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.
- Hunter CW, Stovall B, Chen G, Carlson J, Levy R (March 2018). "Anatomy, Pathophysiology and Interventional Therapies for Chronic Pelvic Pain: A Review". Pain Physician. 21 (2): 147–167. PMID 29565946.
- Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, van Ophoven A, Williams AC (September 2013). "The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development". Eur Urol. 64 (3): 431–9. doi:10.1016/j.eururo.2013.04.035. PMID 23684447.
- Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
- Stout AL, Steege JF, Dodson WC, Hughes CL (1991). "Relationship of laparoscopic findings to self-report of pelvic pain". Am J Obstet Gynecol. 164 (1 Pt 1): 73–9. PMID 1824741.
- Dydyk AM, Gupta N. PMID 32119472 Check
|pmid=value (help). Missing or empty
- Fitzgerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, Kotarinos R, Fraser L, Cosby A, Fortman C, Neville C, Badillo S, Odabachian L, Sanfield A, O'Dougherty B, Halle-Podell R, Cen L, Chuai S, Landis JR, Mickelberg K, Barrell T, Kusek JW, Nyberg LM (January 2013). "Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes". J Urol. 189 (1 Suppl): S75–85. doi:10.1016/j.juro.2012.11.018. PMID 23234638.
- Loving S, Nordling J, Jaszczak P, Thomsen T (April 2012). "Does evidence support physiotherapy management of adult female chronic pelvic pain? A systematic review". Scand J Pain. 3 (2): 70–81. doi:10.1016/j.sjpain.2011.12.002. PMID 29913781.
- Kanter G, Volpe KA, Dunivan GC, Cichowski SB, Jeppson PC, Rogers RG, Komesu YM (February 2017). "Important role of physicians in addressing psychological aspects of interstitial cystitis/bladder pain syndrome (IC/BPS): a qualitative analysis". Int Urogynecol J. 28 (2): 249–256. doi:10.1007/s00192-016-3109-2. PMC 5292090. PMID 27581769.
- Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE (April 2010). "Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome". Gastroenterology. 138 (4): 1321–9. doi:10.1053/j.gastro.2009.12.040. PMC 2847007. PMID 20044997.
- Rowe E, Smith C, Laverick L, Elkabir J, Witherow RO, Patel A (June 2005). "A prospective, randomized, placebo controlled, double-blind study of pelvic electromagnetic therapy for the treatment of chronic pelvic pain syndrome with 1 year of followup". J Urol. 173 (6): 2044–7. doi:10.1097/01.ju.0000158445.68149.38. PMID 15879822.
- Shoskes DA, Nickel JC, Kattan MW (June 2010). "Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT". Urology. 75 (6): 1249–53. doi:10.1016/j.urology.2010.01.021. PMID 20363491.
- Hanno PM, Buehler J, Wein AJ (April 1989). "Use of amitriptyline in the treatment of interstitial cystitis". J Urol. 141 (4): 846–8. doi:10.1016/s0022-5347(17)41029-9. PMID 2926877.
- Fritjofsson A, Fall M, Juhlin R, Persson BE, Ruutu M (September 1987). "Treatment of ulcer and nonulcer interstitial cystitis with sodium pentosanpolysulfate: a multicenter trial". J Urol. 138 (3): 508–12. doi:10.1016/s0022-5347(17)43242-3. PMID 2442416.
- Bates SM, Hill VA, Anderson JB, Chapple CR, Spence R, Ryan C, Talbot MD (February 2007). "A prospective, randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome". BJU Int. 99 (2): 355–9. doi:10.1111/j.1464-410X.2007.06667.x. PMID 17313424.