Chronic Pelvic Pain

Abstract This chapter presents a clinical case of chronic pelvic pain. Chronic pelvic pain correlates more closely with central changes in regional brain morphology and function rather than pelvic pathology. The condition is less dependent on nociceptive input from the periphery and more dependent on the extensive modulation of the input by affective and cognitive mechanisms. The chapter discusses the differential diagnosis, assessment methods (including family history, bedside sensory testing, laboratory tests, imaging studies, and tests of the bladder and bowel), and pathophysiology of chronic pelvic pain. Techniques for managing the condition follow a behavioral approach in which function is emphasized more than relief of pain, and the patient is encouraged to take an active role in managing pain. This approach includes addressing biopsychosocial symptoms such as insomnia, substance misuse or dependence, anxiety disorders, and post-traumatic stress disorder.