Interventional Therapies for Controlling Pelvic Pain: What is the Evidence?

Abstract

Chronic pelvic pain (CPP) has many potential causes and is often a complex disorder with multiple contributing etiologies. The evaluation and treatment of women with CPP often requires a multidimensional approach. The treatment of CPP consists of two approaches: 1) treatment of pain itself or global treatment, and 2) treatment of disease-specific etiologies. Most often, treatment requires a combination of both approaches. This article reviews recent literature in the global treatment of CPP, including pharmacologic, psychotherapy, and neuroablative, as well as specific interventions for endometriosis, interstitial cystitis, pelvic adhesive disease, adenomyosis, and pelvic venous congestion.

Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration

“…Chronic pelvic pain (CPP) is an elusive, and complex condition with a high socioeconomic burden. It affects both men and women with an estimated prevalence as high as 40% . In the United States, the annual healthcare costs related to diagnostic workup and treatment of CPP, in women alone, approaches nearly three billion dollars per year .…”

“…The term “CPP” encompasses a variety of chronic pain conditions, including coccydynia, proctalgia, pudendal neuralgia, and vulvodynia to name a few. The recognition and diagnosis of CPP from the time of symptom onset is typically delayed by as much as ten years due to CPP clinical characteristics resemble other pathologies . Compounded by the fact that this delay is often accompanied by treatment mismanagement due to the failure to recognize CPP, these patients are left in states of extreme emotional distress for exorbitant periods of time.…”

Intermittent low back pain referred from a uterine adenomyosis: a case report

“…30,31 In addition, there is some evidence to suggest that a diet high in green vegetables, fiber, fish oil, and vitamins B 1 and B 12 , and low in red meat, eggs, and cheese may reduce the risk of dysmenorrhea. [32][33][34] Furthermore, there is little evidence to suggest that exercise, 35 magnesium or vitamin E supplementation, 33 psychotherapy, 36 or behavioral interventions 37 are effective at improving the symptoms of dysmenorrhea.…”

Ganglion Impar Radiofrequency Ablation For Intractable Cancer Pain: A Case Report

“…Neoplastic invasion of neural tissues and infiltration of organs and sphinters results in severe pain whose treatment requires high doses of medications and often results in unsatisfactory pain relief. 1 Ganglion impar neurolysis is a well documented technique to reduce pain arising from perineal visceral structures such as rectum and anus. [1][2][3][4][5][6][7][8][9][10] Sensitive C and Aδ afferent fibers run from visceral structures to the spinal ganglia where the neuron body is located and they run together with the sympathetic fibers innervating splanchnic organs.…”

“…1 Ganglion impar neurolysis is a well documented technique to reduce pain arising from perineal visceral structures such as rectum and anus. [1][2][3][4][5][6][7][8][9][10] Sensitive C and Aδ afferent fibers run from visceral structures to the spinal ganglia where the neuron body is located and they run together with the sympathetic fibers innervating splanchnic organs. 9 Afferent sensitive fibers cross the sympathetic ganglia without synapsing in it, therefore, lesioning the sympathetic chain could result in a reduction of pain transmitted through these somatic fibers.…”