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GENITAL PAIN IN MEN: CAUSATION AND MANAGEMENT
Baranowski, A.
Consultant in Pain Medicine, National Hospital for Neurology and
Neurosurgery, Queen Square, London, WC1N 3BG
The urological and pain literature is replete with grand sounding
diagnoses for chronic pain syndromes which hide our
ignorance of our lack of understanding of chronic
pain syndrome's that affect the male genitalia. Such
diagnosis serves little to help the patient. Over
the past few years there have been several meetings
to look at the diagnosis and hence the management
of male urogenital pain. Recently the European Association
of Urology have published guidelines (European Urology
46 2004 - 689). However, it is interesting how rapidly
matters develop and even as those guidelines are published,
several over committees look to take the guidelines
further forward and produce an even newer way to approach
the problem. Within these groups, there is a significant
move towards a mechanistic approach to pain management
using symptoms and signs aimed at understanding the
mechanism rather than for producing a single diagnosis.
It is treatment of the symptoms and signs that we
strive for. This presentation will look at the differences
between men and women in respect of their perception
of pain and response to its management. It will discuss
that, cause does not necessarily translate into mechanism,
and that a single cause (and even a single diagnosis)
may occure as a result of multiple mechanism. As a
consequence a mechanistic approach to pain management
based upon symptom and sign analysis is the way forward.
The role of evidence based medicine in the management
of urogential pain using case histories to illustrate
treatment options will be explored. It will emphasise
the importance of a team approach.
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