Chronic Pelvic Pain

Aim. The aim of the study is to compare the prevalence of depression in women surgically diagnosed with endometriosis according to the presence or absence of pelvic pain. Methods. This cross-sectional prospective study evaluated 100 women receiving care at the Outpatients' equally divided into two groups: one suffering from chronic pelvic pain and the other pain-free. The Beck Depression Inventory was used in order to measure depression. Results. Depression was detected in 86 and 38% of the women with and without chronic pelvic pain, respectively. Complaints of depression, such as somatic concerns, work inhibition, dissatisfaction, and sadness, were observed at a significantly higher rate in the group with pain. A sensation of failure was the only variable observed more frequently in the pain-free group. Conclusions. Depression is highly prevalent in women with endometriosis, especially those with pelvic pain. Careful evaluation can identify women with depression who may benefit from treatment.

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) afflicts 2%-10% of adult men. Available therapies offer little or no proven benefit. Because acupuncture represents an attractive "natural" therapy, we compared the efficacy of acupuncture to sham acupuncture for CP/CPPS. METHODS: Participants met US National Institutes of Health (NIH) consensus criteria for CP/CPPS, were aged Ն20 years old, and had a total score Ն15 on the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) and symptoms for at least 3 of the preceding 6 months. They were randomized 1:1 to acupuncture or sham acupuncture. Treatment consisted of twice-weekly 30-minute sessions for 10 weeks (20 sessions total) without needle stimulation, herbs, or adjuvants. The primary response criterion was a 6-point decrease from baseline to week 10 in NIH-CPSI total score (range 0-43). RESULTS: Thirty-two (73%) of 44 participants responded in the acupuncture group compared with 21 (47%) of 45 sham group participants (relative risk 1.81, 95% confidence interval, 1.3-3.1, P ϭ .02). Long-term responses 24 weeks after completing therapy without additional treatment occurred in 14 (32%) of 44 acupuncture group participants and in 6 (13%) of 45 sham group participants (relative risk 2.39, 95% confidence interval, 1.0-5.6, P ϭ .04). CONCLUSIONS: After 10 weeks of treatment, acupuncture proved almost twice as likely as sham treatment to improve CP/CPPS symptoms. Participants receiving acupuncture were 2.4-fold more likely to experience long-term benefit than were participants receiving sham acupuncture.

The aim of the study was to report our results of sacral nerve stimulation in patients with pelvic pain after failed conservative treatment. From 1992 to August 1998 we treated 111 patients (40 males, 71 females, ages 46 + 16 years) with chronic pelvic pain. All patients with causal treatment were excluded from this study. Pelvic floor training, transcutaneous electrical nerve stimulation (TENS) and intrarectal or intravaginal electrostimulation were applied and sacral nerve stimulation was used for therapy-resistant pain. The outcome of conservative treatment and sacral nerve stimulation (VAS <3/10; >50% pain relief) was related to symptoms of voiding dysfunction and dyschezia, and urodynamic proof of dysfunctional voiding, not to the pain localization or treatment modality. Outcome was inversely related to neuropathic pain. When conservative treatment failed, a test stimulation of the S3 root was effective in 16/26 patients, and 11 patients were implanted successfully with a follow-up of 36 + 8 months. So far no late failures have been seen. A longer test stimulation is needed in patients with pelvic pain because of a higher incidence of initial false positive tests. Our conclusion is that sacral nerve stimulation is effective in the treatment of therapy-resistant pelvic pain syndromes linked to pelvic floor dysfunction.

Usually, women suffering from chronic pelvic pain experience it for some time and do not seek treatment until the pain becomes so severe that it adversely affects a woman’s normal daily functioning, preventing her from maintaining a normal lifestyle and leading to development of chronic pain syndrome. Chronic pelvic pain syndrome is often accompanied by behavioral disorders, cognitive, psychoemotional and sexual disorders, as well as symptoms of dysfunction of the lower urinary and digestive systems, pelvic organs, gynecological dysfunction, which are the result of neurobiological, physiological and sometimes anatomical changes in the body and central nervous system.
Often a gynecologist automatically focuses exclusively on gynecological organs, assuming that they are the cause of the problem, but most often the cause of chronic pelvic pain is a group of factors. Disorders of the gastrointestinal, urological, and musculoskeletal systems are at least as common as disorders of the reproductive system in women with chronic pelvic pain. Therefore, diagnostic measures should be aimed at identifying all the causes which requires doctors to take a multidisciplinary approach to the diagnosis and management of chronic pelvic pain. The causes of the problem in most cases can be identified by a thorough history taking and physical examination, which should be more detailed than usual. As a diagnostic tool, it can minimize the need for expensive laboratory testing and imaging or risky surgery. The use of specialized assessment forms and questionnaires for chronic pelvic pain can be important and useful to ensure coverage of all critical points.
When planning a diagnostic plan for women with chronic pelvic pain, it is important to consider the key role of the nervous system in the perception of pain. Experiencing pain for a long period of time can change how the brain perceives and processes pain signals, leading to an amplification of pain and cross-organ sensitization.
Complicated differential diagnosis often causes the absence of a definitive diagnosis in most patients who complain of chronic pelvic pain. Therefore, during the first visit of the patient, it is sometimes impossible to immediately determine the cause of pain. Because the causes of many disorders associated with chronic pelvic pain have not been identified, most clinicians treat them empirically. Therefore, in the presence of several etio-pathogenetic factors, treatment of only some of them will lead to incomplete relief.
The definition of «chronic pelvic pain» can hide many diseases, the detection of which requires the involvement of a multidisciplinary team of gynecologists, urologists, gastroenterologists, nephrologists, vascular surgeons, orthopedists, psychiatrists, psychologists and doctors of other specialties. However, it is mostly gynecologists who are the first to come into contact with this pathology because, in most cases, women who suffer from chronic pelvic pain first turn to them for help. That is why they should be the main members of the multidisciplinary team and take responsibility for its creation. Unfortunately, physicians often lack an interdisciplinary approach to the management of chronic pelvic pain, which complicates comprehensive assessment, diagnosis, and treatment and leads to frustration among women who go from one specialist to another without an adequate solution to their problem.

Originally published as © Vasquez A. Microbial Origins of Fibromyalgia. Naturopathic Doctor News and Reviews 2016 Apr ndnr.com/pain-medicine/microbial-origins-of-fibromyalgia derived from Inflammation Mastery, 4th Edition excerpted as Pain Revolution (full-color) and Brain Inflammation (discounted grayscale printing). Copyright © 2014-present by Dr Alex Vasquez https://www.InflammationMastery.com/fibromyalgia 
See related video archive at https://www.inflammationmastery.com/fibromyalgia-migraine-videos-news

Introduction and hypothesis: Female chronic pelvic pain is prevalent and causes disability. Can women with self-reported chronic pelvic pain (CPP) be distinguished from pain-free women by demonstrating a greater number of abnormal musculoskeletal findings on examination? Methods: In this cross-sectional study, blinded examiners performed 9 physical exam maneuvers on 48 participants; 19 with CPP, and 29 pain-free. Frequency of positive findings between groups, total number of positive exam findings, cluster analysis, and sensitivity -specificity analyses were performed. Results: Women with CPP presented with significantly more abnormal findings than pain-free women. By using two examination maneuvers, examiners correctly classified women with self-reported CPP from pain-free women 85% of the time. Conclusions: Abnormal findings on musculoskeletal exam are more common in women with self-reported CPP. Women with CPP might benefit from a faster time to diagnosis and improved treatment outcomes if a musculoskeletal contribution to CPP was identified earlier. ª

The etiology of chronic pelvic pain is disputed and multifactorial. We studied the effect of Mensendieck somatocognitive therapy aimed at reducing physical pain by changing posture, movement and respiration patterns combined with standard gynecological treatment.Women with chronic pelvic pain unexplained by pelvic pathology were randomized into 2 groups: (1) standard gynecological treatment and (2) gynecological treatment plus somatocognitive therapy. A Mensendieck test of motor function (posture, movement, gait, sitting posture, respiration) and a visual analogue score of pain were obtained before and after the 90-day treatment period.The test results of patients treated by standard gynecological measures were unchanged (nonsignificant). By contrast, the patients receiving somatocognitive therapy in addition improved scores by 25% to 60% for all motor functions (P < .01, largest improvement for respiration, up from average 2.98 [SEM 0.30] to 4.72 [0.37]), and pain scores reduced by 50% (down from 5.60 [0.40] to 2.89 [0.40], P < .01).Mensendieck somatocognitive therapy combined with standard gynecological care improved pain experience and motor functions of women with chronic pelvic pain better than gynecological treatment alone.

Chronic pelvic pain (CPP) has many potential causes and is often a complex disorder with multiple contributing etiologies. The evaluation and treatment of women with CPP often requires a multidimensional approach. The treatment of CPP consists of two approaches: 1) treatment of pain itself or global treatment, and 2) treatment of disease-specific etiologies. Most often, treatment requires a combination of both approaches. This article reviews recent literature in the global treatment of CPP, including pharmacologic, psychotherapy, and neuro-ablative, as well as specific interventions for endometriosis, interstitial cystitis, pelvic adhesive disease, adenomyosis, and pelvic venous congestion.

e u r o p e a n u r o l o g y 5 3 ( 2 0 0 8 ) 6 0 -6 7 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Objectives: Because the term ''interstitial cystitis'' (IC) has different meanings in different centers and different parts of the world, the European Society for the Study of Interstitial Cystitis (ESSIC) has worked to create a consensus on definitions, diagnosis, and classification in an attempt to overcome the lack of international agreement on various aspects of IC. Methods: ESSIC has discussed definitions, diagnostic criteria, and disease classification in four meetings and extended e-mail correspondence.

To perform the Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index (NHI-CPSI), and to study its linguistic validity and its correlations with the Visual Analogue Scale for pain (VAS) and the Italian version of International Prostatic Symptom Score (I-PSS) in men with chronic pelvic pain syndrome (CPPS) and healthy controls. A rigorous double-back translation of the original English NHI-CPSI was performed by a staff composed of 3 professional bilingual experts and 3 urologists. The study population consisted of 160 male CPPS patients and 125 healthy controls, who were asked to self complete the Italian version of the NHI-CPSI together with the VAS and the Italian I-PSS. The discriminatory power, psychometric properties, internal correlations and convergent validity of the questionnaire were tested. Of the 285 enrolled patients, 223 patients (142 with CPPS and 81 healthy patients) were definitively considered for the study. The overall Italian NIH-CPSI scores and each subscale differed significantly (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) between the two groups, and so that the index proved a good discriminant validity. High correlations were found between the VAS and the pain domain (0.88) and between I-PSS and void domain (0.94), suggesting a good convergent validity of the Italian version of the NIH-CPSI. The questionnaire proved to have a high internal consistency. The Italian NIH-CPSI is a reliable symptom index that can be self-administrated in about 5 minutes in daily clinical practice for the follow-up of the Italian patients with chronic prostatitis.

To determine whether electrodermal measures at Jing-Well acupuncture points, ''indicator'' points located at the tips of fingers and toes are associated with clinical measures in adolescent women with chronic pelvic pain. Design: The design of this study was a randomized sham-controlled trial. Analyses of electrodermal measures were based on longitudinal, multivariable analyses using generalized estimating equations. Subjects and setting: The subjects were 14 young women (ages 14-22) with laparoscopically diagnosed endometriosis and chronic pelvic pain. Subjects were randomized to sham acupuncture or Japanese-style active acupuncture. Sixteen (16) treatments were administered over 8 weeks.

Chronic pelvic pain is a complex disorder associated with multiple and often overlapping conditions. It is therefore vital to have a holistic approach to management and not one that is focused on a potential solitary pathology. A systematic approach to history and examination is mandatory to establish appropriate investigation, treatment and referral. Chronic pelvic pain is more common than was previously recognized.

The symptoms typically associated with polycystic ovary syndrome (PCOS) such as acne, hirsutism, irregular menses, amenorrhoea, obesity and subfertility are a major source of psychological morbidity and can negatively affect quality of life (QoL). We systematically searched the literature to identify the impact of symptoms and treatments for PCOS on health-related QoL (HRQoL) and to report on the types and psychometric properties of the instruments used. Papers were retrieved by systematically searching four electronic databases and hand searching relevant reference lists and bibliographies. Nineteen papers used a standardized questionnaire to measure health status; of these 12 (63.2%) used generic tools and 8 (42%) used the disease-specific PCOS questionnaire. Although a meta-analysis was not possible, it appears that weight concerns have a particular negative impact upon HRQoL, although the role of body mass index in affecting HRQoL scores is inconclusive from the available evidence. Acne is the area least reported upon in terms of its impact upon HRQoL. With the exception of three studies, most of the research has focused upon adult women with PCOS. Despite the benefits of HRQoL measures in research, few are being used to evaluate the outcomes of treatment for PCOS upon the subjective health status of women with the condition.

Despite significant research and focus over the last 50 years on gender and organizations, a continued lack of understanding of the importance of gender in working life continues to exist.  Gender intersects with other power dynamics in organizations compounding inequalities.  One such dynamic is chronic pelvic pain, an invisible illness that affects approximately one in seven women and is considered a private topic not openly discussed within organizational contexts.  This study used an interpretative phenomenological analysis methodology to understand the first-hand, lived experiences of six U.S. women managers working at the intersection of work, gender and chronic pelvic pain. Participants were solicited from Facebook support groups and semi-structured interviews were used to explore and capture experiences. Two research questions were asked including: 1) How do U.S. women managers perceive their experience of working and executing management responsibilities while in chronic pelvic pain? and 2) How do U.S. women managers experience power dynamics within their organization while working in chronic pelvic pain? Key findings emerged to answer these questions and revolved around the consistent experience of psychological distress, presenteeism and the perceived need to actively manage co-worker perceptions.

To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. BURDEN OF SUFFERING: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subject...

John Huffman, a founder of the subspecialty of pediatric and adolescent gynecology in North America, first related the diagnosis of endometriosis to thelarche. Subsequently, endometriosis was diagnosed in early puberty between thelarche and menarche. Based on solid evidence, we suggest that the theory of embryonic mullerian rests be added to currently accepted theories of pathogenesis of endometriosis. This article argues for recognition of embryonic mullerian rests as the pathogenesis of some cases of endometriosis not explained by accepted theories. Along with Huffman, we propose that thelarche be recognized as a developmental benchmark, after which endometriosis is included in the differential diagnosis of chronic pelvic pain. Thus, in an effort to refocus research and patient care to early adolescence, this review is limited to endometriosis occurring in young women from thelarche to their sixteenth birthday. Relating endometriosis to thelarche has fundamental implications for pathogenesis, early diagnosis, prognosis, treatment, education, and long-term care of adolescents.

Background and methodology Endometriosis is a chronic condition in which endometrial glands and stroma are present outside of the uterus. Whereas chronic pelvic pain is the most commonly experienced pain of endometriosis, many women also suffer from deep dyspareunia. In order to determine how much of an impact endometriosis-associated dyspareunia has on the lives and relationships of women a qualitative study using semi-structured interviews, supplemented with quantitative data on the extent of dyspareunia, was conducted in a dedicated endometriosis clinic in the West Midlands, UK with 30 women aged from 19 to 44 years.

BACKGROUND: The objective of this multicentre randomized, controlled clinical trial was to compare the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a depot-GnRH-analogue in the control of endometriosis-related pain over a period of six months. METHODS: Eighty-two women, 18 to 40 years of age (mean 30 years), with endometriosis, dysmenorrhoea and/or CPP, were randomized using a computer-generated system of sealed envelopes into either LNG-IUS (n 5 39) or GnRH analogue (n 5 43) treatment groups at three university centres. Daily scores of endometriosis-associated CPP were evaluated using the Visual Analogue Scale (VAS), daily bleeding score was calculated from bleeding calendars, and improvement in quality of life was evaluated using the Psychological General Well-Being Index Questionnaire (PGWBI). The pain score diary was based on the VAS in which women recorded the occurrence and intensity of pain on a daily basis. A monthly score was calculated from the result of the sum of the daily scores divided by the number of days in each observation period. RESULTS: CPP decreased significantly from the first month throughout the six months of therapy with both forms of treatment and there was no difference between the groups (P > 0.999). In both treatment groups, women with stage III and IV endometriosis showed a more rapid improvement in the VAS pain score than women with stage I and II of the disease (P < 0.002). LNG-IUS users had a higher bleeding score than GnRH-analogue users at all time points of observation with 34% and 71% of patients in the LNG-IUS and GnRH-analogue groups, respectively, reporting no bleeding during the first treatment month, and 70% and 98% reporting no bleeding during the sixth month. No difference was observed between groups with reference to improvement in quality of life. CONCLUSIONS: Both, the LNG-IUS and the GnRH-analogue were effective in the treatment of CPP-associated endometriosis, although no differences were observed between the two treatments. Among the additional advantages of the LNG-IUS is the fact that it does not provoke hypoestrogenism and that it requires only one medical intervention for its introduction every 5 years. This device could therefore become the treatment of choice for CPP-associated endometriosis in women who do not wish to conceive.

Background: Past studies that have addressed the health effects of intimate partner violence (IPV) have defined IPV as violence based on physical blows that frequently cause injuries. To our knowledge, no epidemiologic research has assessed the physical health consequences of psychological forms of IPV.

Chronic pelvic pain (CPP) is a common gynecological problem that is also associated with sexual dysfunction. The purpose of this research was to investigate the validity and reliability of Female Sexual Function Index (FSFI) in women with CPP. One hundred women with CPP and 100 age-matched subjects without CPP were compared in the study. Sexual function was assessed by FSFI. Internal consistency (Cronbach&amp;amp;amp;amp;amp;amp;amp;#39;s alpha values = 0.91-0.97) was high for all scales. There were significant differences between women with and without CPP for each of the FSFI domain and total scores with very large effect sizes (1.29-2.56) (P &amp;amp;amp;amp;amp;amp;amp;lt; 0.0001, for all). Interdomain correlations of FSFI in the CPP group corresponded well to each other (P &amp;amp;amp;amp;amp;amp;amp;lt; 0.0001, for all). Moreover, test-retest reliability (r = 0.79-0.90) was also within acceptable ranges for this population. We concluded that the FSFI showed good ability to discriminate between women with and without sexual dysfunctions in the CPP population.

Purpose: A perspective on the neurobehavioral component of the etiology of chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is emerging. We evaluated a new approach to the treatment of CP/CPPS with the Stanford developed protocol using myofascial trigger point assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT).

To investigate whether botulinum toxin type A (BOTOX) injected into the levator ani muscles of women with objective pelvic floor muscle spasm decreases pain symptoms and improves quality of life. A prospective cohort study. Outpatient clinic in a tertiary referral centre, Sydney, Australia. Twelve women, aged 18-55 years, with objective pelvic floor muscle hypertonicity and a minimum 2-year history of chronic pelvic pain were recruited. All women completed visual analog scale pain assessments; questionnaires relating to bladder and bowel symptoms and quality of life; and specific examinations. Forty units of BOTOX at three different dilutions were given bilaterally into the puborectalis and pubococcygeus muscles under conscious sedation. Median visual analog scale scores were significantly improved for dyspareunia (80 vs 28; P=0.01) and dysmenorrhea (67 vs 28; P=0.03), with non-significant reductions in non-menstrual pelvic pain (64 vs 37) and dyschesia (47 vs 29). Pelvic floor musc...

Approche symptomatique des douleurs épididymo-testiculaires chroniques 963 KEYWORDS Chronic testicular pain; Chronic scrotal pain; Chronic pelvic pain; Chronic testicular pain; Diagnosis Summary Objective. -To list clinical and ethiopathogenical elements relevant to the analysis of an epididymal and testicular pain. Material and methods. -Review of published articles on the subject in the Medline ® (PubMed ® ) database, selected according to their scientific relevance.

Chronic pelvic pain (CPP) is a common, burdensome, and costly condition that disproportionately affects women. Touching
an estimated more than 20% of people worldwide or approximately 1 in 7 women,1
CPP is a common problem. In one study of
reproductive-aged women in primary care practices, the reported
prevalence rate of pelvic pain was 39%.2
Of all referrals to gynecologists, 10% are for pelvic pain.3

Background Acupuncture is an attractive treatment option for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) that has proved refractory to conventional medical treatments. Unfortunately, it is diffi cult to determine the benefi t of acupuncture because few studies have employed controls or had physiological outcome measures. Objective To determine the feasibility of a sham, or minimally invasive, acupuncture as a control for studies evaluating the effi cacy of acupuncture treatment for chronic pelvic pain. Methods Participants were recruited from a double-blind randomised trial comparing acupuncture with a sham procedure for patients with CP/CPPS. Acupuncture or sham procedures were performed over a 10-week period. Sham acupuncture involved placement of short needles at sites 0.5 cm away from true acupuncture points (CV1, CV4, SP6 and SP9). Participants were asked to determine their procedure allocation at the end of treatment. A total of 35 participants also agreed to have blood analyses for cortisol, β-endorphin and leucine-enkephalin. Results Thirty-fi ve (78%) of the 45 participants randomised to the sham treatment thought they had received acupuncture compared with 27 (61%) of the 44 participants randomised to acupuncture (p=0.11). Biochemical data showed no differences between the groups immediately after treatment. Thirty-two (73%) of 44 acupuncture participants met the predefi ned clinical response criterion compared with 21 (47%) of 45 sham acupuncture participants (p=0.017, relative risk 1.81, 95% CI 1.3 to 3.1). At the end of the study, β-endorphin and leucine-enkephalin levels were both higher in the acupuncture group (p<0.01). Conclusions Minimally penetrating acupuncture was found to be a valid sham control and may prove useful for evaluating the effi cacy of acupuncture for other conditions. (ClinicalTrials.gov number, NCT00260637)

To assess feasibility, and collect preliminary data for a subsequent randomized, sham-controlled trial to evaluate Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. Randomized, sham-controlled trial. Tertiary-referral hospital. Eighteen young women (13-22y) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain. A Japanese style of acupuncture and a sham acupuncture control. Sixteen treatments were administered over 8 weeks. Protocol feasibility, recruitment numbers, pain not associated with menses or intercourse, and multiple HRQOL instruments including Endometriosis Health Profile, Pediatric Quality of Life, Perceived Stress, and Activity Limitation. Fourteen participants (out of 18 randomized) completed the study per protocol. Participants in the active acupuncture group (n = 9) experienced an average 4.8 (SD = 2.4) point reduction on a 11 point scale (62%) in pain...

The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.

Objectives: On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and followup of chronic pelvic pain patients were established. Method: Guidelines were compiled by a working group and based on current literature following a systematic review using MEDLINE. References were weighted by the panel of experts. Results: The full text of the guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article is a short version of this text and summarises the main conclusions from the guidelines on management of chronic pelvic pain. Conclusion: A guidelines text is presented including chapters on prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecological practice, role of the pelvic floor and pudendal nerve, general treatment of chronic pelvic pain and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from chronic pelvic pain.

Aim To report an unusual location of a transmigrated IUD which become embedded in the right ovary causing chronic pelvic pain and dyspareunia. Case A 22-year-old woman who had an IUD (Copper T), inserted 7 years ago presented with complaint of lower abdominal pain. Pelvic ultrasonographic examination revealed ovarian embedding of the IUD. Laparoscopic IUD removal was successfully performed. Discussion De novo lower abdominal pain in a woman with an IUD in situ should alert the clinician to the possibility of total or partial transmigration of the device into the pelvis or abdomen. Ovarian penetration is very rare and this is the second case of IUD transmigration into the ovary reported in the medical literature.

Objective: To investigate whether different dimensions of chronic pelvic pain are useful in the diagnosis of endometriosis. Design: A prospective questionnaire-based study of 185 women. Setting: Southeast of England. Patient(s): Women undergoing a diagnostic laparoscopy for chronic pelvic pain. Intervention(s): Preoperative questionnaire. Main Outcome Measure(s): Descriptions of pain, areas of pain, and pain intensity.

Widespread central hypersensitivity is present in chronic pain and contributes to pain and disability. According to animal studies, expansion of receptive fields of spinal cord neurons is involved in central hypersensitivity. We recently developed a method to quantify nociceptive receptive fields in humans using spinal withdrawal reflexes. Here we hypothesized that patients with chronic pelvic pain display enlarged reflex receptive fields. Secondary endpoints were subjective pain thresholds and nociceptive withdrawal reflex thresholds after single and repeated (temporal summation) electrical stimulation. 20 patients and 25 pain-free subjects were tested. Electrical stimuli were applied to 10 sites on the foot sole for evoking reflexes in the tibialis anterior muscle. The reflex receptive field was defined as the area of the foot (fraction of the foot sole) from which a muscle contraction was evoked. For the secondary endpoints, the stimuli were applied to the cutaneous innervation area of the sural nerve. Medians (25-75 percentiles) of fraction of the foot sole in patients and controls were 0.48 (0.38-0.54) and 0.33 (0.27-0.39), respectively (P = 0.008). Pain and reflex thresholds after sural nerve stimulation were significantly lower in patients than in controls (P < 0.001 for all measurements). This study provides for the first time evidence for widespread expansion of reflex receptive fields in chronic pain patients. It thereby identifies a mechanism involved in central hypersensitivity in human chronic pain. Reverting the expansion of nociceptive receptive fields and exploring the prognostic meaning of this phenomenon may become future targets of clinical research.

Approche symptomatique des douleurs épididymo-testiculaires chroniques 963 KEYWORDS Chronic testicular pain; Chronic scrotal pain; Chronic pelvic pain; Chronic testicular pain; Diagnosis Summary Objective. -To list clinical and ethiopathogenical elements relevant to the analysis of an epididymal and testicular pain. Material and methods. -Review of published articles on the subject in the Medline ® (PubMed ® ) database, selected according to their scientific relevance.

To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. BURDEN OF SUFFERING: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subject...

The purpose of this study was to assess the effectiveness of presacral neurectomy in women with severe dysmenorrhea caused by endometriosis that was treated with conservative surgical intervention. One hundred forty-one sexually active women of fertile age with chronic severe dysmenorrhea caused by endometriosis were treated with conservative laparoscopic surgery. Patients were assigned randomly to not receive (group A) or receive (group B) presacral neurectomy. At 6 and 12 months after the surgical procedures, the cure rate was evaluated in each patient. The frequency and severity of dysmenorrhea, dyspareunia, and chronic pelvic pain were also evaluated at the same time intervals. The cure rate was significantly higher in group B compared with group A at a follow-up examination at 6 months (87.3% vs 60.3%) and 12 months (85.7% vs 57.1%). At follow-up visits, the frequency and severity of dysmenorrhea, dyspareunia, and chronic pelvic pain were significantly lower in both groups compared with baseline values; in particular, significantly lower values were observed in group B versus group A for the severity. Presacral neurectomy improves the cure rate in women who are treated with conservative laparoscopic surgery for severe dysmenorrhea caused by endometriosis.