PRACTICAL ASPECTS OF MANAGEMENT OF PATIENT WITH CHRONIC PELVIC PAIN
The problem of optimizing the management of women with chronic pelvic pain syndrome (CPP) is actual due to the high frequency of this pathology, unclear many aspects of the pathogenesis, negative impact on quality of life, as well as difficulties in diagnosing the leading factor and effective treatment.
Aim. Optimization of the diagnostic algorithm of managing women with chronic pelvic pain (CPP) and pelvic congestion syndrome (PCS).
Materials and methods. A prospective study was carried out at Ivano-Frankivsk City Clinical Perinatal Center, Ukraine. 112 patients with CPP and 53 women without pain and symptoms of gynecological pathology as a control group have been included. Exclusion criteria are as follows: pelvic tumors, genital endometriosis, acute inflammatory diseases of the pelvic organs and specific inflammatory diseases of the pelvic organs. Clinical and laboratory examination, ultrasound and Doppler ultrasound of the main pelvic veins: uterine, ovarian, internal iliac and arcuate veins, Valsalva᾽s test have been performed, which helps to detect venous diameter and reflux, for all patients. Short Pain Assessment Scale, the McGill Pain Questionnaire (SF-MPQ), and the Visual Analog Scale (VAS) were used for pain assessment. The tests were conducted in the form of interviews and questionnaires. The results were statistically analyzed using Statistica 7.0 program pack (StatSoft Inc., USA) and Microsoft Excel statistical analysis package. The differences between the selections were considered statistically reliable at p<0.05 (Tukey’s test).
Results. Pain duration, examination and treatment of chronic pelvic inflammatory disease were in average 3.8±2.4 years at the time of the first visit. The study has proved that the risk factors for CPP and PCS are high parity (3 or more deliveries), prolonged work in prolong standing or sitting position, interrupted intercourse. 69.6 % of women noted a deterioration in general activity, 43.8 % impaired gait, 79.5 % had difficulties in performing daily work and professional activities, 71.4 % of patients had increased pain in the second phase of the menstrual cycle, and in 83.9 % after prolonged standing. Half of women have sleep disorders, 80.4 % – emotional lability, a third group have periods of depression, and 71.4 % – a negative impact on sexual life according to the results of a Short Pain Assessment Scale. Based on SF-MPQ, it was found that the sensory characteristics of pain were different. 69 (61.6 %) women had convulsive, aching and moderate pain, 16.1 % – severe and burning pain, 8.9% of patients suffered on prickly pain. Evaluation of the emotional scale showed that PCS caused exhaustion in more than half of women, nausea in a third of cases, while 5 (4.5 %) patients reported severe pain that led to despair. Pain intensity due to VAS was 4.44±1.15. Ultrasound revealed an increased diameters of the main pelvic venous collectors, decreased peak systolic bleeding rate in women with CPP and PCS compared with the results of women of the control group (p<0,05). Valsalva᾽s test showed that the presence of reno-ovarian reflux was found in 15.2 % patients of the main group, including bilateral in 23.53 %, isolated left – in 64.7 %.
Conclusions. Women with CPP, especially in the presence of risk factors and the specific clinical picture of pelvic congestion should undergo ultrasound and Doppler ultrasound examination of the uterine, ovarian, internal iliac and arcuate veins. Pain assessment scales have the prognostic value of routine pain assessment to analyze the treatment results.
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