Chronic pelvic pain resident survival guide
Synonyms and Keywords:
Chronic pelvic pain is a symptom, not a diagnosis, and is defined as persistent or recurrent pelvic pain of either men or women for longer than three to six months. It can be classified into two subgroups: specific disease-associated pelvic pain) that there are a pathology to explain the pain such as pelvic inflammatory disease, infections, adnexal pathologies, endometriosis, etc., and chronic pelvic pain syndrome (CPPS), which its diagnosis often based on the history and physical examinations and imaging and laboratory findings are often inconclusive in diagnosing it, and usually, no specific etiology can be found. Ninety-nine percent of all cases of chronic pelvic pain is female. The Pathophysiology of chronic pelvic disease could be related to the somatic structure or viscera pathologies, central sensitization of pain, or both. Treatment of chronic pelvic pain is often complicated and is usually focused on the suspected etiology of the chronic pelvic pain, such as treating a comorbid mood disorder, neuropathy, or uterine dysfunction, which can exacerbate chronic pain.
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Endometriosis (very controversial) Deeply Infiltrative Endometriosis may be more important
- Infection or post-infectious neurological hypersensitivity
- Exaggerated bladder, bowel, or uterine pain sensitivity (also known as visceral pain)
- Ovarian cysts, uterine leiomyoma
Ask about associated symptoms
Examine the patient
❑ To rule out the pregnancy, chronic inflammation, or infection, mass or any pathologic cause, as the source of chronic pelvic pain, order:
|Specific disease-associated pelvic pain|
CPPS (without pathology to explains the pain)
|Treatment of Chronic pelvic pain:|
Treatment of Specific disease-associated pelvic pain(with an underlying pathology)
Treatment of CPPS( without underlying pathology
- Managing chronic pelvic pain syndrome requires an interprofessional team of healthcare professionals that includes a physical therapist, psychologist, pharmacist, and several physicians in different specialties. The importance of multi-disciplinary treatment is emphasized by several reviews.
- Depending on the severity of the patient's pain, prescription analgesics may be necessary for adequate analgesia. A pharmacist helps coordinate care and helps aid in patient understanding, including proper usage and side effects.
- A cognitive-behavioral therapist helps in the coping and understanding of a patient's pain.
- Zafirlukast and prednisone in two low-power placebo-controlled studies failed to show a benefit in prostate pain syndrome.
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