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Friday, August 10, 2012

Pelvic pain classifications

There have been several classifications proposed in the past, many of which do not include musculoskeletal dysfunction.  These two are more inclusive.  The EAU documents is quite inclusive and a good read. 

European Association of Urology  (EAU) Guidelines on chronic pelvic pain (Engeler 2010)
o   Axis 1
§  Specific disease associated pelvic pain
§  Pelvic pain syndrome
o   Axis 2 – System
o   Axis 3 – end organ pain syndrome
o   Axis 4 - referral characteristics
o   Axis 5 – temporal characteristics
o   Axis 6 – character
o   Axis 7 – associated symptoms
o   Axis 8 – psychological symptoms
                                                                   
IUGA / ICS terminology (Haylen 2010)
o   Bladder pain  - suprapubic or retropubic pain, pressure or discomfort, usually increasing with bladder filling, may persist or be relieved by voiding
o   Urethral pain - inside urethra
o   Vulval pain – in and around vulvar
o   Vaginal pain – within vagina above introitus
o   Perineal pain – between posterior fourchette and anus
o   Pelvic pain – pain in pelvis
o   Cyclical (mentraul) pelvic pain
o   Pudendal neuralgia – burning anus to clitoris, pain associated with tenderness over course of pudendal nerve, Nantes criteria
§  Pain in the region of pudendal nerve
§  Pain worse with sitting
§  No night pain
§  No sensory deficit
§  Relief with pudendal block
o   Chronic lower urinary tract and / or other pelvic pain syndromes

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