"Conscious Pain Mapping"...Craig Sobolewski, M.D....at Allentown, PA

From: Helen Dynda (olddad66@runestone.net)
Thu Aug 17 15:19:16 2000


1.) Enter: http://www.lvh.com/search/

2.) Enter: "Pain Mapping" and click: "Search"

3.) Scroll down and click:

Chronic Pelvic Pain Needs Physical and Psychological Approach to Diagnosis and Treatment; New Program at Lehigh Valley Hospital One of Few in Country to Apply "Conscious Pain Mapping"

Allentown, Pa. January 27, 1998 -- "Take a couple of aspirins and lie down for half an hour" usually works for menstrual pain. But for millions of women, pelvic pain is not related to a gynecological problem, is difficult to diagnose and is not something that goes away easily.

To address this health concern, Lehigh Valley Hospital (LVH) has developed a chronic pelvic pain program, which is among the first in the country to apply a minimally-invasive procedure called "conscious pain mapping" to help with diagnosis.

"Pelvic pain accounts for one in 10 visits to the gynecologist and over $1 billion each year in medical costs," said Craig Sobolewski, M.D., LVH gynecologist and director of the program. "Tragically, many women never get an accurate diagnosis of what is wrong.

"Only a minority of the cases are gynecologically related," he continued. "What makes it so tricky is that pain felt in one area doesn't necessarily originate there. Just as a heart attack can cause pains in the arm, pain in the pelvis can be gynecologic, gastrointestinal, urinary, muscle- or bone-related, or even from appendicitis."

Moreover, the problem often is more than physical. Half of the women with chronic pelvic pain have a history of physical or sexual abuse and two-thirds have a history of major depression. Even without those issues, pain that goes on for months or years can become all-consuming, disrupting work, sexuality and family life. "We recognize there are two parts to every pain -- the physical part and the 'volume knob' or the way you perceive the pain psychologically," Sobolewski said. "If you ignore the psychological factors, you are leaving out a whole aspect of patient care that can determine the treatment's success."

One of Sobolewski's key diagnostic tools is laparoscopy, a minimally invasive procedure in which long, thin instruments are inserted into the pelvis through tiny incisions. The specialist views the area on video while performing diagnosis and treatment. With today's fiber optics, these instruments can be so narrow the patient needs only local anesthesia.

An increased amount of traditional gynecological surgery is now being performed through minimally invasive surgery or operative endoscopic surgery. Once limited to tubal surgery such as that for sterilization or treatment of ectopic pregnancy, this procedure has grown rapidly to encompass surgery for gynecological malignancy, pelvic reconstruction, correction of incontinence or pelvic organ prolapse, removal of ovarian or pelvic tumors, and complete or vaginally-assisted hysterectomy.

A few centers in the United States, including LVH, are now applying micro-laparoscopy to pelvic pain mapping under conscious sedation. The idea came about after a patient asked her surgeon what "pain" looked like, Sobolewski said.

With conscious pain mapping, the patient is sedated, but remains awake to give feedback as the surgeon gently probes to produce the exact pain the patient has been feeling. In 15 to 20 percent of the cases, conscious pain mapping will find a cause for the pain that could not be detected otherwise, said Sobolewski, who believes that this procedure will replace standard diagnostic laparoscopy in patients who need surgical evaluation for their pain.

But besides the physical examination, patients in LVH's chronic pelvic pain program also receive a psychological screening. Depending on their needs, patients are treated or referred to other specialists.

"One of the most important aspects of patient care is support," Sobolewski said. "Typically, chronic pelvic pain is a physical problem that has also created a psychological one. Given the holistic way our program works, we're able to assure each patient that we'll stick with her until we figure out what the problem is and then make her as well as we possibly can."


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