Chronic Pelvic Pain Flashcards Preview

B - Gynaecology > Chronic Pelvic Pain > Flashcards

Flashcards in Chronic Pelvic Pain Deck (39)
1

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

2

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

38/1000

3

What are the gynaecological causes of chronic pelvic pain?

- Adenomyosis
- Endometriosis
- Adhesions
- Pelvic venous congestion

4

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

- Trapped ovary syndrome
- Ovarian remnant syndrome

5

What happens in trapped ovary syndrome?

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

6

What happens in ovarian remnant syndrome?

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

7

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

8

What are the gastrointestinal causes of chronic pelvic pain?

- IBS
- Constipation
- Hernia

9

What are the urological causes of chronic pelvic pain?

- Interstitial cystitis
- Urethral syndrome
- Calculi

10

What are the MSK causes of chronic pelvic pain?

- Fibromyalgia
- Trigger points

11

What are the neurological causes of chronic pelvic pain?

- Nerve entrapment
- Neuropathic pain

12

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

13

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

14

What examinations may be done in chronic pelvic pain?

- Abdominal
- Internal
- Rectal

15

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

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

16

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

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

17

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

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

18

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

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

19

What should investigations be guided by in chronic pelvic pain?

History and examination findings

20

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

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

21

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

Trial with GnRH analogue

22

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

23

What does treatment for chronic pelvic pain need to address?

Perpetuating and causative factors

24

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

Within MDT

25

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

It it fits within the woman own belief system

26

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

Analgesic ladder

27

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

Pre-emptive analgesia for predictable cyclical exacerbations

28

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

29

What analgesic options may be useful in chronic pelvic pain?

- Neuropathic treatments
- Topical capsicum on abdominal skin

30

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

- Amitriptyline
- Gabapentin
- Pregabalin

31

What hormonal treatment options can be used in chronic pelvic pain?

- COCP
- Progestagens
- Danazol
- GnRH analogues

32

How long can a GnRHa be combined safely with low-dose HRT?

At least 2 years

33

What % of women attending chronic pelvic pain clinics have MSK disorders?

75%

34

What can improve CPP associated with MSK disorders?

Physiotherapy

35

What are often perpetuating factors for CPP?

Psychosocial and psychosexual issues

36

What can exploring psychosocial and psychosexual issues in a non-threatening environment achieve?

Help improve pain experience and help develop pain management pain

37

What treatments may be useful for CPP associated with negative psychological features?

More specific treatments, such as CBT

38

Is surgery a first line investigation/treatment for CPP?

No, always second line

39

Why is surgery not a first line investigation/treatment for CPP?

Because patients with chronic pelvic pain are more likely to develop post-op pain, and negative laparoscopies reinforce abnormal health beliefs and psychological traits