Conscious pain mapping by laparoscopy in women with chronic pelvic pain

Objective: To evaluate the findings and outcomes of laparoscopic conscious pain mapping in women with unsuccessfully treated chronic pelvic pain. Methods: Fifty consecutive women with at least one prior procedure for chro nic pelvic pain had conscious pain mapping. Operative findings and clinical outcomes were documented. Preoperative and postoperative pain levels were evaluated using visual analog scales. Results: Conscious pain mapping was successful in 35 cases (70%). Twenty-ni ne patients had 42 specific positive sites, and six patients had diffuse vi sceroperitoneal pelvic tenderness. Adhesions and endometriosis accounted fo r 45% of positive lesions or sites. About half of women with endometriosis or adhesions mapped pain specifically to those lesions. For endometriosis, histologic but not visual diagnosis predicted positive mapping. Specific vi scera accounted for 36% of positively mapped sites. Diagnoses of chronic vi sceral pain syndrome were suggested by the findings in 16 (46%) patients wh ose mapping was successful. Mean +/- standard deviation visual analog scale pain levels were 8.7 +/- 1.2 preoperatively and 5.5 +/- 3.7 postoperativel y. Twenty-two women (44%) had decreased pain postoperatively and eight (16% ) were pain-free. Conclusion: Conscious pain mapping can be done with reasonable success in w omen with prior surgical evaluations and treatments for chronic pelvic pain . Chronic visceral pain syndrome, adhesions, and endometriosis were the mos t common diagnoses. (Obstet Gynecol 2000;96:934-9. (C) 2000 by The American College of Obstetricians and Gynecologists.).