pelvic pain – pain management perspective · what is pelvic pain ? definition ; “pelvic pain is...

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Pelvic Pain – Pain management Perspective

Dr.Justin Lane

Consultant in Pain Management

• Definition;

• Classifications;

• Diagnostics/History

/Examination;

• Treatments;

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Presentation Overview

What is Pelvic Pain ?

Definition ;

“Pelvic pain is abdominal pain located below the

level of the umbilicus including, frequently, lower back

pain with or without radiation into the thighs. Such

pain may be acute, chronic, or intermittent and may

be simulated by gastrointestinal disease such as

diverticulitis or by lumbosacral arthritis.”Jones GS, Jones HW. Novak's textbook of gynecology. 10th ed. Baltimore: Williams and Wilkins, 1981.

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Gynaecologic and Obstetric;

Urologic;

Gastrointestinal;

Musculoskeltal;

Psychologic

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Classification according to cause/anatomical site;

• Bladder and Bowel dysfunction;

• Sexual Dysfunction;

• Systemic conditions ; (Benign / Malignant).

• Constitutional symptomatology; (Hormonal / Benign /Malignant).

• Depression;

• Anxiety;5

Associated symptoms and presentations;

• Often referral from Gynaecology / General Surgery Pelvic Floor Service;

i ) History of Gynaecology surgery (Benign or Malignant/ Obstetric

surgery ;

ii) History Gynaecology medical issues;

iii) Most scans / Laparoscopic investigations done;

iv) Trials of medication commenced;

v) Analgesia ladder .6

Diagnosis, History and Examination;

• Occasional referral from Orthopaedic and Spine service;

i) Hip Pain / Radicular Thigh Pain;

ii) Trauma or Surgery;

• Other referral sources;

i) Urology – “Bladder pain”

ii) Primary Care – Hx of renal/gynae symptoms.

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MANAGEMENT; ALWAYS MULTIMODAL / MULTIDISCIPLINARY

CONSIDER LOW DOSE NEUROPATHIC MEDICATIONS – NOCTE INITIALLY

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SPECIALIST PHYSICAL THERAPY

• Lumbosacral arthritis assessment;

• Musculoskeletal dysfunction;

• Abdominal examination;

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PAIN MANAGEMENT ;

• Localised Injection;

• Peripheral nerve blocks;

• Nerve ablation / Radiofrequency;

• Central sympathetic blocks;

• Lumbo – sacral facet injections

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Treatments; Always Multi Disciplinary

REFERENCES;i). Medscape

ii). Kapur BM. Clin Biochem 2014; 47:1169-87.

iii). Jones GS, Jones HW.Novak’s textbook of

gynaecology . 10th Ed.Baltimore;Wiliams and

Wilkins.1981

iv). Ainsworth Institute of Pain Management Ny.

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SPECIALIST PHYSICAL THERAPY