Management of chronic primary pelvic pain syndromes

Abstract

Management of chronic pelvic pain (CPP) remains a huge challenge for care providers and a major burden for healthcare systems. Treating chronic pain that has no obvious cause warrants an understanding of the difficulties in managing these conditions. Chronic pain has recently been accepted as a disease in its own right by the World Health Organization, with chronic pain without obvious cause being classified as chronic primary pain. Despite innumerable treatments that have been proposed and tried to date for CPP, unimodal therapeutic options are mostly unsuccessful, especially in unselected individuals. In contrast, individualised multimodal management of CPP seems the most promising approach and may lead to an acceptable situation for a large proportion of patients. In the present review, the interdisciplinary and interprofessional European Association of Urology Chronic Pelvic Pain Guideline Group gives a contemporary overview of the most important concepts to successfully diagnose and treat this challenging disease.

Defining Molecular Treatment Targets for Bladder Pain Syndrome/Interstitial Cystitis: Uncovering Adhesion Molecules

“…The exclusion of confusable diseases is the mainstay in the diagnosis of BPS/IC. Cystoscopy is usually necessary to rule out underlying pathologies and to screen for typical bladder lesions associated with BPS/IC patients (Parsons et al, 2021). Although cystoscopic examination may be completely normal in a significant proportion of patients, reduced bladder capacity, glomerulations on cystodistension, and Hunner's lesion (Hanno et al, 2015) can be diagnostic for BPS/IC.…”

Prostate Tuberculosis: six forms of clinical presentation

“…Chronic prostatitis with negative urine culture occurred in eight patients and could be considered chronic pelvic pain syndrome. In the European Association of Urology guideline for chronic pelvic pain syndrome, primary prostate pain syndrome is described as "persistent or recurrent episodic pain perceived in the prostate for ≥3 months with no proven infection or obvious local pathology" ( 14 ) In the guideline, there is no reference to tuberculosis as a possible cause of chronic prostatitis, showing that this hypothesis has been neglected. In the evaluation of three recent reviews ( 10 , 15 , 16 ), the association between prostatic tuberculosis and chronic prostatitis or chronic pelvic pain syndrome is practically nonexistent.…”

Changes in Pelvic Floor Ultrasonographic Features after Flat Magnetic Stimulation in Women with Chronic Pelvic Pain and Levator Ani Muscle Hypertonicity

“…CPP is a multifactorial disorder, and pain may originate from gynecological, gastrointestinal, pelvic, musculoskeletal, or nervous systems [ 3 ]. Chronic pelvic pain syndrome (CPPS) is a diagnosis of exclusion based on the presence of CPP in the absence of a confirmed infection or a local pathology accounting for the pain [ 4 ]. In the absence of well-defined pathology, CPPS is classified according to symptoms, signs, and, where possible, investigations.…”

“…Pain is aggravated by trigger point pressure or sustained/repeated pelvic floor muscle contraction, such as pain related to voiding, defecation, or sexual intercourse. [ 4 ]. This condition has also been defined as pelvic floor hypertonicity (PFH).…”