Dr. Labat -- 2 articles

[Violet M]

Prog Urol. 2010 Nov;20(12):973-81. Epub 2010 Oct 13.
[Symptomatic approach to chronic neuropathic somatic pelvic and perineal pain].
[Article in French]

Labat JJ, Robert R, Delavierre D, Sibert L, Rigaud J.

Centre fédératif de pelvipérinéologie, clinique urologique, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France. jjlabat@chu-nantes.fr
Abstract
OBJECTIVES: To determine the characteristics of neuropathic pain and the somatic nerve lesions most frequently encountered in the context of chronic pelvic and perineal pain.

MATERIAL AND METHODS: Review of the literature devoted to pelvic and perineal neuralgia.

RESULTS: The diagnosis of pelvic and perineal pain related to a somatic nerve lesion is essentially clinical. The topography of the pain and its characteristics (burning, paraesthesia, etc.) can help to link the pain to the neurological territory involved. Complementary investigations are poorly contributive. Two main systems are involved in this region: sacral nerve roots that give rise to the pudendal nerve and the posterior cutaneous nerve of the thigh, thoracolumbar nerve roots that give rise to the ilioinguinal, iliohypogastric, genitofemoral and obturator nerves. The first system is essentially perineal and the second is essentially anterior inguinoperineal.

DISCUSSION: Pudendal neuralgia is the most common and most disabling form of pelvic pain. It presents as unilateral or bilateral burning pain of the anterior or posterior perineum that is worse on sitting and relieved by standing, not usually associated with night pain. It is related to a ligamentous nerve compression mechanism. Inferior cluneal neuralgia tends to be experienced as ischial and lateroperineal pain, and is sometimes accompanied by pain in a truncated sciatic territory, corresponding to projections of the posterior cutaneous nerve of the thigh. This neuralgia can be related to a piriformis syndrome or an ischial lesion. Sacral nerve root lesions do not cause acute pain, but are accompanied by sacral sensory loss and urinary, anorectal or sexual disorders. Pain related to ilioinguinal, iliohypogastric and genitofemoral nerves is generally secondary to surgical trauma and scars. Although these various lesions are sometimes difficult to distinguish from each other, an essential part of management consists of performing a local anesthetic block at the trigger point detected in the scar. Referred pain derived from the spinal cord due to thoracolumbar painful minor intervertebral dysfunction is experienced in the inguinal region, pubis, labium majorum and sometimes the trochanter, and only a complete clinical examination of the thoracolumbar region can demonstrate local signs (posterior facet joint pain at several levels, fibromyalgia).

Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21056374 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/21056374
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Prog Urol. 2010 Nov;20(12):843-52. Epub 2010 Oct 20.
[Anatomy and physiology of chronic pelvic and perineal pain].
[Article in French]

Labat JJ, Robert R, Delavierre D, Sibert L, Rigaud J.

Centre fédératif de pelvipérinéologie, clinique urologique, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France. jjlabat@chu-nantes.fr
Abstract
OBJECTIVE: To determine the mechanisms involved in the regulation of pelvic and perineal pain.

MATERIAL AND METHODS: Description of the anatomical pathways mediating nociceptive transmission and the physiological mechanisms of pain control.

RESULTS: The pelvis and perineum do not have the same innervation. The pelvis is innervated by the sympathetic nervous system, while the perineum is innervated by the somatic nervous system via sacral nerve roots (and the pudendal nerve) and the thoracolumbar sympathetic nervous system. Systems of regulation of nociceptive messages are present at all levels of the nervous system. Two of these systems are essential: one situated in the dorsal horns of the spinal cord (gate control) and another supraspinal system (descending inhibitory system). Via a series of filters and amplifiers, the nociceptive message is integrated and analysed in the cerebral cortex, with interconnections with various areas, especially involving memory and emotion.

CONCLUSION: Excessive nociceptive stimulation must be clearly distinguished from dysfunction of pain control systems (for example neuropathic pain). The definition of pain: "unpleasant sensory and emotional experience related to a real or potential tissue lesion or described in terms of such a lesion" clearly indicates that not all pain is inevitably related to a persistent and visible cause. Convergence phenomena identified between nerve pathways of the various systems and pelvic organs account for the possible diffusion of visceral nociceptive messages and interactions between organs. A good knowledge of anatomy is essential to understand the patient's description of the pain, and a good knowledge of the modalities of pain control is essential to correctly adapt treatment strategies (drugs, neurostimulation, psycho-behavioural therapy, etc.).

Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21056357 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/21056357