Chronic%20pelvic%20pain%20in%20women Treatment

• Eg Adhesiolysis, hysterectomy, neurectomy
• The symptomatic effect of surgical procedures for chronic pelvic pain (CPP) relies on the modulation or interruption of the pelvic neural pain transmission
• Often successful if a related pathological finding is believed to be the possible cause of the symptoms even at the clinical stage

Laparoscopy

• If a pelvic abnormality is suspected, laparoscopy is performed to confirm diagnosis and to treat contributing conditions (endometriosis, adhesions or both)
• The mainstay of both diagnosis and surgical treatment of CPP in women

Neuroablation

• Eg Chemical neuroablation, radiofrequency thermocoagulation, pulsed or cooled radiofrequency, cryoneurolysis
• Used for abdominal wall or pelvic floor neuralgia, it directly destroys neural tissue or alters neural conduction
• More studies are needed before this can be recommended 

Neuromodulation

• Eg Sacral nerve stimulation, percutaneous tibial nerve stimulation, pudendal nerve stimulation
• A possible method for chronic pain relief, it should only be considered by specialists in pelvic pain management
• May be considered for bladder pain syndrome, pudendal neuralgia and chronic anal pain syndrome 
• Gabaminergic interneurons are electrically stimulated leading to an exaggerated sensory information with consecutive modulation in the CNS eg spinal cord stimulation, sacral root stimulation, dorsal root ganglion stimulation, or peripheral nerve stimulation
• More detailed research is required

Transurethral Resection (Coagulation and Laser)

• May be considered in patients with bladder pain syndrome type 3C if conventional treatments are ineffective
• Reports suggest that transurethral laser results in prolonged alleviation of pain and urgency 

Open Surgery 

• Should only be considered for patients with bladder pain syndrome after all other therapies have failed
• Some reports suggest that cystectomy with ileal conduit formation or supratrigonal cystectomy with bladder augmentation may provide relief from bladder pain