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Flashcards in Chronic Pelvic Pain Deck (39)
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What is chronic pelvic pain?

The symptom of intermittent or chronic pelvic pain the lower abdomen or pelvis, of at least 6 months duration and not associated with pregnancy


What is the prevalence of CPP in women aged 15-73?



What are the gynaecological causes of chronic pelvic pain?

- Adenomyosis
- Endometriosis
- Adhesions
- Pelvic venous congestion


What disorders caused by adhesions exist that cause chronic pelvic pain?

- Trapped ovary syndrome
- Ovarian remnant syndrome


What happens in trapped ovary syndrome?

After hysterectomy the ovary becomes trapped within dense adhesions at the pelvic side wall


What happens in ovarian remnant syndrome?

A small piece of ovarian tissue, not removed during oophorectomy, becomes embedded within adhesions


What are the features of the pain caused by pelvic venous congestion?

- Worst premenstrually and after prolonged periods of standing and walking
- Dyspareunia often also present


What are the gastrointestinal causes of chronic pelvic pain?

- Constipation
- Hernia


What are the urological causes of chronic pelvic pain?

- Interstitial cystitis
- Urethral syndrome
- Calculi


What are the MSK causes of chronic pelvic pain?

- Fibromyalgia
- Trigger points


What are the neurological causes of chronic pelvic pain?

- Nerve entrapment
- Neuropathic pain


What questions need to be asked in the history in chronic pelvic pain?

As for pelvic pain, but also including;
- Detailed history of pain
- Sexual history and future fertility wishes
- Patients beliefs, wishes, and concerns about the pain


What needs to be included in a detailed history about the pain in chronic pelvic pain?

- Events surrounding its onset
- Site
- Nature
- Radiation
- Time course
- Exacerbating and relieving factors
- Cyclicity


What examinations may be done in chronic pelvic pain?

- Abdominal
- Internal
- Rectal


What should be looked for on abdominal examination in chronic pelvic pain?

As for acute pelvic pain, but also altered sensation and trigger points


When might a speculum examination not be appropriate in chronic pelvic pain?

- History of vaginismus
- Pain secondary to difficult smear
- Abuse


What should be looked for on internal examination in chronic pelvic pain?

- Tension/trigger points in pelvic floor
- Adnexal tenderness/mass
- Cervical tenderness


When should a rectal examination be performed in chronic pelvic pain?

Only if indicated, e.g. strong suspicion of rectal endometriosis


What should investigations be guided by in chronic pelvic pain?

History and examination findings


Why may a pain diary be useful in chronic pelvic pain?

May help clinician and woman make connections which had not previously been noted


What can be a useful diagnostic tool with clearly cyclical chronic pelvic pain?

Trial with GnRH analogue


How can the results of a trail with GnRH analogue be useful in cyclical chronic pelvic pain?

Women requesting total abdominal hysterectomy with bilateral salpingo-oophrectomy can be reassured that it may be a successful treatment if their pain is relieved with a GnRHa, however if their pain persists, they should be counselled that TAH&BSO is unlikely to remove their pain, and other causes should be explored


What does treatment for chronic pelvic pain need to address?

Perpetuating and causative factors


In what setting is treatment for chronic pelvic pain best achieved?

Within MDT


When is success for chronic pelvic pain more likely to be successful?

It it fits within the woman own belief system


What should be used to obtain appropriate pain relief in chronic pelvic pain?

Analgesic ladder


What approach to analgesia might prevent emergency admissions with chronic pelvic pain?

Pre-emptive analgesia for predictable cyclical exacerbations


Describe the role of opiates in the management of chronic pelvic pain?

May be required for severe, acute exacerbations, but if needed regularly, referral to specialist pain clinic should be made


What analgesic options may be useful in chronic pelvic pain?

- Neuropathic treatments
- Topical capsicum on abdominal skin


What neuropathic treatments may be useful for analgesia in chronic pelvic pain?

- Amitriptyline
- Gabapentin
- Pregabalin