Guidelines on Chronic Pelvic Pain

Abstract

itool=iconabstr 6. Bahns E, Halsband U, Janig W. Responses of sacral visceral afferent fibres from the lower urinary tract, colon, and anus to mechanical stimulation. Pflugers Arch 1987;410(3):296-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieved15(10):374-378. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieved3(1):33-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieved29(7):1061-1064. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieved198(1):137-154. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieved38(4):397-421. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieved67:115-131. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3823468&dopt= Abstract&itool=iconnoabstr 13. Meyer RA, Campbell JN, Raja SN. Peripheral neural mechanisms of nociception In: Wall PD, Melzack R, eds. Textbook of Pain. 3rd edn. Edinburgh: Churchill Livingstone, 1994. 1.2 Pain evaluation and measurement 1.2.1 Pain evaluation The symptom of pain must be fully evaluated. As pain is subjective, the history provides the main evaluation. Examination and investigations provide further understanding of the pain syndrome and exclude other conditions. Pain rating(s) are essential in patient and treatment evaluation. Pain evaluation includes: • Baseline and ongoing regular evaluation of severity. • An initial detailed history to include: chronology of onset and progression, character, site pain perceived and radiation, aggravating and relieving factors, associated symptoms. • Questions about thoughts, emotions and behaviour associated with the pain. • Detailed examination, not only of the painful area but of the whole patient, particularly the musculoskeletal and nervous systems. • Investigations to identify well-defined/confusable/non-pain syndromes. • Regular review of the condition as appropriate and its response to interventions. 1.2.2 Pain measurement Pain can only be measured subjectively. The most reliable and well-understood method is a numerical rating scale, from 0 (no pain) to 10 (extreme pain), with half-points marked. This is superior to the widely used visual analogue scale (VAS), which is a 10-cm line with the same labels at the ends. Alternatively, a simple verbal rating scale can be used, e.g. ‘none’, ‘mild’, ‘moderate’, ‘severe’. Both numerical and verbal scales can be used by patients without the need for paper and pen, unlike the visual analogue scale. 0 1 2 3 4 5 6 7 8 9 10 No pain Extreme pain Because pain is multidimensional, a single rating scale combines these dimensions in unknown quantities. Depending on the clinical question, treatment, patient and setting, it can be helpful to assess separately pain intensity, pain distress, and interference of pain with activities of daily life. It can also be helpful