Pain history

The history needs to include the onset and duration of symptoms, the location and radiation of pain, factors associated with exacerbation and relief and the relationship of pain to the menstrual cycle. Dysmenorrhoea may be a separate or related symptom. Dyspareunia may include

Table 43.1 Classification of causes of chronic pelvic pain

Inflammatory, infective: Chronic salpingitis Inflammatory, non-infective: Endometriosis, Vulvodynia with dermatosis Mechanical: Uterine retroversion, Adhesions Functional: Pelvic congestion, Irritable bowel syndrome Neuropathic: Postsurgical, Dysesthetic vulvodynia, Vulval vestibulodynia Musculoskeletal: Pelvic floor myalgia, Abdominal and pelvic trigger points, Postural muscle strain pain during intercourse, but for many women a particularly unpleasant symptom is post-coital pain and specific enquiry should be made about this.

A number of validated pain assessment measures are available for use in research and clinical practice, the most convenient of which are the 10 cm visual analogue scale, the Brief Pain Inventory (BPI), widely used in British pain clinics, and the McGill Short Form Pain Questionnaire. The McGill questionnaire is included in the International Pelvic Pain Society's assessment form, available for downloading at www.pelvicpain.org and the BPI may be downloaded at www.mdanderson.org where details of non-English versions may also be obtained. Patient's recall of pain symptoms over the previous month seems to be adequate and it is probably unnecessary to ask for a daily pain diary: 10 cm visual analogue scales for 'usual' and 'most severe' intensity of pain recalled over the past 4 weeks correlated very well with mean and maximal diary records [6].

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