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Laparoscopy is the examination of the abdomen using a tube-like device with an optical system, called a laparoscope, which is inserted into the abdomen. Forty percent of all laparoscopic procedures in the US are performed to assess pelvic pain. Thirty to 50 percent of cases of chronic pelvic pain are associated with pelvic adhesions, which are fiber-like bands connecting sites in the pelvis. The mechanism whereby adhesions cause pain is not known, but the pain can often be localized to the site of the adhesion. However, physical causes of other chronic pain problems, such as low back pain, are frequently undetermined. Hence, the existence of unique pain fibers and relation between intensity of pain and tissue damage, as suggested by the Cartesian theory of pain perception, is questionable. Other theories suggest that pain is influenced by cultural, psychological, intellectual, emotional, and stress-related factors. The effect of laparoscopic lysis of adhesions (removal of adhesions by tissue breakdown during laparoscopy) for relief of pain was assessed. The study involved 30 women with chronic pelvic pain, including 10 who were diagnosed with the chronic pain syndrome. Laparoscopic lysis of adhesions relieved daily pain and dyspareunia (pain during sexual intercourse) in 4 of the 10 women with the chronic pain syndrome and in 15 of the 20 women without the syndrome. Daily pain and dyspareunia was more likely to improve after lysis of the adhesions in women with chronic pelvic pain, but did not significantly help those with chronic pain syndrome. It is suggested that the role of psychosocial factors in pain relief requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Whether chronic pelvic pain reflects psychological or physiological disturbance is a subject of long-standing debate; studies using laparoscopy (examination of the pelvic organs with a fiberoptic tube) have found a higher percentage of abnormalities in women with such complaints than earlier studies based on laparotomy (surgical opening of the abdomen). Modern approaches to chronic pain conceptualize it as an outcome of behavioral, psychological, and physiological factors. The most common physical abnormalities associated with chronic pelvic pain are endometriosis (tissue of the uterine lining located in abnormal sites) and pelvic adhesions (fibrous tissue attaching abnormally to the pelvic organs). To evaluate the extent to which the presence of these abnormalities is associated with pain, 102 women who underwent laparoscopy were studied (90 reported pain, 12 did not). They completed a questionnaire concerning gynecologic problems, pain during menstruation or sexual intercourse, demographic variables, marital satisfaction, and other issues, as well as standardized pain questionnaires. Sixty-four percent were being examined for pain; 35 percent, for infertility; 19 percent, for follow-up to other abnormal tests; and 15 percent, for sterilization. The extent of their disease was rated by surgeons using a standard scoring system (the surgeon did not know if the patient had complained of pain). The physical disease scores were not correlated with self-reported pain symptoms, nor were pain indexes (from the standardized pain tests) correlated with physical disease scores. While most women with symptoms had some type of physical abnormality in the region where they felt pain, the lack of correlation between the severity of the abnormality and the severity of pain made it likely that psychosocial factors were significant. Treatment of chronic pelvic pain should include attention to both physical and emotional/social problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

This study is a two-part investigation of clinical psychology internship training at the William S. Hall Psychiatric Institute. The first part surveyed 25 intern graduates to identify the relationship between experiences as an intern and current professional activities. Results are related to findings from other research in training clinical psychologists. The second part pertains to suggestions of intern graduates for specific additions and revisions of internship training at the Institute.

A 3-yr. follow-up study, using 5 dependent measures of academic performance, was accomplished on 42 of the original 50 5 1/2-yr.-old youngsters used in the Adkins, et al.(1971) study. A preliminary comparison of the de Hirsch method of classification of children as of potentially high academic risk clearly suggests the possibility of using discriminant function analysis with the de Hirsch Predictive Index. A strategy for evaluating interventions on high-risk children is suggested.