Chronic Pelvic Pain in Women.

Linda M Speer, Linda Speer, Saudia Mushkbar, Tara Erbele
American family physician · 2016 · vol. 93(5) , pp. 380–7 · PMID:26926975 · W2400152667
article OA: closed CC0 ⤵ 25 in-corpus citations
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This paper defines chronic pelvic pain in women as persistent, noncyclic pelvic pain lasting over six months, often lacking a specific etiology and requiring a biopsychosocial approach for management.

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Abstract

Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medroxyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuromodulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach.

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Condition tags

chronic_pelvic_painendometriosisinterstitial_cystitisirritable_bowel_syndrome

MeSH descriptors

Pain Management Pain Measurement Pelvic Pain Pelvic Pain Pelvic Pain Pelvic Pain Chronic Pain Female Humans Pain Management Pain Measurement

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