John C. Slocumb

Neurological factors in chronic pelvic pain: Trigger points and the abdominal pelvic pain syndrome

A collection of neurological signs and symptoms, entitled abdominal pelvic pain syndrome, is identified as the most common cause of chronic pelvic pain. Techniques to identify abdominal wall, vaginal, and sacral components are described, with painful tissues commonly limited to a single dermatomic area. Superficial local areas of hyperpathia (trigger points) appeared not only to cause the pelvic pain but also to be responsive to local anesthetics for a duration in excess of the presence of the medication. Successful responses were noted in 89.3% of 131 patients, with 92.6% requiring five or fewer treatments and 68.2% followed up for longer than 6 months. The diagnosis of the abdominal pelvic pain syndrome is an important component in avoiding unnecessary operation in patients with pelvic pain.

Plants used as abortifacients and emmenagogues by Spanish New Mexicans

Individuals of Spanish and Mexican descent in New Mexico have used a number of plants as emmenagogues and abortifacients. Of the plants used, cotton root bark (Gossypium sp.), inmortal ((Asclepias capricornu Woodson), poleo chino (Hedeoma oblongifolia (Gray) Heller), rue Ruta graveolens L.), wormseed (Chenopodium ambrosioides L.), and three species of Artemesia seem to be used most widely. Of these, the cotton root bark, when used as an abortifacient, seems to exhibit the lowest toxicity. Rue is notable because of its use independently within different cultures, but may exhibit toxic side effects when used as an abortifacient. Seven other plants are outlined on the basis of anecdotal and folkloric reports. Investigations are underway to look at use effectiveness, side effects, impact on fertility, and acceptance among cultures of the Southwestern United States.

Anxiety and depression in patients with the abdominal pelvic pain syndrome

The authors matched gynecologic patients with the abdominal pelvic pain syndrome (N = 41) with other gynecologic patients. They administered to both groups self-rating scales of anxiety, depression, anger-hostility, and somatization of the Hopkins Symptom Checklist and of the Symptom Questionnaire, a questionnaire about disruptions in early home life, and a questionnaire of recent stressful events. Patients with pain rated themselves on the average significantly more anxious, depressed, and hostile, and had more somatic symptoms than other patients; 56% of the patients with pain rated themselves within the normal ranges on all scales. There were no significant differences between the two groups in reports of disruptions of early home life and recent losses. The findings are consistent with the view that patients with the abdominal pelvic pain syndrome are psychologically a heterogeneous group; in many patients, depression and anxiety may be consequences of persistent pain.

Hostility, somatic symptoms, and hypochondriacal fears and beliefs

The authors administered self-rating scales of anger-hostility, somatic symptoms, and hypochondriacal fears and beliefs to seven groups of patients and nonpatients. Somatic symptoms were positively correlated with anger-hostility and were negatively correlated with feelings of friendliness; the correlation coefficients ranged from low to moderately high and were significant in most groups. Somatic symptoms tended to be associated more strongly with symptoms of anxiety and depression than with those of hostility. The associations of hypochondriacal fears and beliefs with hostility were inconsistent, varied between groups and with the concern measured. The findings do not support the view that anger or hostility are main or specific etiological factors either in somatization or in hypochondriacal fears or beliefs.

Fears and beliefs in patients with the pelvic pain syndrome

In order to explore attitudes and beliefs in patients with the pelvic pain syndrome, the authors matched gynaecological patients with this syndrome (N = 41) with other gynaecological patients. They administered the Illness Behavior Questionnaire and Illness Attitude Scales (that measure attitudes, fears and beliefs about illness) to both groups. In spite of thorough investigations, 18 patients (44%) with the pelvic pain syndrome believed that their physician had not diagnosed their illness correctly and feared that they had a serious disease. The findings appear to have implications for treatment.

The use-effectiveness of two contraceptive methods in a Navajo population: the problem of program dropouts.

Navajo Indian intrauterine contraceptive device (IUD) and oral contraceptive users between 1966 and 1971 were followed up to estimate life table rates of complications and continuation. Because of high rates of dropping out, 41.6 per cent of 291 oral contraceptive users and 18.2 per cent of 534 IUD users, a 26 per cent sample survey of the dropout population was used to collate the dropout population data into the life table analysis. Estimates of the IUD continuation rates for one, two, and three years are similar to rates published elsewhere; however, continuation rates for the oral contraceptive are clearly lower than those for other populations, which only 33 per cent continuing after one year, 23 per cent after two years, and 12 per cent after three years. The IUD user is two to three times more successful than the oral contraceptive user in this population.

The use of surgery to avoid childbearing among Navajo and Hopi Indians.

The Hopi Indians neighbors of the Navajos in Northern Arizona have reduced their fertility much more rapidly than the Navajos. Data accumulated from computer tapes of discharges from the Indian Health Service during 1972-1973 and data published by the Commission on Professional and Hospital Activities for 1971 were the basis of this report. The Hopis and the Navajos have the same rate of uncomplicated deliveries. Both groups have a low rate of abortion. However the age-specific pattern of abortions is distinctly different. The abortion rate in the Hopis rises dramatically in the age group over 40. In determining the number of hysterectomies Hopis clearly have a higher rate. However hysterectomies for sterilizations are difficult to separate from those for other causes. The rate of bilateral tubal ligations among the Hopis occurs during their fertile years. Differences between the tribes above the age of 35 are less apparent. Hopi women are determined to terminate childbearing when they reach their late 30s and early 40s and are still having children. Vasectomies among both tribes are rare. Because data on other methods of contraception are unavailable it is difficult to make a definitive answer as to whether the increased frequency of surgery among the Hopis is the result of failure with more conventional contraceptive methods. Other variables may also affect the results (education physician characteristics and hospital accessibility).

The changing sex ratio of the Navajo tribe

Abstract Data presented indicate that the sex ratio of the Navajo Tribe has shifted since the 1940s and now shows a preponderance of women rather than men. The reasons for this shift, which roughly parallel a similar shift in the general population of the United States, are : (1) a decline in maternal mortality rates; (2) an increase in male mortality rates, particularly from accidents; and (3) greater out‐migration of men than women. Some of the consequences of the changing ratio include: increasing proportion of young widows with dependent children; a growing desire for labor force participation on the part of women; out‐marriage of Navajo women; and, in the future, the probable isolation of elderly widows who may become the responsibility of social welfare agencies.