Chronic Pelvic Pain in Women

Abstract

ImportanceChronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world’s female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions.ObservationsChronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process.Conclusions and RelevanceChronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.

Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside

“… 60–62 This approach could have an impact on the relevant treatment 63 , 64 and could save time, effort and resources with diagnostic tests and surgical procedures that are often unnecessary. 61 , 65 …”

“… 66 Furthermore, there appears to be a consensus that psychosocial aspects associated with women with CPP should be evaluated. 60 , 65 The collection of these data should be systematized, taking possible physiopathological mechanisms into consideration. Not doing so can result in further confusion, failed treatment and discouragement, both for the patients and for the healthcare professionals.…”

“…On the other hand, religiosity has been positively associated with quality of life in women with CPP. 90 Further studies are necessary to investigate psychological variables, 65 , 83 religiosity and spirituality 90 in women with CPP.…”

“…93 The use of self-administered questionnaires to be completed by the patients in the waiting room prior to medical consultation or even during consultation has been suggested. 8 , 65 , 66 …”

“…Another option is to investigate, within the scope of the clinical interview, topics such as quality of life, sexual function, beliefs regarding pain, strategies for dealing with pain, family, social and religious support networks, and the impact of pain on an individual’s professional life. 8 , 65 , 66 , 90 The most important factor for a woman with CPP may be feeling that her complaints are being taken seriously and that she is being listened to, not necessarily through the use of previously validated instruments. Because CPP is a condition that requires long term monitoring, 99 more delicate subjects such as sexual function and a history of sexual abuse can be gradually addressed at future consultations when the relationship of trust between the healthcare professional and the patient has already been established.…”