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CHRONIC PELVIC PAIN
Treatment Guideline Chart
Chronic pelvic pain (CPP) is a persistent, distressing, & severe pain of >6 month duration.
It occurs intermittently, cyclically, or situationally.
Localized to the pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks.
It is severe enough to cause functional disability or need medical care.
In women, CPP is not restricted to intercourse or menstruation & is not associated w/ pregnancy.
It is a symptom w/ a number of contributory factors & not a diagnosis; pathophysiology is complex & not well understood.
It is assumed that in the development of chronic pain, the nervous system is affected among others by inflammatory & chemical mediators & hormones.
A complex problem that is both multifactorial & multidimensional

Chronic Pelvic Pain References

  1. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin no. 51. Chronic pelvic pain. Obstet Gynecol. 2004 Mar;103(3):589-605. https://www.clinicalkey.com. Accessed 13 Mar 2015. PMID: 14990428
  2. Engeler D, Baranowski AP, Borovicka J, et al. Guidelines on chronic pelvic pain. European Association of Urology (EAU). http://uroweb.org. 2014. Accessed 06 Nov 2014.
  3. Engeler DS, Baranowski AP, Dinis-Oliveira P, et al; European Association of Urology. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol. 2013 Sep;64(3):431-439. doi: 10.1016/j.eururo.2013.04.035. Accessed 06 Nov 2014. PMID: 23684447
  4. Jarrell JF, Vilos GA, Allaire C, et al; Chronic Pelvic Pain Working Group; Society of Obstetricians and Gynaecologists of Canada. Consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can. 2005 Aug;27(8):781-826. http://sogc.org. Accessed 13 Mar 2015. PMID: 16287011
  5. Jarrell JF, Vilos GA, Allaire C, et al; Chronic Pelvic Pain Working Group; Society of Obstetricians and Gynaecologists of Canada. Consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can. 2005 Sep;27(9):869-910. http://sogc.org. Accessed 13 Mar 2015. PMID: 19830953
  6. Ortiz DD. Chronic pelvic pain in women. Am Fam Physician. 2008 Jun 1;77(11):1535-1542. http://www.aafp.org. Accessed 13 Mar 2015. PMID: 18581833
  7. Royal College of Obstetricians & Gynaecologists (RCOG). The initial management of chronic pelvic pain. Green-top guideline no. 41. RCOG. https://www.rcog.org.uk. May 2012. Accessed 06 Nov 2014.
  8. Royal College of Obstetricians & Gynaecologists (RCOG). Therapies targeting the nervous system for chronic pelvic pain relief. Scientific impact paper no. 46. RCOG. https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip46.pdf. Jan 2015. Accessed 25 Mar 2015.
  9. Siedentopf F on behalf of the International Society of Psychosomatic Obstetrics and Gynaecology (ISPOG) Study Group. ISPOG practice protocol chronic pelvic pain in women. ISPOG. http://www.ispog.org. 17 Dec 2012. Accessed 13 Mar 2015.
  10. Stein SL. Chronic pelvic pain. Gastroenterol Clin North Am. 2013 Dec;42(4):785-800. doi: 10.1016/j.gtc.2013.08.005. Accessed 25 Mar 2015. PMID: 24280400
  11. Rees J, Abrahams M, Doble A, Cooper A; Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015 Oct;116(4):509-525. doi: 10.1111/bju.13101. Accessed 09 Aug 2016. PMID: 25711488
  12. Engeler D, Baranowski AP, Borovicka J, et al. EAU guidelines on chronic pelvic pain. European Association of Urology (EAU). http://uroweb.org. 2016. Accessed 09 Aug 2016.
  13. Hanno PM, Burks DA, Clemens JQ, et al. American Urological Association (AUA) guideline: diagnosis and treatment of interstitial cystitis/bladder pain syndrome. American Urological Association (AUA). https://www.auanet.org. 2014. Accessed 09 Aug 2016.
  14. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Gynecology. Chronic pelvic pain: ACOG Practice Bulletin, Number 218. Obstet Gynecol. 2020 Mar;135(3):e98-e109. doi: 10.1097/AOG.0000000000003716. PMID: 32080051
  15. Engeler D, Baranowski AP, Berghmans B, et al. EAU guidelines on chronic pelvic pain. European Association of Urology (EAU). http://uroweb.org/. 2023.
  16. Ayorinde AA, Macfarlane GJ, Saraswat L, et al. Chronic pelvic pain in women: an epidemiological perspective. Womens Health (Lond). 2015 Nov;11(16):851-864. doi: 10.2217/whe.15.30. PMID: 26450216
  17. Carter JE. Management of chronic pelvic pain. Contemporary OB/GYN. www.contemporaryobgyn.net/. 2011.
  18. Kim A, Kim HY. Recent trends in chronic pelvic pain diagnosis. Kosin Med J. 2012 Jun;27(1):11-16. doi: 10.7180/kmj.2012.27.1.11.
  19. Mabrouk A, Alloush A, Foye P. Coccyx pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
  20. National Institute for Health and Clinical Excellence (NICE). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE. https://www.nice.org.uk/. 07 Apr 2021.
  21. Parsons BA, Baranowski AP, Berghmans B, et al. Management of chronic primary pelvic pain syndromes. BJU Int. 2022 May;129(5):572-581. doi: 10.1111/bju.15609. PMID: 34617386
  22. Passavanti MB, Pota V, Sansone P, et al. Chronic pelvic pain: assessment, evaluation, and objectivation. Pain Res Treat. 2017;2017:0472925. doi: 10.1155/2017/9472925. PMID: 29359045
  23. Sandrasegaram N, Gupta R, Baloch M. Diagnosis and management of sacrococcygeal pain. BJA Educ. 2020 Mar;20(3):74-79. doi: 10.1016/j.bjae.2019.11.004. PMID: 33456933
  24. Uppal T, Amarasekara C, Kaushik V. Chronic pelvic pain. Australas J Ultrasound Med. 2011 Feb;14(1):24-27. doi: 10.1002/j.2205-0140.2011.tb00182.x. PMID: 28191100
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