الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage and is described in terms of such damage .
Pelvic pain is a common problem, the prevalence of the condition is about 38/1000 among people aged 20–50 years, The main gynaecological diagnoses include endometriosis, pelvic inflammatory disease and adhesions. The most common gastrointestinal diagnosis is irritable bowel syndrome and possible genitourinary diagnosis includes pathology such as interstitial cystitis .
The WHO ladder is divided into three steps :
• Step One: Non-Opioid Analgesia - The first step is the use of non-opioid analgesia. This includes paracetamol (acetaminophen) and NSAIDs .
For a segment of the cancer pain population, pain control remains inadequate despite full compliance with the WHO analgesic guidelines including use of co-analgesics .
There are a variety of techniques used by interventional pain physicians, which may be grossly divided into modalities affecting the spinal canal (e.g., intrathecal or epidural space), called neuraxial techniques and those that target individual nerves or nerve bundles, termed neurolytic techniques .
The recognition of the importance of psychological, especially cognitive, factors in the experience of pain has lead to the development of cognitive-behavioural models of pain, and cognitive behavioral principles underlie effective interventions for adults with chronic pain .
• The incidence of cancer worldwide is 6–7 million patients per year, with half or more occurring in developing countries. Every year, approximately 4.5 million patients die from cancer, and 3.5 million suffer from cancer pain daily, with only a limited number of them receiving adequate pain treatment .
The WHO ladder is divided into three steps :
Step One: Non-Opioid Analgesia - The first step is the use of non-opioid analgesia. This includes paracetamol (acetaminophen) and NSAIDs.
Step Two: Weak Opioids - There are several weak opioids available, however codeine 60mg 6-hourly is the most commonly used in combination with paracetamol 1 g 6-hourly .
• Opioids are critical to providing effective analgesia in cancer pain. There is great interindividual variability in response to a particular agent . there is no evidence that a specific opioid agonist is superior to another as first-line therapy.
• A significant factor in non adherence to an analgesic regimen is opioid related adverse effects, particularly constipation, sedation , Nausea , vomiting and pruritus.
• Neurolysis describes intentional injury to a nerve or group of nerves by chemical (e.g., alcohol or phenol), thermal (heat), surgical, or cryogenic (freezing) methods with the intent to relieve pain. The effects of neurolytic therapy typically persist between 3–6 months.