P049 ‘Ablating the silence: endometriosis, chronic pelvic pain and the role of interventional pain medicine – a case report’

Background and Aims Chronic pelvic pain (CPP) is a frequent and often debilitating symptom of deep infiltrating endometriosis, with a complex pathophysiology involving nociceptive, neuropathic, and central sensitization mechanisms that remains a significant therapeutic challenge, often requiring a tailored, multidisciplinary, and multimodal approach. This case report illustrates the successful integration of pharmacologic, psychological, physiotherapeutic, and interventional strategies in the management of refractory CPP in a patient with rectovaginal endometriosis.

A 32-year-old female with a history of bipolar disorder and previous excision of a serous cystadenoma was referred to the chronic pain clinic in 2024 for CPP characterized by dysmenorrhea, dyschezia, dyspareunia, and dysuria. She had undergone laparoscopic resection of a 3 cm rectovaginal endometriotic nodule invading the hypogastric plexus in 2021, with intraoperative evidence of frozen pelvis. Despite ongoing hormonal suppression, a complex psychopharmacological regimen, pelvic floor physiotherapy, and psychological support, her symptoms persisted. After a positive diagnostic block, thermal radiofrequency ablation (RFA) of the superior hypogastric plexus was performed using three 90-second lesions on each side.

At four-month follow-up, the patient reported significant improvement in pelvic pain and dyspareunia, with no complications observed. The intervention allowed better functional outcomes and reduced interference with daily activities.

This case highlights the value of a multidisciplinary and multimodal strategy in managing complex CPP secondary to endometriosis. Thermal radiofrequency ablation of the superior hypogastric plexus proved to be a safe and effective interventional option within a broader multimodal strategy, offering meaningful symptom relief, particularly when unresponsive to conservative measures. The sustained clinical improvement observed reinforces the relevance of a multimodal and multidisciplinary strategy—combining pharmacologic, psychological, physiotherapeutic, and interventional modalities—as essential to managing complex and refractory pain syndromes.