Conscious Pain Mapping Research Articles

Diagnosis, treatment and follow up of women undergoing conscious pain mapping for chronic pelvic pain: a prospective cohort study

To assess the efficacy of conscious pain mapping in diagnosing and treating chronic pelvic pain (CPP). Prospective cohort study. Setting Gynaecology Department, UK District General Hospital. Forty-three women diagnosed with CPP. The cohort was followed up for 18-24 months after diagnosis and treatment based on conscious pain mapping. Improvement of pain assessed by using visual analogue scale (VAS) pain scores at 6-month follow up. Thirty-nine women had successful conscious pain mapping. Pelvic pathology was identified in 18, pelvic congestion in 13 and 8 women had normal pelvic organs. In 35 women (90%), conscious pain mapping identified the cause of pain. Five out of eight women (63%) who were judged to have a normal pelvis had positive findings at pain mapping. VAS scores fell significantly from pre-treatment to post-treatment values at 6-month follow up (P < 0.01). Overall, 26 women (74%) felt that their symptoms had improved after treatment based on findings at pain mapping. However, we concluded that pain mapping only contributed to the diagnosis and treatment in seven women (27%), who may not have received appropriate diagnosis and treatment if they had a laparoscopy under general anaesthetic. Conclusions CONSCIOUS: pain mapping is a useful additional investigation in the management of women with CPP. It can be employed in women with a negative laparoscopy or with visible pathology where the conventional treatment has failed.

Conscious pain mapping using standard laparoscopic equipment and symptom oriented pain mapping form

Conscious pain mapping using standard laparoscopic equipment and symptom oriented pain mapping form

Diagnostic conscious pain mapping using laparoscopy under local anaesthetic and sedation in general surgical patients

Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. Two patients were found to have pain arising from the gall bladder and subsequently underwent laparoscopic cholecystectomy with resolution of their symptoms. A third patient had a clinical presentation of chronic acalculous cholecystitis and a normal laparoscopy. She decided to undergo laparoscopic cholecystectomy, which cured her pain. Another patient had pain arising from the appendix, which resolved after an appendicectomy. Three patients had pelvic adhesions, which caused chronic abdominal pain. After adhesiolysis, one is pain free; the others declined surgery for adhesions and their pain resolved. Conscious pain mapping was negative in two patients. Laparoscopy can be carried out in the conscious patient, who is then usually able to collaborate with the surgeon in establishing the source of the pain experienced during conscious pain mapping. Long-term effectiveness and diagnostic accuracy has not yet been established.

Six of the Best, General 24

Aims: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. Methods: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. Results: Two patients were found to have pain arising from the gall bladder and subsequently underwent laparoscopic cholecystectomy with resolution of their symptoms. A third patient had a clinical presentation of chronic acalculous cholecystitis and a normal laparoscopy. She decided to undergo laparoscopic cholecystectomy, which cured her pain. Another patient had pain arising from the appendix, which resolved after an appendicectomy. Another patient had pelvic adhesions and after adhesiolysis is pain free. One patient declined surgery for adhesions, which produced chronic pain and another patient had adhesions secondary to an appendicectomy but did not cause any pain at the time of her laparoscopy. Another patient awaits a repeat laparoscopic adhesiolysis. One patient had a normal laparoscopy and a gastroenterologist has made a diagnosis of irritable bowel syndrome. Conclusion: Laparoscopy can be carried out in the awake patient, who is then usually able to differentiate the type of pain experienced during conscious pain mapping. Long-term effectiveness and diagnostic accuracy has not yet been established.

The use of minilaparoscopy for conscious pain mapping

Conscious pain mapping via minilaparoscopy is a technique designed to localize the source of abdominal pain by taking advantage of the best monitor for pain—the patient. The areas of concern are examined laparoscopically in a lightly sedated patient. The patient then directs the physician to the area of concern. Careful in vivo examination often reveals pathologic conditions that are not recognized by other means. When the source of pain has been identified, subsequent treatment steps are often clear. When the pain source is localized to a nerve, such as the genitofemoral nerve, a cryoanesthetic block can be placed on the nerve with direct visualization. If conscious pain mapping assessment is correct, placement of the cryoanesthetic block should render the patient's pain improved. Cryoanesthesia provides a reversible, nondestructive nerve block. This allows for assessment of blockade well beyond the placebo period and may have an effect on central nervous system wind-up. Copyright © 2001 by W.B. Saunders Company

Pain outcomes in patients undergoing conscious pain mapping versus standard laparoscopy

Pain outcomes in patients undergoing conscious pain mapping versus standard laparoscopy

Conscious Pain Mapping by Laparoscopy in Women With Chronic Pelvic Pain

In Brief Objective To evaluate the findings and outcomes of laparoscopic conscious pain mapping in women with unsuccessfully treated chronic pelvic pain. Methods Fifty consecutive women with at least one prior procedure for chronic pelvic pain had conscious pain mapping. Operative findings and clinical outcomes were documented. Preoperative and postoperative pain levels were evaluated using visual analog scales. Results Conscious pain mapping was successful in 35 cases (70%). Twenty-nine patients had 42 specific positive sites, and six patients had diffuse visceroperitoneal pelvic tenderness. Adhesions and endometriosis accounted for 45% of positive lesions or sites. About half of women with endometriosis or adhesions mapped pain specifically to those lesions. For endometriosis, histologic but not visual diagnosis predicted positive mapping. Specific viscera accounted for 36% of positively mapped sites. Diagnoses of chronic visceral pain syndrome were suggested by the findings in 16 (46%) patients whose mapping was successful. Mean ± standard deviation visual analog scale pain levels were 8.7 ± 1.2 preoperatively and 5.5 ± 3.7 postoperatively. Twenty-two women (44%) had decreased pain postoperatively and eight (16%) were pain-free. Conclusion Conscious pain mapping can be done with reasonable success in women with prior surgical evaluations and treatments for chronic pelvic pain. Chronic visceral pain syndrome, adhesions, and endometriosis were the most common diagnoses. Laparoscopic conscious pain mapping might be useful for evaluating women with unsuccessfully treated chronic pelvic pain.

Conscious pain mapping by laparoscopy in women with chronic pelvic pain

Objective: To evaluate the findings and outcomes of laparoscopic conscious pain mapping in women with unsuccessfully treated chronic pelvic pain. Methods: Fifty consecutive women with at least one prior procedure for chronic pelvic pain had conscious pain mapping. Operative findings and clinical outcomes were documented. Preoperative and postoperative pain levels were evaluated using visual analog scales. Results: Conscious pain mapping was successful in 35 cases (70%). Twenty-nine patients had 42 specific positive sites, and six patients had diffuse visceroperitoneal pelvic tenderness. Adhesions and endometriosis accounted for 45% of positive lesions or sites. About half of women with endometriosis or adhesions mapped pain specifically to those lesions. For endometriosis, histologic but not visual diagnosis predicted positive mapping. Specific viscera accounted for 36% of positively mapped sites. Diagnoses of chronic visceral pain syndrome were suggested by the findings in 16 (46%) patients whose mapping was successful. Mean ± standard deviation visual analog scale pain levels were 8.7 ± 1.2 preoperatively and 5.5 ± 3.7 postoperatively. Twenty-two women (44%) had decreased pain postoperatively and eight (16%) were pain-free. Conclusion: Conscious pain mapping can be done with reasonable success in women with prior surgical evaluations and treatments for chronic pelvic pain. Chronic visceral pain syndrome, adhesions, and endometriosis were the most common diagnoses.

The role of laparoscopy as a diagnostic tool in chronic pelvic pain

More than 40% of laparoscopies are performed for the diagnosis of chronic pelvic pain (CPP). Although laparoscopic evaluation is sometimes considered a routine part of the evaluation, ideally the decision to perform a laparoscopy should be based on the patient's history, physical examination and findings of non-invasive tests. About 65% of women with CPP have at least one diagnosis detectable by laparoscopy and it is common to attribute causality to this diagnosis. Endometriosis is diagnosed in one-third of laparoscopies for CPP. Endometriosis requires histological confirmation to assure an accurate diagnosis. Adhesions are diagnosed in about one-quarter of laparoscopies. Ovarian cysts, hernias, pelvic congestion syndrome, ovarian remnant syndrome, ovarian retention syndrome, post-operative peritoneal cysts and endosalpingiosis are other diagnoses that can be made laparoscopically in some cases. Laparoscopic conscious pain mapping has the potential to improve the accuracy of laparoscopy as a diagnostic tool in CPP.

Microlaparoscopy under local anesthesia and conscious pain mapping for the diagnosis and management of pelvic pain.

Chronic pelvic pain is a complex disorder with multiple etiologies. Recently, the technique of microlaparoscopy under local anesthesia has been applied to chronic pelvic pain. The specialized technique of conscious pain mapping has been developed to aid in the diagnosis of these patients. This paper will review the history and usage of office and microlaparoscopy in general. It will then discuss specific applications for patients with acute or chronic pelvic pain.

Conscious pain mapping for chronic pelvic pain

Conscious pain mapping for chronic pelvic pain

Office microlaparoscopy under local anesthesia in the diagnosis and treatment of chronic pelvic pain

To evaluate the safety of diagnostic and operative microlaparoscopy performed in the office under local anesthesia in the diagnosis and treatment of chronic pelvic pain. Prospective study (Canadian Task Force classification II-2). Office-based, free-standing private obstetrics and gynecology practice. Twenty women with chronic pelvic pain. Diagnostic and operative microlaparoscopy performed under local anesthesia with conscious sedation. All 20 patients had diagnostic microlaparoscopy and 19 had conscious pain mapping. Nine of 14 patients with endometriosis underwent fulguration of lesions and 7 of 8 with pelvic adhesions had lysis of adhesions. Four women with uterosacral ligament involvement had laparoscopic uterosacral nerve ablation. All patients tolerated office diagnostic and operative procedures without difficulty and had no complications. In selected women, several laparoscopic procedures traditionally done in a hospital or ambulatory surgery center under general anesthesia can be performed safely in the office laparoscopy suite under local anesthesia with conscious sedation.

Conscious pain mapping for chronic pelvic pain

Conscious pain mapping for chronic pelvic pain

Conscious pain mapping

To present the technique and usefulness of conscious pain mapping. Prospective, observational study (Canadian Task Force classification II-2). Gynecology departments of a university-affiliated hospital and a private community hospital. Fifty consecutive women undergoing diagnostic microlaparoscopy. Conscious pain mapping was performed in all 50 women. Conscious pain mapping helped to identify foci of chronic pelvic pain. The appendix and pelvic adhesions accounted for a significant amount of pelvic pain in these women. Conscious pain mapping helps to uncover sites of pelvic pain that might not be identified during traditional laparoscopy under general anesthesia.

Office microlaparoscopy under local anesthesia

We assessed the utility, tolerance, and costs associated with office microlaparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) for 100 of the following procedures: diagnostic laparoscopy to evaluate infertility including chromopertubation; diagnostic laparoscopy for chronic pelvic pain (CPP), including biopsy of endometriosis and conscious pain mapping; and early second-look laparoscopy including lysis of adhesions. A prospective nonselected cohort study was conducted on all women with CPP or infertility who consented to office microlaparoscopy under local anesthesia. A questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures, and women were screened preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with modification of the McGill pain inventory relative intensity scale. A subset of questions evaluated the recovery period, and time and length of all aspects of the procedure and recovery were recorded. Second-look procedures were significantly more painful than diagnostic ones, and women with CPP experienced significantly greater pain than those with infertility. Virtually all expressed high satisfaction with the procedure. There were no complications, and no procedures required general anesthesia. Compared with traditional laparoscopy, there was a reduction in costs greater than 70%.

Combining new immune therapies with traditional endometriosis treatment

Surgical treatment of endometriosis removes endometrial implants, but leaves the systemic disease intact. The diagnosis of the disease includes (needle) microlaparoscopy with conscious pain mapping under local anesthesia. Treatment is operative laparoscopy to remove endometrial implants and immune therapy for the systemic disease. The immune treatment program consists of oral tolerization, immune supplement, and diet changes. According to case studies, this therapy looks promising. Multicenter, controlled, long-term studies are warranted.

Office microlaparoscopy under local anesthesia for chronic pelvic pain

Study Objective. To investigate the utility, tolerance, and costs associated with a program of office laparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) for the evaluation of patients with chronic pelvic pain (CPP). Design. Prospective, nonselected cohort study. Setting. Office-based free-standing faculty practice at a tertiary care referral center. Patients. All women with a history of CPP from February to June 1995 who required diagnostic laparoscopy were compared with a cohort of patients undergoing in office diagnostic laparoscopy for the evaluation of infertility during the same period. Interventions. All patients underwent diagnostic office microlaparoscopy under local anesthesia (OLULA) with supplemental intravenous sedation, as well as conscious pain mapping. Measurements and Main Results. A specific questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures, and all patients were queried preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with a modification of the McGill pain inventory. A subset of questions evaluated the length of time until usual activities were resumed, anxiety level, and general acceptance of the procedure including set-up, operative time, and recovery time until discharge. Overall, there was a high degree of patient acceptance and satisfaction with OLULA; however, women with CPP experienced greater intraoperative and postoperative pain than those with infertility. Some patients with CPP had a generalized visceral hypersensitivity to pain; all areas of the pelvis and bowel were sensitive, and pain was not completely blocked with local anesthesia. Average procedure length was similar for the two groups. Patients with CPP required greater postoperative analgesia and took longer to return to work. Conscious pain mapping identified a focal source of pain in three patients and generalized visceral hypersensitivity in a majority of patients with CPP. Neither of these were found in patients with infertility. Compared with traditional laparoscopy there was almost an 80% reduction in costs. Conclusion. Office laparoscopy under local anesthesia is safe and effective for the evaluation of patients with CPP and is less expensive than traditional laparoscopy. Although the procedure is better tolerated by women undergoing infertility evaluation, it was well tolerated by both groups. Conscious pain mapping helps identify potential areas of pelvic pain and helps further characterize patients with CPP.