The Significance of Cutaneous Allodynia in a Woman With Chronic Pelvic Pain John Jarrell, MD, MSc, FRCSC,, Lamia Malekzadeh, MSc, Hua Yang, MD, FRCPC,

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The Significance of Cutaneous Allodynia in a Woman With Chronic Pelvic Pain John Jarrell, MD, MSc, FRCSC,, Lamia Malekzadeh, MSc, Hua Yang, MD, FRCPC, Lars Arendt-Nielsen, PhD Journal of Obstetrics and Gynaecology Canada Volume 37, Issue 7, Pages 628-632 (July 2015) DOI: 10.1016/S1701-2163(15)30201-2 Copyright © 2015 Society of Obstetricians and Gynaecologists of Canada Terms and Conditions

Figure 1 Findings on testing for cutaneous allodynia in a woman who developed chronic pelvic pain after uterine artery embolization for postpartum hemorrhage. The lines indicate the initial and subsequently more superior limits of abdominal wall sensitivity. The circles indicate areas of extreme tenderness on testing of pressure thresholds for pain, and indicate the sites of emergence of the anterior cutaneous nerves of the abdominal wall. Botulinum toxin was injected at the four lowest sites (two on each side) Journal of Obstetrics and Gynaecology Canada 2015 37, 628-632DOI: (10.1016/S1701-2163(15)30201-2) Copyright © 2015 Society of Obstetricians and Gynaecologists of Canada Terms and Conditions

Figure 2 Embolization material within the myometrium associated with extensive foreign body type reaction with multinucleated giant cells in the periphery. The myometrium shows no infarction type necrosis (HE×40) Journal of Obstetrics and Gynaecology Canada 2015 37, 628-632DOI: (10.1016/S1701-2163(15)30201-2) Copyright © 2015 Society of Obstetricians and Gynaecologists of Canada Terms and Conditions

Figure 3 A composite diagram indicating the woman’s experience over time in terms of pain experience, pain pressure thresholds, and pedometer measurements in response to four separate botulinum toxin injections Journal of Obstetrics and Gynaecology Canada 2015 37, 628-632DOI: (10.1016/S1701-2163(15)30201-2) Copyright © 2015 Society of Obstetricians and Gynaecologists of Canada Terms and Conditions

Figure 4 Demonstration of the greatly reduced extent of cutaneous allodynia one year after hysterectomy and three weeks after injections of botulinum toxin Journal of Obstetrics and Gynaecology Canada 2015 37, 628-632DOI: (10.1016/S1701-2163(15)30201-2) Copyright © 2015 Society of Obstetricians and Gynaecologists of Canada Terms and Conditions