{"paper_id":"86362ad4-ac37-4bbc-8749-1a85864f88af","body_text":"Abstract\nBackground\nChronic pelvic pain (CPP) in women is a debilitating condition with symptoms that affect both medical and psychological systems, yet for those with idiopathic CPP (i.e., those without a known physiologic cause), no consensus for intervention exists.\nAim\nA systematic review was conducted to identify the effectiveness of current biomedical, psychosocial, and integrative interventions for idiopathic CPP (ICPP).\nMethod\nFive databases (PubMed, CINAHL, Cochrane, PsycInfo, Web of Science) were systematically searched with multiple keywords for publications from 2008–2022. Articles were coded for sample characteristics, research design, type of intervention, and intervention outcomes.\nResults\nNineteen studies met criteria. The majority of the interventions (14 studies) were biomedical, either invasive (e.g., injections), or non-invasive (e.g., medications). Five studies evaluated integrative interventions that combined biomedical and psychosocial components (e.g., a multimodal pain treatment center). Invasive biomedical interventions were better at relieving short-term pain and non-invasive biomedical interventions were superior for long-term pain; integrated interventions reduced both short-term and long-term pain. Integrative interventions also improved mental health, sexual health, and QOL.\nConclusion\nAlthough most interventions for ICPP have been biomedical, integrative interventions showed greater outcome effectiveness, suggesting a focus on integrative interventions in the future.\nSimilar content being viewed by others\nAvailability of Data and Materials\nThe authors have full control of all primary data and agree to allow the journal to review their data upon request.\nReferences\nBartley JM, Carrico DJ, Gilleran JP, Sirls LT, Peters KM. Chronic pelvic pain in women: common etiologies and management approach recommendations. Clin Pract. 2013;10:89–103.\nDoggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn. 2017;36:984–1008.\nEngeler D, Baranowski AP, Borovicka J, Cottrell AM, Dinis-Oliveira P, Elneil S, et al. EAU guidelines on chronic pelvic pain. Arnhem, The Netherlands: EAU Guidelines Office; 2022.\nSiedentopf F, Weijenborg P, Engman M, Maier B, Cagnacci A, Mimoun S, et al. ISPOG European Consensus Statement - chronic pelvic pain in women (short version). J Psychosom Obstet Gynecol. 2015;36:161–70.\nHawkey A, Chalmers KJ, Micheal S, Diezel H, Armour M. “A day-to-day struggle”: A comparative qualitative study on experiences of women with endometriosis and chronic pelvic pain. Fem Psychol. 2022;32:482–500.\nDemir F, Ozcimen EE, Oral HB. The role of gynecological, urological, and psychiatric factors in chronic pelvic pain. Arch Gynecol Obstet. 2012;286:1215–20.\nZondervan KT, Yudkin PL, Vessey MP, Jenkinson CP, Dawes MG, Barlow DH, et al. Chronic pelvic pain in the community–symptoms, investigations, and diagnoses. Am J Obstet Gynecol. 2001;184:1149–55.\nGhai V, Jan H, Shakir F, Haines P, Kent A. Diagnostic delay for superficial and deep endometriosis in the United Kingdom. J Obstet Gynaecol. 2020;40:83–9.\nMathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87:321–7.\nGrace VM, MacBride-Stewart S. ‘Women get this’: gendered meanings of chronic pelvic pain. Health (London). 2007;11:47–67.\nJones G, Jenkinson C, Kennedy S. The impact of endometriosis upon quality of life: a qualitative analysis. J Psychosomat Obstetrics Gynaecol. 2004;25.\nSamulowitz A, Gremyr I, Eriksson E, Hensing G. “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag. 2018;2018:6358624.\nPrice J, Farmer G, Harris J, Hope T, Kennedy S, Mayou R. Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study. BJOG: Int J Obstetrics Gynaecol. 2006;113:446–52.\nRoth RS, Punch MR, Bachman JE. Patient beliefs about pain diagnosis in chronic pelvic pain: relation to pain experience, mood and disability. J Reprod Med. 2011;56:123–9.\nFitzgerald MP, Link CL, Litman HJ, Travison TG, McKinlay JB. Beyond the lower urinary tract: the association of urologic and sexual symptoms with common illnesses. Eur Urol. 2007;52:407–15.\nSavidge CJ, Slade P, Stewart P, Li TC. Women’s perspectives on their experiences of chronic pelvic pain and medical care. J Health Psychol. 1998;3:103–16.\nCrook J. Women with chronic pain. In: Roy R, Tunks E, editors. Chronic pain: Psychosocial factors in rehabilitation. Baltimore: Williams & Wilkins; 1982.\nWorld Health Organization. ICD-10: International statistical classification of diseases and related health problems: Tenth revision. World Health Organization; 2004.\nMcgowan L, Pitts M, Carter DC. Chronic pelvic pain: The general practitioner’s perspective. Psychol Health Med. 1999;4:303–17.\nReiter RC, Gambone JC. Demographic and historic variables in women with idiopathic chronic pelvic pain. Obstet Gynecol. 1990;75:428–32.\nTill SR, As-Sanie S, Schrepf A. Psychology of chronic pelvic pain: Prevalence, neurobiological vulnerabilities, and treatment. Clin Obstet Gynecol. 2019;62:22–36.\nPetrini L, Arendt-Nielsen L. Understanding pain catastrophizing: putting pieces together. Front Psychol. 2020;11.\nPage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.\nBaranowski A. Defining the urological chronic pelvic pain syndromes. Reviews in Pain. 2008;2:29–31.\nOuzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.\nDowns SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.\nHorne AW, Vincent K, Cregg R, Daniels J. Is gabapentin effective for women with unexplained chronic pelvic pain? BMJ. 2017;j3520.\nHewitt CA, Vincent K, Middleton LJ, Romaniuk L, Koscielniak M, Doust AM, et al. Gabapentin to reduce pain in women aged between 18 and 50 years with chronic pelvic pain: The GaPP2 RCT. Efficacy and Mechanism Evaluation. 2020;7:1–60.\nHaugstad GK, Haugstad TS, Kirste UM, Leganger S, Wojniusz S, Klemmetsen I, et al. Continuing improvement of chronic pelvic pain in women after short-term Mensendieck somatocognitive therapy: Results of a 1-year follow-up study. Am J Obstet Gynecol. 2008;199:615.e1-615.e8.\nDaniels J, Gray R, Hills RK, Latthe P, Buckley L, Gupta J, et al. Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: A randomized controlled trial. JAMA. 2009;302:955–61.\nLewis SC, Bhattacharya S, Wu O, Vincent K, Jack SA, Critchley HOD, et al. Gabapentin for the management of chronic pelvic pain in women (GaPP1): A pilot randomised controlled trial. PLoS ONE. 2016;11: e0153037.\nAbdelHafeez MA, Reda A, Elnaggar A, El-Zeneiny H, Mokhles JM. Gabapentin for the management of chronic pelvic pain in women. Arch Gynecol Obstet. 2019;300:1271–7.\nda Rosa KF, Amantéa VA, dos Santos AC, Savaris RF. Efficacy of paraspinal anesthetic block in patients with chronic pelvic pain refractory to drug therapy: A randomized clinical trial. Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia. 2015;37:105–9.\nde Bernardes NO, Marques A, Ganunny C, Bahamondes L. Use of intravaginal electrical stimulation for the treatment of chronic pelvic pain: A randomized, double-blind, crossover clinical trial. J Reprod Med. 2010;55:19–24.\nChong OT, Critchley HO, Williams LJ, Haraldsdottir E, Horne AW, Fallon M. The impact of meridian balance method electro-acupuncture treatment on chronic pelvic pain in women: A three-armed randomised controlled feasibility study using a mixed-methods approach. Br J Pain. 2018;12:238–49.\nFlynn MJ, Campbell TS, Robert M, Nasr-Esfahani M, Rash JA. Intranasal oxytocin as a treatment for chronic pelvic pain: A randomized controlled feasibility study. Int J Gynecol Obstet. 2021;152:425–32.\nAmin MM, Ait-Allah AS, Ali AE-SA, Salem RA, Ahmed SR, Alsammani MA. Inferior hypogastric plexus blockade versus acupuncture for the management of idiopathic chronic pelvic pain: A randomized clinical trial. Biomed J. 2015;38:317–22.\nMontenegro MLLS, Braz CA, Rosa-e-Silva JC, Candido-dos-Reis FJ, Nogueira AA, Poli-Neto OB. Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain. BMC Anesthesiol. 2015;15:175.\nHooper P, Jutai JW, Strong G, Russell-Minda E. Age-related macular degeneration and low-vision rehabilitation: A systematic review. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK); 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK76514/\nCarrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction: Serum diazepam levels and efficacy data. Urol Nurs. 2011;31(279–84):299.\nSokal P, Zieliński P, Harat M. Sacral roots stimulation in chronic pelvic pain. Neurol Neurochir Pol. 2015;49:307.\nSillem M, Juhasz-Böss I, Klausmeier I, Mechsner S, Siedentopf F, Solomayer E. Osteopathy for endometriosis and chronic pelvic pain – a pilot study. Geburtshilfe Frauenheilkd. 2016;76:960–3.\nYasaei R, Katta S, Saadabadi A. Gabapentin [Internet]. StatPearls. 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK493228/\nSharma N, Rekha K, Srinivasan JK. Efficacy of transcutaneous electrical nerve stimulation in the treatment of chronic pelvic pain. J Midlife Health. 2017;8:36–9.\nPriya K, Rajaram S, Goel N. Comparison of combined hormonal vaginal ring and low dose combined oral hormonal pill for the treatment of idiopathic chronic pelvic pain: A randomised trial. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016;207:141–6.\nSaxena R, Gupta M, Shankar N, Jain S, Saxena A. Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. Int J Yoga. 2017;10:9–15.\nFerreira Gurian MB, Poli Neto OB, Rosae Silva JC, Nogueira AA, Candido-dos-Reis FJ. Reduction of pain sensitivity is associated with the response to treatment in women with chronic pelvic pain. Pain Med. 2015;16:849–54.\nAboussouan AB, Mandell D, Johnson J, Thompson N, Huffman KL. An interdisciplinary chronic pain rehabilitation program effectively treats impairment in sexual function, depression, alexithymia, and pain in women with chronic pelvic pain. J Psychosom Obstet Gynecol. 2020;1–11.\nHaugstad GK, Haugstad TS, Kirste UM, Leganger S, Klemmetsen I, Malt UF. Mensendieck somatocognitive therapy as treatment approach to chronic pelvic pain: Results of a randomized controlled intervention study. Am J Obstet Gynecol. 2006;194:1303–10.\nTurner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: A randomized, controlled trial. Pain. 2006;121:181–94.\nKeefe FJ, Caldwell DS, Williams DA, Gil KM, Mitchell D, Robertson C, et al. Pain coping skills training in the management of osteoarthritic knee pain: A comparative study. Behav Ther. 1990;21:49–62.\nUrits I, Callan J, Moore WC, Fuller MC, Renschler JS, Fisher P, et al. Cognitive behavioral therapy for the treatment of chronic pelvic pain. Best Pract Res Clin Anaesthesiol. 2020;34:409–26.\nLeventhal H, Benyamini Y, Brownlee S, Diefenbach M, Leventhal E, Patrick-Miller L, et al. Illness Representations: Theoretical Foundations. In: Petrie KJ, Weinman J, editors. Perceptions of Health and Illness: Current Research and Applications. Taylor & Francis; 1997.\nRadojevic V, Nicassio PM, Weisman MH. Behavioral intervention with and without family support for rheumatoid arthritis. Behav Ther. 1992;23:13–30.\nLaMontagne LL, Hepworth JT, Cohen F, Salisbury MH. Cognitive-behavioral intervention effects on adolescents’ anxiety and pain following spinal fusion surgery. Nurs Res. 2003;52:183.\nWetherell JL, Afari N, Rutledge T, Sorrell JT, Stoddard JA, Petkus AJ, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. 2011;152:2098–107.\nMellado BH, Falcone ACM, Poli-Neto OB, Rosa E, Silva JC, Nogueira AA, Candido-Dos-Reis FJ. Social isolation in women with endometriosis and chronic pelvic pain. Int J Gynaecol Obstet. 2016;133:199–201.\nSchwartz GE. Testing the biopsychosocial model: The ultimate challenge facing behavioral medicine? J Consult Clin Psychol. 1982;50:1040–53.\nJohnson R. Exploring identity: Who are the Métis and what are their rights? | CBC News [Internet]. CBC. 2019. Available from: https://www.cbc.ca/news/indigenous/metis-identity-history-rights-explainer-1.5098585\nAcknowledgements\nThe authors thank Nicole Aglialoro for her help with coding, fact-checking, and references.\nFunding\nNo funding was obtained for this review.\nAuthor information\nAuthors and Affiliations\nContributions\nThe authors confirm contributions to the paper as follows: MRW: Study conception and design; data collection; analysis and interpretation of results; manuscript preparation. TAR, JSF, and ANK: Analysis and interpretation of results; manuscript preparation.\nCorresponding author\nEthics declarations\nEthical Approval\nFor this type of study, formal consent is not required.\nInformed Consent\nAs human subjects were not recruited for this review, informed consent was not obtained.\nResearch Involving Human Participants\nThis article does not contain any studies with human participants performed by any of the authors.\nCompeting Interests\nThe authors declare that they have no conflict of interest.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nWirtz, M.R., Revenson, T.A., Ford, J.S. et al. Effective Interventions for Idiopathic Chronic Pelvic Pain: A Systematic Review. Int.J. Behav. Med. 31, 819–832 (2024). https://doi.org/10.1007/s12529-024-10309-y\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s12529-024-10309-y","source_license":"CC0","license_restricted":false}