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Internal use only by approved personnel. Unpublished Work © 2019 Beacon Hospital. All rights Reserved. In Strict Confidence.
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