Management of Patients with Chronic Pelvic Pain Associated with Endometriosis Refractory to Conventional Treatment

Abstract

The literature contains numerous studies on the diagnosis, pathogenesis, atypical locations, and clinical (hormonal) and surgical management of the disorder. However, no information is available on the management of endometriosis involving pain refractory to the usual treatment from the perspective of a pain unit. Our hospital has a pain unit specifically dedicated to pain in gynecology and obstetrics. The unit has been functioning since December 2005, and 52% of the attended patients have CPP of different origins. Endometriosis is present in 48% of all patients with CPP and is the most prevalent pathology in our practice. It moreover poses an important challenge in view of its enormous complexity. A descriptive study was made of the management of 44 patients with endometriosis refractory to therapy, evaluated and treated over a period of 3 years in the Pain Unit of the Maternity Center of La Paz University Hospital (Madrid, Spain).

Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study

“…When studying the peripheral nerves, DTI with tractography has been recommended to visualise the proximal sciatic nerve using a 1.5-T MRI [27,28] and the distal median nerve using a 3 T MRI [29,30]. When studying the spinal roots, Eguchia and colleagues [25] used tractography to study the lumbar nerve roots and quantitatively evaluate lumbar nerve entrapment with foraminal stenosis.…”

The Effect of Neuromodulatory Drugs on the Intensity of Chronic Pelvic Pain in Women: A Systematic Review

“…1 This condition greatly impacts the patient's quality of life, interfering with sexual activity, urination, and work activities, among others, thus representing a major socio-sanitary problem. 2 The frequent inexistence of a causal link between examination findings and clinical reality means that CPP treatment does not always bring satisfactory results. Pelvic pain can be of gynecological, urological, gastrointestinal, musculoskeletal, or psychiatric causes, and it usually has a visceral or neuropathic origin.…”

“…1 This condition greatly impacts the patient's quality of life, interfering with sexual activity, urination, and work activities, among others, thus representing a major socio-sanitary problem. 2…”

Pelvic Pain: Mechanistically Enigmatic, Therapeutically Challenging

“…Very different stimulation modes (nerve root, retrograde sacral, peripheral stimulation of the right iliohypogastric and ilioinguinal nerves) were performed in the patients. There was no description as to why each type of neuromodulation was chosen . Currently, evidence is scant but some future directions for study can be suggested based upon clinical reports.…”

“…There was no description as to why each type of neuromodulation was chosen. 5 Currently, evidence is scant but some future directions for study can be suggested based upon clinical reports.…”