The Management of Chronic Pelvic Pain

Sung-Tack Oh
In: Journal of the Korean Medical Association · 2008 · vol. 51(1) , pp. 53 · doi:10.5124/jkma.2008.51.1.53 · W2051272677
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This paper reviews the definition and management strategies for chronic pelvic pain, characterized by lower abdominal pain persisting for a minimum of six months.

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This paper reviews chronic pelvic pain (CPP), defined as lower abdominal pain lasting at least 6 months, discussing its cyclic versus continuous forms and differentiating primary from secondary dysmenorrhea. It states that the most common origin of secondary dysmenorrhea and CPP is endometriosis, and outlines a stepwise approach to managing endometriosis-associated pain that includes medical and surgical treatment, postoperative medical therapy, trigger point injections, NSAIDs, and immune therapy, while noting other etiologies such as adenomyosis, pelvic congestion syndrome, psychological and gastrointestinal conditions, urinary diseases, and musculoskeletal disorders. It also lists supportive interventions for CPP (e.g., laparoscopic adhesiolysis, uterine suspension, LUNA, presacral neurectomy, and hysterectomy) and emphasizes that treatment is difficult and that exact diagnosis of the pain origin is necessary with combination treatment. This paper is centrally about endometriosis — it presents endometriosis as the most common cause of secondary dysmenorrhea and CPP and focuses on step-by-step management of endometriosis-related pain within a broader CPP review.

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Abstract

C hronic pelvic pain (CPP) is defined as lower abdominal pain lasting for at least 6 months.
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Keywords

Dysmenorrhea; Chronic pelvic pain; Endoemetriosis ೨बਊয ૐ

Abstract

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Fall M, Johannson SL, Aldenberg F. Chronic interstitial cystitis: A heterogeneous syndrome. J Urol 1987; 137: 35-38. 50. Holm Bentzen M, Jacobsen F, Nerstrom B, Lose G, Kris- tensen JK, Pedersen RH, Krarup T, Feggetter J, Bates P, Bar- nard R. Painful bladder disease: Clinical and pathoanatomical differences in 115 patients. J Urol 1987; 138: 500-502. 51. Larsen S, Thompson SA, Hald T, Barnard RJ, Gilpin CJ, Dixon JS, Gosling JA. Mast cells in interstitial cystitis. Br J Urol 1982; 54: 283-286. 52. Travell J, Rinzler SH. The myofascial genesis of pain. Postgrad Med 1952; 11: 425-434. 53. Slocumb JC. Neurological factors in chronic pelvic pain: trigger point and the abdominal pelvic pain syndrome. Am J Obstet Gynecol 1984; 149: 536-543. 54. Carter JE. Surgical treatment for chronic pelvic pain. J Soc Laparoendosc Surg 1998; 2: 129-139. 55. Simons DG. Diagnostic criteria of myofascial pain caused by trigger points. J Musculoskel Pain 1999; 7: 111-113. 56. Chan CL, Wood C. Pelvic adhesiolysis the assessment of symptom relief by 100 patients. Aust N Z J obstet Gynaecol 1985; 25: 295-298. 57. Nezhat FR, Crystal FR, Nezhat CH, Nezhat CR. Laparoscopic adhesiolysis and relief of chronic pelvic pain. JSLS 2000; 4: 281-285. 58. Sutton C, McDonald R. Laser laparoscopic adhesiolysis. J Gynecol Surg 1990; 6: 155-159. 59. Sutton C, Hill D. Laser laparoscopy in the treatment of endo- metriosis. Br J Obstet Gynecol 1990; 97: 181-185. 60. Lichten EM, Bombard J. Surgical treatment of primary dys- menorrhoea with laparoscopic uterosacral nerve ablation. J Reprod Med 1987; 32: 37-41. 61. Parsons LH, Stovall TG. Surgical management of chronic pelvic pain. Obstet Gynecol Clin North Am 1993; 20: 765-778. The Management of Chronic Pelvic Pain ఖ1.ಕ੉૑  64ܐ Oh ST Peer Reviewer Commentary ী ҙೠ ୭न ૑Ѽਸ ӝ ೞ৓Ҋ ੋҗ੸ ૕ജ ৻ী ਤ द ҙ଴ೞৈ ੿नҗ੸ ೞ ׮ ੋҗ ೠ ജ੗ ݶ ׮ ࠂחغ۲ ݺ ۞ ׮ ӝ੹ਸ ੉೧ ١ ী ੐ೡ ׮ ੋҗ ఖ1.ಕ੉૑ 

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