Chronic pain in women: new perspectives on pathophysiology and management

William Stones
In: Reproductive Medicine Review · 2000 · vol. 8(3) , pp. 229–240 · doi:10.1017/s096227990000034x · W2152007454
article OA: closed CC0 ⤵ 13 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This review discusses current neurobiological concepts of pain physiology and therapy to reframe the clinical problem of chronic pelvic pain in women, highlighting its bio-psycho-social nature.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper is a narrative review that examines why chronic pelvic pain in women has not been systematized as quickly as other gynecologic conditions, and it discusses contemporary concepts of pain physiology and therapy with emphasis on neurobiology. It frames chronic pelvic pain using a bio-psycho-social perspective and contrasts the availability of plausible causal models and effective treatments for conditions such as endometriosis and hormone-responsive syndromes with the more elusive nature of pelvic pain models and treatments. The main limitation is that it is a high-level review and explicitly does not present new original study data, relying instead on synthesis of existing “current concepts.” This paper is centrally about endometriosis only insofar as it cites endometriosis as an example of a symptomatic gynecological condition with a coherent pathogenesis framework that pelvic pain has yet to achieve.

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Abstract

Over the last fifty years the understanding of a number of symptomatic gynaecological conditions has crystallized to the point where a coherent framework of pathogenesis and a systematic approach to treatment can be discerned. Examples are endometriosis, menorrhagia, premenstrual syndrome and the symptoms associated with the climacteric. Chronic pelvic pain is only now reaching the stage of similar systematization, and it is interesting to speculate why this has taken so long. Two factors can perhaps be cited as relevant: in the conditions listed above, either reasonably plausible models for causation based on visible pathology have been available, as with endometriosis, or effective treatments have been readily available, for example hormone replacement therapy (HRT) for estrogen deficiency symptoms. In the case of pelvic pain, models of causation have often been speculative rather than based on research, and simple effective treatments have proved elusive. In this review current concepts of pain physiology and therapy are discussed with a view to placing in perspective the clinical problem of pelvic pain. The condition is best seen from a bio-psycho-social perspective but the main focus of the present review is the neurobiological aspect.

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Condition tags

endometriosischronic_pelvic_pain

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