PELVIC PAIN

Cancers of the cervix, uterus, bladder and rectum can cause recurrent disease in pelvic lymph nodes with:

• Pain

• Leg swelling (lymphedema)

• Urinary frequency

• Hydronephrosis

The best method of diagnosing recurrence is by CT scan. A pelvic mass may not be palpable. Recurrence after surgery can be treated and sometimes cured by radiotherapy.

Pelvic pain has several components:

• Visceral (supra-pubic and back pain)

• Pelvic floor (perineal pain)

• Posterior infiltration (sacral pain)

• Lumbo-sacral plexus infiltration (buttock and leg pain)

The continuous visceral component of pain usually responds well to morphine, but the nerve pain can be difficult to control.

A number of other options exist:

• Radiotherapy (for bone pain)

• High dose of steroids (reduces peri-neural edema)

• Epidural steroids (for nerve pain)

• Intrathecal neurolysis (for perineal pain)

• Sacral cryo-analgesia (for perineal pain)

• Epidural morphine

• Epidural bupivacaine

Careful selection of patients for these specialized procedures is essential. (see Nerve Blocks, Nerve Pain, Spinal Opioids)

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.