Chronic Pelvic Pain

Excerpt

Chronic pelvic pain can be a disabling, chronic, persistent pain, within the pelvis in women. Relatively common, chronic pelvic pain is associated with comorbidities such as irritable bowel syndrome, major depressive disorder, or pelvic inflammatory syndrome. One in seven women in the United States is affected. The prevalence is similar to migraine headaches, asthma, and chronic back pain. Chronic pelvic pain is considered a form of chronic regional pain syndrome. The diagnosis of chronic pelvic pain is made after three to six months of pelvic pain and is often based on history or physical; there are numerous associated symptoms or precipitating factors that help establish the diagnosis. While imaging and laboratory findings are often inconclusive in making the diagnosis of chronic pelvic pain, often, they are useful in the diagnosis of a comorbid condition responsible for the development of chronic pelvic pain. An estimated fifty percent of cases remain undiagnosed.

Chronic pelvic pain is a form of centralized pain, where the body develops a low threshold for pain, often a result of chronic pain. For example, if a woman developed endometriosis, the acute pain associated with this condition could become centralized during a three to six months duration, as the pain becomes chronic. In centralized pain, the previous mild to moderate pain is experienced as severe pain (hyperalgesia), or tactile sensations can be interpreted as painful (allodynia). Furthermore, chronic pelvic pain has a strong association with previous physical or emotional trauma. Thus the etiology of chronic pelvic pain may also be related to a functional somatic pain syndrome. Treatment of chronic pelvic pain is often complicated, with limited evidence-based options. Treatment is usually focused on the suspected etiology of the chronic pelvic pain, such as treating a comorbid mood disorder, neuropathy, or uterine dysfunction. Chronic pelvic pain is seen in an estimated four to sixteen percent of women. Given its prevalence, there must be a high suspicion in patients experiencing chronic pelvic pain. Management of chronic pelvic pain requires an interprofessional team approach; a collaboration between multiple specialties is needed to provide adequate pain relief. Some patients with chronic pelvic pain may benefit from cognitive behavioral therapy and hormone replacement. In contrast, others may require more invasive treatment interventions such as spinal cord stimulation or total hysterectomy.