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The Role of Laparoscopy in the Chronic Pelvic Pain Patient

Introduction Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is always subjective and individuals describe pain based on their experience of actual or potential tissue injury or damage. Universally it is the unpleasantness of the bodily sensation that characterizes pain, and this makes pain an emotional experience, not just a sensory experience. The definition of pain avoids tying pain to the stimulus. This perspective of pain is important to the gynecologists’ understanding of the role of laparoscopy, in which specific pathology is being sought to explain the presence and the severity of the patient’s pain. There is not a generally accepted definition of chronic pelvic pain. Most but not all authors have used duration of 6 or more months as the major criterion of the definition of chronicity. Specifying only duration allows for significant ambiguity. Does this include cyclic pain (dysmenorrhea), intermittent pain (dyspareunia), or noncyclic pain? The concern about inconsistencies in defining chronic pelvic pain is not pedantic, but has clinical relevance. In reviewing any research on the causes or treatments of chronic pelvic pain, it is crucial that one know what definition was used. A proposed working definition of chronic pelvic pain is noncyclic pain of 6 or more months’ duration that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks, and is of sufficient severity as to cause functional disability or lead to medical care. Chronic pelvic pain is a significant problem and is far more common than generally recognized. For example, a U.S. study conducted by the Gallup Organization found that 15% of women aged 18 to 50 years have chronic pelvic pain and a U.K. study found that chronic pelvic pain has a prevalence similar to that of asthma, back pain, and migraine in women aged 18 to 49 years. There Correspondence: Fred M. Howard, MD, University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642 E-mail: fred_howard@urmc.rochester.edu CLINICAL OBSTETRICS AND GYNECOLOGY Volume 46, Number 4, 749–766 © 2003, Lippincott Williams & Wilkins, Inc.