Therapies Targeting the Nervous System for Chronic Pelvic Pain Relief

‘intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy’.1 Women with CPP may experience constant or cyclical pain, which can be unprovoked or associated with specific activities including urination (dysuria), bowel opening (dyschezia) or sexual intercourse (dyspareunia). CPP is associated with a significant reduction in quality of life and psychological distress is frequently seen in these women. Over one million women in the UK suffer with CPP2 yet it is a condition that is frequently difficult to treat, with many patients not achieving adequate analgesia even after many years.3 While CPP is known to occur in association with a number of gynaecological pathologies, including endometriosis, adenomyosis, chronic pelvic inflammatory disease and pelvic organ prolapse, in many cases an underlying pathology cannot be identified (chronic pelvic pain syndrome [CPPS]).4 Moreover, even where a cause is found, such as endometriosis, the painful symptoms experienced may be disproportionate to the extent of disease identified or persist after optimal treatment.5 The experience of pain necessitates the involvement of the central nervous system (CNS) and there is increasing evidence that pain, no matter where it is perceived to originate from, can be both generated and perpetuated by the CNS itself.6 Furthermore, chronic pain is associated with long-lasting changes