Chronic Pelvic Pain

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This paper describes research on chronic pelvic pain, focusing on its underlying mechanisms and potential therapeutic targets.

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This paper is a narrative review of chronic pelvic pain (CPP), describing its burden, common comorbidities, and the need to tailor treatment to underlying causes, noting that for non-specific chronic pain first-line management often involves over-the-counter analgesics. It discusses the endocannabinoid system as a mechanistic rationale for medicinal cannabis (including THC and CBD) and summarizes evidence from broader pain literature that cannabinoids can have analgesic effects and may reduce opioid use. The paper also reports that cross-sectional surveys suggest medicinal cannabis could alleviate CPP across multiple gynecological conditions, while explicitly stating that there is a lack of clinical research with no published randomized controlled trials for cannabis in CPP. It further notes some evidence from systematic review data and a recent RCT that palmitoylethanolamide (PEA) may alleviate CPP, but it does not provide detailed trial outcomes within the excerpt. Relevance to endometriosis: the paper’s framing of CPP and its citations include dedicated discussion of cannabinoids for endometriosis-related pain, linking this review to endometriosis as part of CPP in women.

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Abstract

Chronic pelvic pain (CPP) is a condition that disproportionately affects women and has a significant individual, societal, and economic burden. CPP is associated with many different conditions, and can be a symptom and a syndrome in its own right. CPP is associated with many different comorbidities, including irritable bowel syndrome, major depressive disorder, and pelvic inflammatory syndrome. Treatment depends on the underlying cause; first-line treatment of non-specific chronic pain is typically with over-the-counter analgesics. The endocannabinoid system (ECS) is found within all parts of the pain pathways and provides a rationale for why medicinal cannabis (MC) might be a useful treatment option where other strategies have failed, as components of MC interact with the ECS. There is evidence from the general pain literature that MC and key components, tetrahydrocannabinol (THC) and cannabidiol (CBD), have analgesic actions and that MC is effective in reducing pain as well as potentially reducing use of opioids. Cross-sectional surveys suggest that MC may be useful in alleviating CPP across a range of gynecological conditions, but there is a lack of clinical research in CPP with no randomized controlled trials (RCTs) published to date. A systematic review and a recent RCT provide some evidence that palmitoylethanolamide (PEA) may be useful in alleviating CPP. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others Notes - 1. - 2. Each soft gel contained 15.7 mg CBD, 0.5 mg THC, 0.3 mg cannabidivarin (CBDV), 0.9 mg cannabidiolic acid (CBDA), 0.8 mg cannabichrome (CBC), and > 1% botanical terpene blend.

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Author information Authors and Affiliations Rights and permissions Copyright information © 2025 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter O’Brien, K., Bosak, C. (2025). Chronic Pelvic Pain. In: Medicinal Cannabis in Women’s Health. Springer, Cham. https://doi.org/10.1007/978-3-032-01737-6_4 Download citation DOI: https://doi.org/10.1007/978-3-032-01737-6_4 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-032-01736-9 Online ISBN: 978-3-032-01737-6 eBook Packages: MedicineMedicine (R0)

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