{"paper_id":"f926dfdf-13c9-4862-8a8c-e6c6093afa3a","body_text":"Title:Central and Peripheral Pain Generators in Women with Chronic Pelvic Pain: Patient Centered Assessment and Treatment\nVolume: 11\nIssue: 2\nAuthor(s): Donna Hoffman\nAffiliation:\nKeywords:\nCentral sensitization, chronic pelvic pain, fear- avoidance, multi-disciplinary treatment, pain catastrophizing, patient\n–centered care, pelvic floor hypertonus.\nAbstract: Women with chronic pelvic pain (CPP) often present without obvious cause on imaging\nstudies, laboratory values or physical exam. Dysfunctional sensory processing in the central nervous\nsystem (CNS) may explain pain of unclear origin. Central sensitization (CS), a mechanism of centrally\nmediated pain, describes this abnormal processing of sensory information. Women with CPP often\npresent with several seemingly unrelated symptoms. This can be explained by co-existing chronic pain\nsyndromes occurring in the same patient. Central sensitization occurs in all of these pain syndromes,\nalso described as dysfunctional pain syndromes, and thus may explain why several often occur in the\nsame patient. Six of the most common pain disorders that co-exist in CPP include endometriosis, painful\nbladder syndrome/interstitial cysitis, vulvodynia, myofascial pain/ pelvic floor hypertonus, irritable bowel syndrome,\nand primary dysmenorrhea. Central pain generators, (pain originating from CS) and peripheral pain generators, (pain from\nlocal tissue damage), can both occur in each of these six conditions. These pain generators will be described.\nChronic pain, specifically dysfunctional sensory processing, is recognized as a systemic disease process like diabetes to be\nmanaged as opposed to a local problem to be “fixed” or cured. A multi-disciplinary approach to assessment and treatment\nwith a focus on improving emotional, physical and social functioning instead of focusing strictly on pain reduction is\nmore effective in decreasing disability. This is best achieved by determining the patient’s needs and perspective through a\npatient-centered approach. Algorithms for such an approach to assessment and treatment are outlined.","source_license":"CC0","license_restricted":false}