Pain referral patterns in the pelvis

Study Objective. To determine if right-left pelvic pain orientation exists in all patients, and to estimate the frequency of pain referral patterns in the pelvis. Design. Prospective, nonrandomized trial (Canadian Task Force classification II-1). Setting. University-affiliated hospital. Patients. One hundred consecutive women with no pain undergoing tubal sterilization or investigation of infertility (group A) were compared with 225 women with chronic pelvic pain of greater than 6 months' duration (group B). Intervention. Patient-assisted laparoscopy with intravenous conscious sedation and pelvic pain mapping. Measurements and Main Results. Of women in group A, 69% had correct right-left orientation, 18% had pain perceived on the opposite side of the abdomen, and 31% had pain referred to another location in the abdomen. The results were similar in women in group B, 65% of whom had correct orientation, 75% had pain perceived on the opposite side of the abdomen, and 35% had pain referred to another location. Conclusion. This demonstrates the need to ask on which side a woman feels pain during physical examination. It is not correct to assume that an answer of "yes" means the same side of the pelvis that is being examined. Patient-assisted laparoscopy and pelvic pain mapping are excellent in correlating the symptom with the pathology.