Relationship of laparoscopic findings to self-report of pelvic pain

Article Abstract:

Whether chronic pelvic pain reflects psychological or physiological disturbance is a subject of long-standing debate; studies using laparoscopy (examination of the pelvic organs with a fiberoptic tube) have found a higher percentage of abnormalities in women with such complaints than earlier studies based on laparotomy (surgical opening of the abdomen). Modern approaches to chronic pain conceptualize it as an outcome of behavioral, psychological, and physiological factors. The most common physical abnormalities associated with chronic pelvic pain are endometriosis (tissue of the uterine lining located in abnormal sites) and pelvic adhesions (fibrous tissue attaching abnormally to the pelvic organs). To evaluate the extent to which the presence of these abnormalities is associated with pain, 102 women who underwent laparoscopy were studied (90 reported pain, 12 did not). They completed a questionnaire concerning gynecologic problems, pain during menstruation or sexual intercourse, demographic variables, marital satisfaction, and other issues, as well as standardized pain questionnaires. Sixty-four percent were being examined for pain; 35 percent, for infertility; 19 percent, for follow-up to other abnormal tests; and 15 percent, for sterilization. The extent of their disease was rated by surgeons using a standard scoring system (the surgeon did not know if the patient had complained of pain). The physical disease scores were not correlated with self-reported pain symptoms, nor were pain indexes (from the standardized pain tests) correlated with physical disease scores. While most women with symptoms had some type of physical abnormality in the region where they felt pain, the lack of correlation between the severity of the abnormality and the severity of pain made it likely that psychosocial factors were significant. Treatment of chronic pelvic pain should include attention to both physical and emotional/social problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Evaluation, Endometriosis

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Resolution of chronic pelvic pain after laparoscopic lysis of adhesions

Article Abstract:

Laparoscopy is the examination of the abdomen using a tube-like device with an optical system, called a laparoscope, which is inserted into the abdomen. Forty percent of all laparoscopic procedures in the US are performed to assess pelvic pain. Thirty to 50 percent of cases of chronic pelvic pain are associated with pelvic adhesions, which are fiber-like bands connecting sites in the pelvis. The mechanism whereby adhesions cause pain is not known, but the pain can often be localized to the site of the adhesion. However, physical causes of other chronic pain problems, such as low back pain, are frequently undetermined. Hence, the existence of unique pain fibers and relation between intensity of pain and tissue damage, as suggested by the Cartesian theory of pain perception, is questionable. Other theories suggest that pain is influenced by cultural, psychological, intellectual, emotional, and stress-related factors. The effect of laparoscopic lysis of adhesions (removal of adhesions by tissue breakdown during laparoscopy) for relief of pain was assessed. The study involved 30 women with chronic pelvic pain, including 10 who were diagnosed with the chronic pain syndrome. Laparoscopic lysis of adhesions relieved daily pain and dyspareunia (pain during sexual intercourse) in 4 of the 10 women with the chronic pain syndrome and in 15 of the 20 women without the syndrome. Daily pain and dyspareunia was more likely to improve after lysis of the adhesions in women with chronic pelvic pain, but did not significantly help those with chronic pain syndrome. It is suggested that the role of psychosocial factors in pain relief requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Laparoscopy

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Preoperative ultrasound to predict infraumbilical adhesions: A study of diagnostic accuracy

Article Abstract:

The study of diagnostic accuracy aims to determine the test characteristics of preoperative abdominal ultrasound in predicting infraumbilical adhesions in women. The visceral slide is measured that improves preoperative prediction of both presence and absence of bowel adhesions in patients with previous abdominal operations or infections

United States, Research and Development in the Physical, Engineering, and Life Sciences, Science & research, Research and Testing Services, Gynecological R&D, Research, Usage, Fetus, Preoperative care, Pregnancy, Complications of, Pregnancy complications, Gynecological research, Prenatal ultrasonography, Ultrasonics in obstetrics

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