Name: demonstration of cutaneous allodynia in association with chronic pelvic pain
Uploaded: 2009-06-23T00:00:00
Description: Watch this Scientific Journal Video about Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain at JoVE.com

Introduction
In most cases the areas of cutaneous allodynia will be identified in the dermatomes of the abdomen and perineum that innervate the intra-pelvic structures &ndash; T11-L1 and S3,4,5 respectively. The term allodynia refers to the presence of a painful sensation as a consequence of a stimulus that is not normally painful, in this case a cotton-tipped culture stick.
1. Abdomen
<ol>
<li>An explanation of the test is undertaken and permis...

<ol>
	<li>Giamberardino, M. A., Affaitati, G., Lerza, R., Lapenna, D., Costantini, R., Vecchiet, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+pain+symptoms+and+referred+sensory+and+trophic+changes+in+patients+with+gallbladder+pathology.">Relationship between pain symptoms and referred sensory and trophic changes in patients with gallbladder pathology.</a> Pain. 114 (1-2), 239-249 (2005).</li><li>Giamberardino, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Women+and+visceral+pain:+are+the+reproductive+organs+the+main+protagonists?+Mini-review+at+the+occasion+of+the+&amp;quot;European+Week+Against+Pain+in+Women+2007.">Women and visceral pain: are the reproductive organs the main protagonists? Mini-review at the occasion of the &amp;quot;European Week Against Pain in Women 2007.</a> Eur J Pain. 12 (3), 257-260 (2008).</li><li>Baranauskas, G., Nistri, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensitization+of+pain+pathways+in+the+spinal+cord:+cellular+mechanisms.">Sensitization of pain pathways in the spinal cord: cellular mechanisms.</a> Prog Neurobiol. 54 (3), 349-365 (1998).</li></ol>

The presence of cutaneous allodynia indicates the woman has had severe pain in the past to the extent that neuropathic changes have occurred. Although the problem may have originated from dysmenorrhea or endometriosis, a new condition has emerged &ndash; Chronic Pelvic Pain. The original condition may be active or quiescent. Recognition of this new development is important for patient education and to initiate processes of rehabilitative care. Recognition of the development of this state may also permit the clinici...

demonstration of cutaneous allodynia in association with chronic pelvic pain

Pelvic pain is a common condition that is associated with dysmenorrhea and endometriosis. In some women the severe episodes of cyclic pain change and the resultant pain becomes continuous and this condition becomes known as Chronic Pelvic Pain. This state can be present even after the appropriate medical or surgical therapy has been instituted. It can be associated with pain and tenderness in the muscles of the abdomen wall and intra-pelvic muscles leading to severe dyspareunia. Additional symptoms of irritable bowel and interstitial cystitis are common. A common sign of the development of this state is the emergence of cutaneous allodynia which emerges from the so-called viscero-somatic reflex. A simple bedside test for the presence of cutaneous allodynia is presented that does not require excessive time or special equipment. This test builds on previous work associated with changes in sensation related to gall bladder function and the viscera-somatic reflex(1;2).
The test is undertaken with the subject s permission after an explanation of how the test will be performed. Allodynia refers to a condition in which a stimulus that is not normally painful is interpreted by the subject as painful. In this instance the light touch associated with a cotton-tipped applicator would not be expected to be painful. A positive test is however noted by the woman as suddenly painful or suddenly sharp. The patterns of this sensation are usually in a discrete pattern of a dermatome of the nerves that innervate the pelvis.
The underlying pathology is now interpreted as evidence of neuroplasticity as a consequence of severe and repeating pain with changes in the functions of the dorsal horns of the spinal cord that results in altered function of visceral tissues and resultant somatic symptoms(3). 
The importance of recognizing the condition lies in an awareness that this process may present coincidentally with the initiating condition or after it has been treated. It also permits the clinician to evaluate the situation from the perspective that alternative explanations for the pain may be present that may not require additional surgery.

Watch this Scientific Journal Video about Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain at JoVE.com

Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain

A demonstration of the bedside test for cutaneous allodynia and its clinical implications.

Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain

Pelvic pain is a common condition that is associated with dysmenorrhea and endometriosis.  In some women the severe episodes of cyclic pain change and the ...

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