Mp59-11 Neurologic Diagnoses Are Prevalent in Subspecialty Chronic Pelvic Pain Referrals

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Basic Research & Pathophysiology (MP59)1 May 2024MP59-11 NEUROLOGIC DIAGNOSES ARE PREVALENT IN SUBSPECIALTY CHRONIC PELVIC PAIN REFERRALS Dyer Pettijohn, Charles E. Argoff, and Elise J. B. De Dyer PettijohnDyer Pettijohn , Charles E. ArgoffCharles E. Argoff , and Elise J. B. DeElise J. B. De View All Author Informationhttps://doi.org/10.1097/01.JU.0001009476.18935.3b.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic pelvic pain (CPP) is defined as pain perceived to originate from pelvic structures lasting >3-6 months, often associated with a range of visceral, neurological, musculoskeletal, and psychological symptoms. We previously demonstrated a high prevalence of small fiber neuropathy (SFN) in patients with complex CPP. In this study we actively screened CPP patients within our Urology/Urogynecology specialty referral pain clinics for neurologic symptoms and, if present, conducted combined evaluation with a neurologic pain specialist in a multidisciplinary clinic approach. METHODS: Systematic neurological evaluation was provided if the patient screened positive for: Pain radiating from the spine; Combination of bladder, bowel, sexual or pain symptoms referable to the lower spine; Pain within a dermatome referable to a specific nerve/root; Balance/gait alteration; Abnormal reflexes; Upper motor neuron (UMN) findings on urodynamics or some cases of hypotonic bladder; History suggesting neurologic contributor; Multiple autonomic symptoms; Chronic overlapping pain syndromes. Subsequent workup was tailored to the neurological evaluation and presenting complaints, including video urodynamic testing, magnetic resonance imaging (MRI), laboratory testing, electromyography (EMG), autonomic testing, and skin biopsy for SFN. RESULTS: 187 patients underwent combined evaluation. 96% underwent formal neurological examination: 45 had UMN findings, 16 lower motor neuron findings, and 103 nonfocal examinations. 73 were evaluated via EMG, 38 by skin biopsy, 108 with MRI, and 79 with laboratory studies. 75 (40%) are still undergoing workup. Of 113 patients who have completed evaluation, 75 (66%) were confirmed to have a neurologic diagnosis and 38 had an unremarkable workup. Most common neurologic diagnoses included SFN, large fiber neuropathy, severe spinal stenosis, and lumbosacral radiculopathy (Table 1). CONCLUSIONS: Neurologic disease is prevalent, present in 66% of subspecialty chronic pelvic pain patients who screen positive for neurologic symptoms. Most of the diagnoses in this study were de novo and patients had experienced diagnostic delay for up to years. Screening for neurological conditions is recommended in urologic and gynecologic patients with CPP to facilitate appropriate diagnosis and management. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e961 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dyer Pettijohn More articles by this author Charles E. Argoff More articles by this author Elise J. B. De More articles by this author Expand All Advertisement PDF downloadLoading ...