Centralization keys chronic pelvic pain diagnosis. (Spinal Cord May Retain 'Memory' of Pain).

PALM BEACH, FLA. -- An understanding of the neurophysiology involved in chronic pelvic pain and the use of innovative evaluation methods can lead to improved patient outcomes, Dr. John Steege said.

An understanding of centralization--the "memory" of chronic pain that the spinal cord is believed to retain and recreate even after the initial cause of pain has resolved--is key to diagnosis and treatment, he said at the annual meeting of District V of the American College of Obstetricians and Gynecologists.

Centralization helps explain why chronic pain is refractory to medical management and why laparoscopy is sometimes unsuccessful.

Patients are often referred to Dr. Steege's pelvic pain clinic at the University of North Carolina, Chapel Hill, after undergoing multiple procedures. Often they remain pain free for 3-6 months after surgery only to find that the pain returns after the placebo effect wears off or the lesions grow back, he said.

Assessment begins with observation of the patient's demeanor, gait, and positioning.

For instance, "A patient with a levator spasm often sits forward in the chair or rests more of her weight on one buttock than the other," he said.

A detailed pain history follows. Look for indications of chronic pelvic pain syndrome. Iris characterized by pain that has persisted for 6 months or more, has caused significant impairment of physical and sexual function, has begun causing vegetative signs of depression, and has become the family's primary focus. Although a few studies have found that women with chronic pelvic pain are more likely to have a history of sexual abuse, Dr. Steege warned against prematurely attributing the pain to abuse.