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Pain referral patterns in the pelvis
1Department of Obstetrics and Gynecology, University of Calgary and Rockyview General Hospital, 271-A 1600, 90 Avenue SW, Calgary, Alberta, Canada T2V 5B8.
Study Objective:
To determine if right-left pelvic pain orientation exists in all patients, and to estimate the frequency of pain referral patterns in the pelvis.
Design:
Prospective, nonrandomized trial (Canadian Task Force classification II-1).
Setting:
University-affiliated hospital.
Patients:
One hundred consecutive women with no pain undergoing tubal sterilization or investigation of infertility (group A) were compared with 225 women with chronic pelvic pain of greater than 6 months' duration (group B).
Intervention:
Patient-assisted laparoscopy with intravenous conscious sedation and pelvic pain mapping.
Measurements And Main Results:
Of women in group A, 69% had correct right-left orientation, 18% had pain perceived on the opposite side of the abdomen, and 31% had pain referred to another location in the abdomen. The results were similar in women in group B, 65% of whom had correct orientation, 15% had pain perceived on the opposite side of the abdomen, and 35% had pain referred to another location.
Conclusion:
This demonstrates the need to ask on which side a woman feels pain during physical examination. It is not correct to assume that an answer of "yes" means the same side of the pelvis that is being examined. Patient-assisted laparoscopy and pelvic pain mapping are excellent in correlating the symptom with the pathology.