidades de cuidados primá-rios, 39% das mulheres queixam-se de dor pélvica. É responsável por 40 a 50% das laparoscopias ginecológicas, 10% das consultas ginecológicas e, aproximadamente, 12% das histerectomias [8][9][10] . Adicionalmente, implica custo direto e indireto superior a dois bilhões de dólares por ano nos Estados Unidos 11 .…”

Section: Introductionunclassified

Abordagem da dor pélvica crônica em mulheres

Nogueira¹,

Reis²,

Neto³

2006

Rev. Bras. Ginecol. Obstet.

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RESUMODor pélvica crônica é uma doença debilitante e de alta prevalência, com grande impacto na qualidade de vida e produtividade, além de custos signifi cantes para os serviços de saúde. O dilema no manejo da dor pélvica crônica continua a frustrar médicos confrontados com o problema, em parte porque sua fi siopatologia é pobremente compreendida. Conseqüentemente, seu tratamento é muitas vezes insatisfatório e limitado ao alívio temporário dos sintomas. Nesta revisão, nós discutimos uma abordagem ampliada da dor pélvica crônica. Salientamos que uma história clínica e exame físico adequados deveriam incluir atenção especial aos sistemas gastrintestinal, urinário, ginecológico, músculo-esquelético, neurológico, psicológico e endócrino. Dessa forma, uma abordagem multidisciplinar é recomendada. Adicionalmente, enfatizamos que, embora úteis, procedimentos cirúrgicos específi cos, tais como a laparoscopia, deveriam ser indicados somente para pacientes selecionadas, após excluir principalmente síndrome do intestino irritável e dor de origem miofascial. PALAVRAS-CHAVE: Dor pélvica; Síndrome do intestino irritável; Cistite intersticial; Endometriose; Laparoscopia; Prevalência ABSTRACTChronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond signifi cant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specifi c surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin.

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The Role of Laparoscopy in Chronic Pelvic Pain: Promise and Pitfalls

Cited by 397 publications

References 0 publications

Factors Predisposing Women to Chronic Pelvic Pain: Systematic Review

Factors Predisposing Women to Chronic Pelvic Pain: Systematic Review

Imaging in gynecology

Abordagem da dor pélvica crônica em mulheres

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