Abstract
Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.
Highlights
IntroductionChronic pelvic pain is defined as pain of six or more months’ duration that is situated in the abdomen, groin or lower back [1]
Chronic pelvic pain is a complex disorder that is poorly understood
Women suffering from chronic pelvic pain are often personally challenged because of the absence of evidence to support their complaints of severe pain [4, 5]
Summary
Chronic pelvic pain is defined as pain of six or more months’ duration that is situated in the abdomen, groin or lower back [1]. Recognized causes of chronic pelvic pain include visceral conditions such as endometriosis, pelvic inflammatory disease, and pelvic adhesions and somatic conditions such as lower genital tract surgery or vehicular trauma to the pelvis [6, 7]. In many cases the differentiation between visceral and somatic reasons is obvious, but in some, the distinction is not evident. This can lead to situations where investigations and surgery are repeated and in some cases extensively
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