Medical, surgical and alternative treatments for chronic pelvic pain in women: A descriptive review

Paolo Vercellini, Paola Viganò, Edgardo Somigliana, Annalisa Abbiati, Giussy Barbara, Luigi Fedele

Research output: Contribution to journalArticle

Abstract

Several causes of chronic pelvic pain (CPP) are recognised, but in many women a definite diagnosis cannot be made. Few randomised controlled trials on treatment of CPP have been conducted. In a Cochrane systematic review, only medroxy-progesterone acetate, counselling, a multidisciplinary approach and lysis of deep adhesions had a proven benefit. The aim of this descriptive review is to describe the management of CPP, which can focus on treating the pain itself, the underlying cause, or both. Combination drug therapy with medications with different mechanisms of action may improve therapeutic results. Pelvic denervating procedures should be indicated in selected circumstances, as the magnitude of the effect is undefined. Several alternative non-invasive treatments have been proposed including exercise programmes, cognitive and behavioural medicine, physical therapy, dietary modification, massage and acupuncture. When the woman has completed her family and particularly when pelvic varices have been demonstrated, hysterectomy can be considered after a careful pre-operative assessment. However, substantial pain relief may be achieved in no more than 60-70% of the cases. A minority of patients (3-5%) will experience worsening of pain or will develop new symptoms after surgery. Treatment of CPP, generally, requires acceptance of the concept of managing rather than curing symptoms.

Original languageEnglish
Pages (from-to)208-221
Number of pages14
JournalGynecological Endocrinology
Volume25
Issue number4
DOIs
Publication statusPublished - Apr 2009

Keywords

  • Chronic pelvic pain
  • Interstitial cystitis
  • Irritable bowel syndrome
  • Pelvic varices
  • Post-operative adhesions

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Obstetrics and Gynaecology

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