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%20pelvic%20pain Treatment

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


  • 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

Invasive Neuromodulation Techniques

  • 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 primary bladder pain syndrome, pudendal neuralgia, and primary 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


  • 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

Transurethral Resection (Coagulation and Laser)

  • May be considered in patients with primary 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 primary 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

Microsurgical Denervation

  • Microsurgical denervation of the spermatic cord can be offered to patients with primary testicular pain syndrome
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