chronic%20pelvic%20pain
CHRONIC PELVIC PAIN
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

Surgical Intervention

  • 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

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

Laparoscopy

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

Transurethral resection (Coagulation & 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 & 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
Editor's Recommendations
Most Read Articles
5 days ago
Use of statin appears to reduce the risks of osteoporosis, hip fractures and vertebral fracture in patients newly diagnosed with a stroke, suggests a recent study.
07 Oct 2018
Patients using long-acting opioids with immunosuppressive properties are at greater risk of developing serious infections compared with those using the nonimmunosuppressive opioid counterpart, according to a study.
6 days ago
Speech therapy may effectively reduce excessive supragastric belching, according to a study. This treatment is aimed at increasing awareness of air inhalation and injection manoeuvres, as well as performing exercises to enhance abdominal, quiet and fluent breathing (without sudden stops).
6 days ago
Monitoring of adverse events is lower in ambulatory patients on amiodarone than in those on dofetilide, a recent study has found. Improving the monitoring of such agents may help reduce the risk of morbidity in this population.