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Pathophysiology of visceral pain
Scoring of pain
Pain is a subjective feeling and cannot be measured objectively.
As scoring systems have been developed
* the Biberoglu-Behrman scale scoring dysmenorrhoea, chronic pelvic pain, deep dyspareunea, (and dyschesia) , pelvic nodularity and tenderness
* more elaborate visual analog scales and questionnaires
Endometriosis is a prime cause of chronic pelvic pain in women. In summary:
Subtle: no pain
Typical: can be a cause of pain but many women do not have pain
Cystic: most women have severe pain but some 10 to 20% are pain free
Deep: most women have very severe pain but some 10% are without pain
Adenomyosis: probably the majority of women is pain free
Adhaesions can cause pain, but probably 50% of women with adhaesions do not have pain.
Almost any pathology can cause pain e.g.
Gynaecology: bleeding, a persistent copus luteum, myoma, hydrosalpinx, bowels
Radiated pain from the sacro-ileac joint
Treatment and Placebo effect
Since pain is so multifactoreal a careful investigation is mandatory.
Treatment of pain is associated with a high placebo effect: pain gets better for a few months after which pain starts again.
Visit Dr. Koninckx website Gynsurgery.org