A Woman Who Suffers Always and Forever: Management of Chronic Pelvic Pain

In: Bio-Psycho-Social Obstetrics and Gynecology · 2017 · pp. 199–215 · doi:10.1007/978-3-319-40404-2_11 · W2589290566
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Chronic pelvic pain in women is common, poorly understood, and negatively impacts health, making pain-maintaining factors and cognitive behavioral approaches important treatment targets.

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This chapter discusses chronic pelvic pain (CPP) in women, reviewing its prevalence, poorly understood pathogenesis, and the disconnect between identified somatic pathologies (including endometriosis and adhesions) and the severity/location of pain. It emphasizes that pain adjustment, appraisals, and coping strategies can maintain or worsen pain, and notes a relative paucity of evidence for effective surgical or nonsurgical interventions. A cognitive behavioral approach is described and illustrated with a case history as a way to tailor a pain management program to individual needs. The chapter does not present new comparative trial results and acknowledges that effective interventions for CPP remain insufficiently demonstrated. Relevance to endometriosis: it explicitly references endometriosis as one of the somatic factors studied in relation to pelvic pain, though it states that the association with pain severity and location remains unclear, while the chapter’s main focus is biopsychosocial management of chronic pelvic pain.

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Abstract

Chronic pelvic pain (CPP) in women is a long-lasting condition and affects about 5–26 % of women in the general population. The pathogenesis is poorly understood. The role of various somatic factors, such as endometriosis and adhesions, as a cause of pelvic pain have been studied thoroughly, but the association between identified pathologies and the (severity and location of) pain remains unclear. CPP can have a significant impact on physical and mental health in the affected women, resulting in distress and disability. Pain adjustment, pain appraisals, and pain coping strategies are important factors that can maintain and even worsen the individual experience of pain. So far, there is a paucity of studies demonstrating the effectiveness of any surgical or nonsurgical intervention on pain in CPP women. Therefore, like in other chronic pain conditions, it seems valid to concentrate treatment on pain maintaining factors. A cognitive behavioral approach of CPP women is explained and is illustrated with a case history. Following this approach a pain management program tailored to a patient’s needs can be offered. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

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