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John Pier - One of the best experts on this subject based on the ideXlab platform.
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sacroiliac joint Pain referral maps upon applying a new injection arthrography technique part ii clinical evaluation
Spine, 1994Co-Authors: Joseph Fortin, Charles Aprill, Bruce Ponthieux, John PierAbstract:STUDY DESIGN: A Pain referral map generated from Part I of this study was tested in 54 consecutive patients. Pain diagrams, completed by each patient, were compared to the map generated from sacroiliac injections in 10 volunteers (Part I). Two clinicians, blinded to the examination of each individual, selected the diagrams most consistent with the Pain map. OBJECTIVES: To determine the applicability of a Pain referral map as a screening tool for sacroiliac joint dysfunction. SUMMARY OF BACKGROUND DATA: Two independent examiners, blinded to the patients' examinations, selected 16 individuals whose Pain diagrams most represented the map generated in Part I. There was a 100% concordance of patients selected. All 16 patients selected had a provocation-positive SI joint injection. Ten of these individuals also received lumbar discography and lumbar facet injections. Only the SI injection on the symptomatic side was provocation positive. METHODS: Patients selected for evaluation based on Pain Mapping received sacroiliac joint injection. Provocation-positive injections were used to confirm the diagnosis of sacroiliac joint dysfunction. Ten subjects subsequently underwent lumbar discography and lumbar facet joint injections to further confirm the diagnosis. RESULTS: Few studies involving low back Pain have used Pain referral maps. In the present study, patients were successfully screened for sacroiliac joint dysfunction using a Pain referral map generated from provocation of asymptomatic volunteers. CONCLUSION: Patients can be successfully screened for sacroiliac joint dysfunction based on comparison with a Pain referral map. Further study on the false negative rates of sacroiliac Pain maps is needed.
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Sacroiliac joint: Pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation.
Spine, 1994Co-Authors: Joseph Fortin, Charles Aprill, Bruce Ponthieux, John PierAbstract:Study design A Pain referral map generated from Part I of this study was tested in 54 consecutive patients. Pain diagrams, completed by each patient, were compared to the map generated from sacroiliac injections in 10 volunteers (Part I). Two clinicians, blinded to the examination of each individual, selected the diagrams most consistent with the Pain map. Objectives To determine the applicability of a Pain referral map as a screening tool for sacroiliac joint dysfunction. Summary of background data Two independent examiners, blinded to the patients' examinations, selected 16 individuals whose Pain diagrams most represented the map generated in Part I. There was a 100% concordance of patients selected. All 16 patients selected had a provocation-positive SI joint injection. Ten of these individuals also received lumbar discography and lumbar facet injections. Only the SI injection on the symptomatic side was provocation positive. Methods Patients selected for evaluation based on Pain Mapping received sacroiliac joint injection. Provocation-positive injections were used to confirm the diagnosis of sacroiliac joint dysfunction. Ten subjects subsequently underwent lumbar discography and lumbar facet joint injections to further confirm the diagnosis. Results Few studies involving low back Pain have used Pain referral maps. In the present study, patients were successfully screened for sacroiliac joint dysfunction using a Pain referral map generated from provocation of asymptomatic volunteers. Conclusion Patients can be successfully screened for sacroiliac joint dysfunction based on comparison with a Pain referral map. Further study on the false negative rates of sacroiliac Pain maps is needed.
Joseph Fortin - One of the best experts on this subject based on the ideXlab platform.
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sacroiliac joint Pain referral maps upon applying a new injection arthrography technique part ii clinical evaluation
Spine, 1994Co-Authors: Joseph Fortin, Charles Aprill, Bruce Ponthieux, John PierAbstract:STUDY DESIGN: A Pain referral map generated from Part I of this study was tested in 54 consecutive patients. Pain diagrams, completed by each patient, were compared to the map generated from sacroiliac injections in 10 volunteers (Part I). Two clinicians, blinded to the examination of each individual, selected the diagrams most consistent with the Pain map. OBJECTIVES: To determine the applicability of a Pain referral map as a screening tool for sacroiliac joint dysfunction. SUMMARY OF BACKGROUND DATA: Two independent examiners, blinded to the patients' examinations, selected 16 individuals whose Pain diagrams most represented the map generated in Part I. There was a 100% concordance of patients selected. All 16 patients selected had a provocation-positive SI joint injection. Ten of these individuals also received lumbar discography and lumbar facet injections. Only the SI injection on the symptomatic side was provocation positive. METHODS: Patients selected for evaluation based on Pain Mapping received sacroiliac joint injection. Provocation-positive injections were used to confirm the diagnosis of sacroiliac joint dysfunction. Ten subjects subsequently underwent lumbar discography and lumbar facet joint injections to further confirm the diagnosis. RESULTS: Few studies involving low back Pain have used Pain referral maps. In the present study, patients were successfully screened for sacroiliac joint dysfunction using a Pain referral map generated from provocation of asymptomatic volunteers. CONCLUSION: Patients can be successfully screened for sacroiliac joint dysfunction based on comparison with a Pain referral map. Further study on the false negative rates of sacroiliac Pain maps is needed.
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Sacroiliac joint: Pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation.
Spine, 1994Co-Authors: Joseph Fortin, Charles Aprill, Bruce Ponthieux, John PierAbstract:Study design A Pain referral map generated from Part I of this study was tested in 54 consecutive patients. Pain diagrams, completed by each patient, were compared to the map generated from sacroiliac injections in 10 volunteers (Part I). Two clinicians, blinded to the examination of each individual, selected the diagrams most consistent with the Pain map. Objectives To determine the applicability of a Pain referral map as a screening tool for sacroiliac joint dysfunction. Summary of background data Two independent examiners, blinded to the patients' examinations, selected 16 individuals whose Pain diagrams most represented the map generated in Part I. There was a 100% concordance of patients selected. All 16 patients selected had a provocation-positive SI joint injection. Ten of these individuals also received lumbar discography and lumbar facet injections. Only the SI injection on the symptomatic side was provocation positive. Methods Patients selected for evaluation based on Pain Mapping received sacroiliac joint injection. Provocation-positive injections were used to confirm the diagnosis of sacroiliac joint dysfunction. Ten subjects subsequently underwent lumbar discography and lumbar facet joint injections to further confirm the diagnosis. Results Few studies involving low back Pain have used Pain referral maps. In the present study, patients were successfully screened for sacroiliac joint dysfunction using a Pain referral map generated from provocation of asymptomatic volunteers. Conclusion Patients can be successfully screened for sacroiliac joint dysfunction based on comparison with a Pain referral map. Further study on the false negative rates of sacroiliac Pain maps is needed.
John F. Steege - One of the best experts on this subject based on the ideXlab platform.
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Practical Guide to Laparoscopic Pain Mapping
Journal of minimally invasive gynecology, 2010Co-Authors: A.c. Yunker, John F. SteegeAbstract:Conscious laparoscopic Pain Mapping, a technique that has been described in the literature for more than a decade, can be a particularly helpful tool to assist with pelvic Pain diagnosis and treatment decisions. Several factors, when optimized, increase the likelihood of a good outcome. Herein, we review the literature and address common questions about Pain Mapping including appropriate patient selection, standard technique, typical outcomes, and how the results might influence treatment.
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Long-term outcomes after surgical and nonsurgical management of chronic pelvic Pain: One year after evaluation in a pelvic Pain specialty clinic
American journal of obstetrics and gynecology, 2006Co-Authors: Georgine Lamvu, Denniz Zolnoun, Rachel E. Williams, Mary Ellen Wechter, Anne Shortliffe, Grace Fulton, John F. SteegeAbstract:Objective The purpose of this study was to describe long-term outcomes for women with chronic pelvic Pain (CPP) after evaluation in a CPP specialty clinic. Study design This was a prospective observational cohort study of women treated for CPP at the UNC Pelvic Pain clinic between 1993 and 2000. The primary outcome was improvement in Pain and the main exposure was treatment group: primarily medical (pharmacotherapy, psychotherapy, physical therapy, or combinations of the 3) or surgical (hysterectomy, resection or ablative procedures, oophrectomy, diagnostic surgery, Pain Mapping, vulvar or vestibular repair). Univariate, bivariate, and multivariable analyses were performed to look for relationships between background characteristics, treatment group, and improvement in Pain. Results Of 370 participants; 189 had surgical treatment and 181 had medical treatment. One year after evaluation, 46% reported improvement in Pain and 32% improvement in depression. Improvement in Pain was similar in both treatment groups and odds of improvement were equal even after adjusting for background characteristics, psychosocial comorbidity, and previous treatments. Conclusion One year after evaluation in a CPP specialty clinic, women experienced modest improvements in Pain and depression after recommended surgical or nonsurgical treatment.
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The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic Pain.
Obstetrics and gynecology clinics of North America, 2004Co-Authors: Georgine Lamvu, Sawsan As-sanie, Denniz Zolnoun, John F. SteegeAbstract:Laparoscopy is a useful tool for the diagnosis and treatment of conditions associated with chronic pelvic Pain. In the evaluation of chronic pelvic Pain, laparoscopic techniques vary from conservative procedures, such as Pain Mapping, excision, and nerve ablation, to more extensive procedures like oophorectomy and hysterectomy. Although useful for diagnosis, laparoscopy continues to have a controversial role in the treatment of chronic pelvic Pain.
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Clinical utility of pelvic Pain Mapping.
The Journal of the American Association of Gynecologic Laparoscopists, 2001Co-Authors: John F. SteegeAbstract:Abstract Study Objective To survey physicians' opinions concerning the impact of pelvic Pain Mapping on clinical management and surgical decisions. Design Opinions of physicians based on clinical experience (Canadian Task Force classification III). Setting Evening meetings appended to two national meetings. Measurements and Main Results After viewing videotaped interviews, physical examinations, standard laparoscopy, and pelvic Pain Mapping at laparoscopy in two patients, practicing gynecologists completed questionnaires recording their opinions about the utility of pelvic Pain Mapping. A second group of gynecologists viewed only one tape. The first group considered Pain Mapping to be moderately or extremely useful (patient 1, 57.9%; patient 2, 73.7%). Mapping data either made surgeons change the surgical procedure they would have chosen or further clarified the diagnosis (patient 1, 68.4%; patient 2, 84.2%). Of the second group of 67 surgeons, 73% thought that Mapping results would have made them change their surgical approach. Conclusion In appropriate cases, pelvic Pain Mapping during microlaparoscopy under conscious sedation can provide information that may influence surgical decisions as well as general clinical management.
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Superior Hypogastric Block During Microlaparoscopic Pain Mapping
The Journal of the American Association of Gynecologic Laparoscopists, 1998Co-Authors: John F. SteegeAbstract:Pelvic Pain Mapping during laparoscopy performed under conscious sedation can provide useful information about visceral and somatic sources of chronic pelvic Pain. Diagnostic superior hypogastric plexus block can be performed under direct laparoscopic visualization and the pelvis then remapped to determine if Painful areas are supplied by hypogastric plexuses. Results of Mapping may allow more informed selection of patients for presacral neurectomy.
Fred M. Howard - One of the best experts on this subject based on the ideXlab platform.
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chronic pelvic Pain
Obstetrics & Gynecology, 2003Co-Authors: Fred M. HowardAbstract:Chronic pelvic Pain is a common and significant disorder of women. It is estimated to have a prevalence of 3.8% in women. Often the etiology of chronic pelvic Pain is not clear, as there are many disorders of the reproductive tract, gastrointestinal system, urological organs, musculoskeletal system, and psychoneurological system that may be associated with chronic pelvic Pain. The history and physical examination are crucial in evaluating a woman with chronic pelvic Pain and must address all of the possible systems potentially involved in chronic pelvic Pain, not just the reproductive system. Laboratory and imaging studies should be selectively utilized, as should laparoscopy. Conscious laparoscopic Pain Mapping has been proposed as a way to improve information derived from laparoscopic evaluations. Treatment of chronic pelvic Pain may consist of two approaches. One is to treat chronic Pain itself as a diagnosis, and the other is to treat diseases or disorders that might be a cause of or a contributor to chronic pelvic Pain. These two approaches are not mutually exclusive, and in many patients effective therapy is best achieved by using both approaches. Treatment of chronic Pain as well as treatment of four of the more common disorders associated with chronic pelvic Pain (endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis) are discussed in this review.
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The role of laparoscopy as a diagnostic tool in chronic pelvic Pain
Best Practice & Research in Clinical Obstetrics & Gynaecology, 2000Co-Authors: Fred M. HowardAbstract:More than 40% of laparoscopies are performed for the diagnosis of chronic pelvic Pain (CPP). Although laparoscopic evaluation is sometimes considered a routine part of the evaluation, ideally the decision to perform a laparoscopy should be based on the patient's history, physical examination and findings of non-invasive tests. About 65% of women with CPP have at least one diagnosis detectable by laparoscopy and it is common to attribute causality to this diagnosis. Endometriosis is diagnosed in one-third of laparoscopies for CPP. Endometriosis requires histological confirmation to assure an accurate diagnosis. Adhesions are diagnosed in about one-quarter of laparoscopies. Ovarian cysts, hernias, pelvic congestion syndrome, ovarian remnant syndrome, ovarian retention syndrome, post-operative peritoneal cysts and endosalpingiosis are other diagnoses that can be made laparoscopically in some cases. Laparoscopic conscious Pain Mapping has the potential to improve the accuracy of laparoscopy as a diagnostic tool in CPP.
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Conscious Pain Mapping by laparoscopy in women with chronic pelvic Pain.
Obstetrics and gynecology, 2000Co-Authors: Fred M. Howard, Ahmed M. El-minawi, Reinaldo A SanchezAbstract:Abstract Objective: To evaluate the findings and outcomes of laparoscopic conscious Pain Mapping in women with unsuccessfully treated chronic pelvic Pain. Methods: Fifty consecutive women with at least one prior procedure for chronic pelvic Pain had conscious Pain Mapping. Operative findings and clinical outcomes were documented. Preoperative and postoperative Pain levels were evaluated using visual analog scales. Results: Conscious Pain Mapping was successful in 35 cases (70%). Twenty-nine patients had 42 specific positive sites, and six patients had diffuse visceroperitoneal pelvic tenderness. Adhesions and endometriosis accounted for 45% of positive lesions or sites. About half of women with endometriosis or adhesions mapped Pain specifically to those lesions. For endometriosis, histologic but not visual diagnosis predicted positive Mapping. Specific viscera accounted for 36% of positively mapped sites. Diagnoses of chronic visceral Pain syndrome were suggested by the findings in 16 (46%) patients whose Mapping was successful. Mean ± standard deviation visual analog scale Pain levels were 8.7 ± 1.2 preoperatively and 5.5 ± 3.7 postoperatively. Twenty-two women (44%) had decreased Pain postoperatively and eight (16%) were Pain-free. Conclusion: Conscious Pain Mapping can be done with reasonable success in women with prior surgical evaluations and treatments for chronic pelvic Pain. Chronic visceral Pain syndrome, adhesions, and endometriosis were the most common diagnoses.
Charles Aprill - One of the best experts on this subject based on the ideXlab platform.
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sacroiliac joint Pain referral maps upon applying a new injection arthrography technique part ii clinical evaluation
Spine, 1994Co-Authors: Joseph Fortin, Charles Aprill, Bruce Ponthieux, John PierAbstract:STUDY DESIGN: A Pain referral map generated from Part I of this study was tested in 54 consecutive patients. Pain diagrams, completed by each patient, were compared to the map generated from sacroiliac injections in 10 volunteers (Part I). Two clinicians, blinded to the examination of each individual, selected the diagrams most consistent with the Pain map. OBJECTIVES: To determine the applicability of a Pain referral map as a screening tool for sacroiliac joint dysfunction. SUMMARY OF BACKGROUND DATA: Two independent examiners, blinded to the patients' examinations, selected 16 individuals whose Pain diagrams most represented the map generated in Part I. There was a 100% concordance of patients selected. All 16 patients selected had a provocation-positive SI joint injection. Ten of these individuals also received lumbar discography and lumbar facet injections. Only the SI injection on the symptomatic side was provocation positive. METHODS: Patients selected for evaluation based on Pain Mapping received sacroiliac joint injection. Provocation-positive injections were used to confirm the diagnosis of sacroiliac joint dysfunction. Ten subjects subsequently underwent lumbar discography and lumbar facet joint injections to further confirm the diagnosis. RESULTS: Few studies involving low back Pain have used Pain referral maps. In the present study, patients were successfully screened for sacroiliac joint dysfunction using a Pain referral map generated from provocation of asymptomatic volunteers. CONCLUSION: Patients can be successfully screened for sacroiliac joint dysfunction based on comparison with a Pain referral map. Further study on the false negative rates of sacroiliac Pain maps is needed.
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Sacroiliac joint: Pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation.
Spine, 1994Co-Authors: Joseph Fortin, Charles Aprill, Bruce Ponthieux, John PierAbstract:Study design A Pain referral map generated from Part I of this study was tested in 54 consecutive patients. Pain diagrams, completed by each patient, were compared to the map generated from sacroiliac injections in 10 volunteers (Part I). Two clinicians, blinded to the examination of each individual, selected the diagrams most consistent with the Pain map. Objectives To determine the applicability of a Pain referral map as a screening tool for sacroiliac joint dysfunction. Summary of background data Two independent examiners, blinded to the patients' examinations, selected 16 individuals whose Pain diagrams most represented the map generated in Part I. There was a 100% concordance of patients selected. All 16 patients selected had a provocation-positive SI joint injection. Ten of these individuals also received lumbar discography and lumbar facet injections. Only the SI injection on the symptomatic side was provocation positive. Methods Patients selected for evaluation based on Pain Mapping received sacroiliac joint injection. Provocation-positive injections were used to confirm the diagnosis of sacroiliac joint dysfunction. Ten subjects subsequently underwent lumbar discography and lumbar facet joint injections to further confirm the diagnosis. Results Few studies involving low back Pain have used Pain referral maps. In the present study, patients were successfully screened for sacroiliac joint dysfunction using a Pain referral map generated from provocation of asymptomatic volunteers. Conclusion Patients can be successfully screened for sacroiliac joint dysfunction based on comparison with a Pain referral map. Further study on the false negative rates of sacroiliac Pain maps is needed.
