Pain mapping of adhesions

Abstract

Study objective: To determine the nature and location of adhesions and their relationship to abdominal pain in patients undergoing awake microlaparoscopy.

Design: Retrospective analysis (Canadian Task Force classification II-1).

Setting: University teaching hospital.

Patients: Thirty women ages 26-49 years with chronic pelvic pain were studied over a 9-month period.

Intervention: Patients were kept awake during their laparoscopy to determine the site and degree of pain when the adhesions were palpated.

Measurements and main results: Patients with abdominal pain and a history suggestive that the pain was due to adhesions underwent an awake laparoscopy. Visual analog scores were used to evaluate the pain on palpation of the adhesion as it related to the nature of the adhesion as well as the location of the adhesion. Filmy adhesions that allowed for movement between two structures had the highest association with pain. Fixed adhesions that did not allow movement had the lowest pain scores. Adhesions that had a relationship to the peritoneum had a high association with pain.

Conclusion: Filmy adhesions between a movable structure, such as an ovary, and the peritoneum had the highest pain scores. Fixed or dense adhesions, no matter where they were located, had the lowest pain scores.