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Chronic and Recurrent Pelvic Pain

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Handbook of Pediatric Chronic Pain
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Abstract

Chronic and recurrent pelvic pain (CPP) in ­children and adolescents has been recognized for decades. However, data on the etiology, natural history, treatment, and long-term consequences of painful pelvic conditions in these patients are lacking. The problem’s prevalence remains uncertain, and the majority of therapies are extrapolated from research on adults. The normal developmental changes and coping strategies of children and adolescents and the role of the family and social environment are only now being examined and understood. The complex nature of pain and its context has led to recommendations for a multimodal and multidisciplinary approach to patient care.

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References

  • Allen, L. A., Woolfolk, R. L., Escobar, J. I., Gara, M. A., & Hamer, R. M. (2006). Cognitive-behavioral therapy for somatization disorder: A randomized controlled trial. Archives of Internal Medicine, 166, 1512–1518.

    Article  PubMed  Google Scholar 

  • Almeida, O. D., Jr., & Val-Gallas, J. M. (1997). Conscious pain mapping. The Journal of the American Association of Gynecologic Laparoscopists, 4, 587–590.

    Article  PubMed  Google Scholar 

  • American College of Obstetricians and Gynecologists. (2005). ACOG committee opinion. Number 310, April 2005. Endometriosis in adolescents. Obstetrics and Gynecology, 105, 921–927.

    Article  Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC: American Psychiatric Association.

    Google Scholar 

  • American Society for Reproductive Medicine. (1997). Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility, 67, 817–821.

    Article  Google Scholar 

  • Antolak, S. J., Jr., Hough, D. M., Pawlina, W., & Spinner, R. J. (2002). Anatomical basis of chronic pelvic pain syndrome: The ischial spine and pudendal nerve entrapment. Medical Hypotheses, 59, 349–353.

    Article  PubMed  Google Scholar 

  • Baccini, F., Pallotta, N., Calabrese, E., Pezzotti, P., & Corazziari, E. (2003). Prevalence of sexual and physical abuse and its relationship with symptom manifestations in patients with chronic organic and functional gastrointestinal disorders. Digestive and Liver Disease, 35, 256–261.

    Article  PubMed  CAS  Google Scholar 

  • Badura, A. S., Reiter, R. C., Altmaier, E. M., Rhomberg, A., & Elas, D. (1997). Dissociation, somatization, ­substance abuse, and coping in women with chronic pelvic pain. Obstetrics and Gynecology, 90, 405–410.

    Article  PubMed  CAS  Google Scholar 

  • Batt, R. E., & Mitwally, M. F. (2003). Endometriosis from thelarche to midteens: Pathogenesis and prognosis, prevention and pedagogy. Journal of Pediatric and Adolescent Gynecology, 16, 337–347.

    Article  PubMed  Google Scholar 

  • Bernstein, G. A., Massie, E. D., Thuras, P. D., Perwien, A. R., Borchardt, C. M., & Crosby, R. D. (1997). Somatic symptoms in anxious-depressed school refusers. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 661–668.

    Article  PubMed  CAS  Google Scholar 

  • Braverman, P. K. (2000). Sexually transmitted diseases in adolescents. The Medical Clinics of North America, 84, 869–889.

    Article  PubMed  CAS  Google Scholar 

  • Brown, R. T., & Hewitt, G. D. (2004). Chronic pelvic pain and recurrent abdominal pain in female adolescents. Endocrine Development, 7, 213–224.

    Article  PubMed  Google Scholar 

  • Campo, J. V., Jansen-McWilliams, L., Comer, D. M., & Kelleher, K. J. (1999). Somatization in pediatric primary care: Association with psychopathology, functional impairment, and use of services. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1093–1101.

    Article  PubMed  CAS  Google Scholar 

  • Champion, J. D., Piper, J. M., Holden, A. E., Shain, R. N., Perdue, S., & Korte, J. E. (2005). Relationship of abuse and pelvic inflammatory disease risk behavior in minority adolescents. Journal of the American Academy of Nurse Practitioners, 17, 234–241.

    Article  PubMed  Google Scholar 

  • Chandler, B., Beegle, M., Elfrink, R. J., & Smith, W. J. (2002). To leave or not to leave? A retrospective review of appendectomy during diagnostic laparoscopy for chronic pelvic pain. Missouri Medicine, 99, 502–504.

    PubMed  Google Scholar 

  • Cheong, Y., & Stones, R. W. (2006). Chronic pelvic pain: Aetiology and therapy. Best Practice & Research. Clinical Obstetrics & Gynaecology, 20, 695–711.

    Article  Google Scholar 

  • Chung, M. K., Chung, R. P., & Gordon, D. (2005). Interstitial cystitis and endometriosis in patients with chronic pelvic pain: The “Evil Twins” syndrome. Journal of the Society of Laparoendoscopic Surgeons, 9, 25–29.

    PubMed  Google Scholar 

  • Collett, B. J., Berkley, K., & Task Force on Fact Sheets for the Global Year Against Pain ‘Pain in Women’ 2007/8. (2007). The IASP Global Year against pain in women. Pain, 132(Suppl 1), S1–S2.

    Article  PubMed  Google Scholar 

  • Craig, T. K., Cox, A. D., & Klein, K. (2002). Intergenerational transmission of somatization behaviour: A study of chronic somatizers and their children. Psychological Medicine, 32, 805–816.

    Article  PubMed  CAS  Google Scholar 

  • Economy, K. E., & Laufer, M. R. (1999). Pelvic pain. Adolescent Medicine, 10, 291–304.

    PubMed  CAS  Google Scholar 

  • Farley, M., & Keaney, J. C. (1997). Physical symptoms, somatization, and dissociation in women survivors of childhood sexual assault. Women & Health, 25, 33–45.

    Article  CAS  Google Scholar 

  • Fillingim, R. B. (2000). Sex, gender and pain: Women and men really are different. Current Review of Pain, 4, 24–30.

    PubMed  CAS  Google Scholar 

  • Fillingim, R. B., & Edwards, R. R. (2005). Is self-reported childhood abuse history associated with pain perception among healthy young women and men? The Clinical Journal of Pain, 21, 387–397.

    Article  PubMed  Google Scholar 

  • Fillingim, R. B., Wilkinson, C. S., & Powell, T. (1999). Self-reported abuse history and pain complaints among young adults. The Clinical Journal of Pain, 15, 85–91.

    Article  PubMed  CAS  Google Scholar 

  • Fritz, G. K., Fritsch, S., & Hagino, O. (1997). Somatoform disorders in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1329–1338.

    Article  PubMed  CAS  Google Scholar 

  • Fry, R. P., Beard, R. W., Crisp, A. H., & McGuigan, S. (1997). Sociopsychological factors in women with chronic pelvic pain with and without pelvic venous congestion. Journal of Psychosomatic Research, 42, 71–85.

    Article  PubMed  CAS  Google Scholar 

  • Goldstein-Ferber, S., & Granot, M. (2006). The association between somatization and perceived ability: Roles in dysmenorrhea among Israeli Arab adolescents. Psychosomatic Medicine, 68, 136–142.

    Article  PubMed  Google Scholar 

  • Greco, C. D. (2003). Management of adolescent chronic pelvic pain from endometriosis: A pain center perspective. Journal of Pediatric and Adolescent Gynecology, 16(3 Suppl), S17–S19.

    Article  PubMed  Google Scholar 

  • Greenspan, J. D., Craft, R. M., LeResche, L., Arendt-Nielsen, L., Berkley, K. J., Fillingim, R. B., Gold, M. S., Holdcroft, A., Lautenbacher, S., Mayer, E. A., Mogil, J. S., Murphy, A. Z., Traub, R. J., & Consensus Working Group of the Sex, Gender, and Pain SIG of the IASP. (2007). Studying sex and gender differences in pain and analgesia: A consensus report. Pain, 132(Suppl 1), S26–S45.

    Article  PubMed  Google Scholar 

  • Haggerty, C. L., Peipert, J. F., Weitzen, S., Hendrix, S. L., Holley, R. L., Nelson, D. B., Randall, H., Soper, D. E., Wiesenfeld, H. C., Ness, R. B., & PID Evaluation and Clinical Health (PEACH) Study Investigators. (2005). Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease. Sexually Transmitted Diseases, 32, 293–299.

    Article  PubMed  Google Scholar 

  • Hanno, P. M., Landis, J. R., Matthews-Cook, Y., Kusek, J., Nyberg, L., Jr., & The Interstitial Cystitis Database Study Group. (1999). The diagnosis of interstitial cystitis revisited: Lessons learned from the National Institutes of Health Interstitial Cystitis Database study. The Journal of Urology, 161, 553–557.

    Article  PubMed  CAS  Google Scholar 

  • Hastie, B. A., Riley, J. L., & Fillingim, R. B. (2005). Ethnic differences and responses to pain in healthy young adults. Pain Medicine, 6, 61–71.

    Article  PubMed  Google Scholar 

  • Haugaard, J. J. (2004). Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated: Somatization and other somatoform disorders. Child Maltreatment, 9, 169–176.

    Article  PubMed  Google Scholar 

  • Hediger, M. L., Hartnett, H. J., & Louis, G. M. (2005). Association of endometriosis and body size and figure. Fertility and Sterility, 84, 1366–1374.

    Article  PubMed  Google Scholar 

  • Hewitt, G. D., & Brown, R. T. (2000). Acute and chronic pelvic pain in female adolescents. The Medical Clinics of North America, 84, 1009–1025.

    Article  PubMed  CAS  Google Scholar 

  • Highfield, E. S., Laufer, M. R., Schnyer, R. N., Kerr, C. E., Thomas, P., & Wayne, P. M. (2006). Adolescent endometriosis-related pelvic pain treated with acupuncture: Two case reports. Journal of Alternative and Complementary Medicine, 12, 317–322.

    Article  Google Scholar 

  • Hornstein, M. D., Harlow, B. L., Thomas, P. P., & Check, J. L. (1995). Use of a new CA 125 assay in the diagnosis of endometriosis. Human Reproduction, 10, 932–934.

    PubMed  CAS  Google Scholar 

  • Igra, V. (1998). Pelvic inflammatory disease in adolescents. AIDS Patient Care and STDs, 12, 109–124.

    Article  PubMed  CAS  Google Scholar 

  • Kişlal, F. M., Kutluk, T., Çetin, F. C., Derman, O., & Kanbur, N. Ö. (2005). Psychiatric symptoms of adolescents with physical complaints admitted to an adolescence unit. Clinical Pediatrics, 44, 121–130.

    Article  PubMed  Google Scholar 

  • Leserman, J., Zolnoun, D., Meltzer-Brody, S., Lamvu, G., & Steege, G. F. (2006). Identification of diagnostic subtypes of chronic pelvic pain and how subtypes differ in health status and trauma history. American Journal of Obstetrics and Gynecology, 195, 554–561.

    Article  PubMed  Google Scholar 

  • Lieb, R., Zimmermann, P., Friis, R. H., Höfler, M., Tholen, S., & Wittchen, H.-U. (2002). The natural course of DSM-IV somatoform disorders and syndromes among adolescents and young adults: A prospective-longitudinal community study. European Psychiatry, 17, 321–331.

    Article  PubMed  Google Scholar 

  • Momoeda, M., Taketani, Y., Terakawa, N., Hoshiai, H., Tanaka, K., Tsutsumi, O., Osuga, Y., Maruyama, M., Harada, T., Obata, K., & Hayashi, K. (2002). Is endometriosis really associated with pain? Gynecologic and Obstetric Investigation, 54(Suppl 1), 18–23.

    Article  PubMed  Google Scholar 

  • Monsen, K., & Havik, O. E. (2001). Psychological functioning and bodily conditions in patients with pain disorder associated with psychological factors. British Journal of Medical Psychology, 74, 183–195.

    Article  CAS  Google Scholar 

  • Muris, P., & Meesters, C. (2004). Children’s somatization symptoms: Correlations with trait anxiety, anxiety sensitivity, and learning experiences. Psychological Reports, 94, 1269–1275.

    PubMed  Google Scholar 

  • Muris, P., Vlaeyen, J., & Meesters, C. (2001). The relationship between anxiety sensitivity and fear of pain in healthy adolescents. Behaviour Research and Therapy, 39, 1357–1368.

    Article  PubMed  CAS  Google Scholar 

  • Ness, R. B., Soper, D. E., Holley, R. L., Peipert, J., Randall, H., Sweet, R. L., Sondheimer, S. J., Hendrix, S. L., Amortegui, A., Trucco, G., Songer, T., Lave, J. R., Hillier, S. L., Bass, D. C., & Kelsey, S. F. (2002). Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: Results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) randomized trial. American Journal of Obstetrics and Gynecology, 186, 929–937.

    Article  PubMed  Google Scholar 

  • Newkirk, G. R. (1996). Pelvic inflammatory disease: A contemporary approach. American Family Physician, 53, 1127–1135.

    PubMed  CAS  Google Scholar 

  • Powell-Boone, T., Ness, T. J., Cannon, R., Lloyd, L. K., Weigent, D. A., & Fillingim, R. B. (2005). Menstrual cycle affects bladder pain sensation in subjects with interstitial cystitis. The Journal of Urology, 174, 1832–1836.

    Article  PubMed  Google Scholar 

  • Propst, A. M., & Laufer, M. R. (1999). Endometriosis in adolescents: Incidence, diagnosis and treatment. The Journal of Reproductive Medicine, 44, 751–758.

    PubMed  CAS  Google Scholar 

  • Rasquin, A., Di Lorenzo, C., Forbes, D., Guiraldes, E., Hyams, J. S., Staiano, A., & Walker, L. S. (2006). Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterology, 130, 1527–1537.

    Article  PubMed  Google Scholar 

  • Reed, B. D., Haefner, H. K., Punch, M. R., Roth, R. S., Gorenflo, D. W., & Gillespie, B. W. (2000). Psychosocial and sexual functioning in women with vulvodynia and chronic pelvic pain: A comparative evaluation. The Journal of Reproductive Medicine, 45, 624–632.

    PubMed  CAS  Google Scholar 

  • Rhee, H., Holditch-Davis, E., & Miles, M. S. (2005). Patterns of physical symptoms and relationships with psychosocial factors in adolescents. Psychosomatic Medicine, 67, 1006–1012.

    Article  PubMed  Google Scholar 

  • Rickert, V. I., & Kozlowski, K. J. (2000). Pelvic pain: A SAFE approach. Obstetrics and Gynecology Clinics of North America, 27, 181–193.

    Article  PubMed  CAS  Google Scholar 

  • Salmon, P., & Calderbank, S. (1996). The relationship of childhood physical and sexual abuse to adult illness behavior. Journal of Psychosomatic Research, 40, 329–336.

    Article  PubMed  CAS  Google Scholar 

  • Samelius, L., Wijma, B., Wingren, G., & Wijma, K. (2007). Somatization in abused women. Journal of Women’s Health, 16, 909–918.

    Article  PubMed  Google Scholar 

  • Sanfilippo, J. S., & Black, A. (2003). Adolescent pelvic pain. Best Practice & Research. Clinical Obstetrics & Gynaecology, 17, 93–101.

    Article  Google Scholar 

  • Scialli, A. R., Barbieri, R. L., Glasser, M. H., Olive, D. L., & Winkel, C. A. (2000). Chronic pelvic pain: An integrated approach. APGO educational series on women’s health issues. Washington DC: Association of Professors of Gynecology and Obstetrics.

    Google Scholar 

  • Seng, J. S., Graham-Bermann, S. A., Clark, M. K., McCarthy, A. M., & Ronis, D. L. (2005). Posttraumatic stress disorder and physical comorbidity among female children and adolescents: Results from service-use data. Pediatrics, 116, e767–e776.

    Article  PubMed  Google Scholar 

  • Silber, T. J., & Pao, M. (2003). Somatization disorders in children and adolescents. Pediatrics in Review, 24, 255–264.

    Article  PubMed  Google Scholar 

  • Society for Pudendal Neuralgia (SPuN). (2008). www.spuninfo.org. Last updated 5 May 2008.

  • Solnik, M. J. (2006). Chronic pelvic pain and endometriosis in adolescents. Current Opinion in Obstetrics & Gynecology, 18, 511–518.

    Article  Google Scholar 

  • Song, A. H., & Advincula, A. P. (2005). Adolescent chronic pelvic pain. Journal of Pediatric and Adolescent Gynecology, 18, 371–377.

    Article  PubMed  Google Scholar 

  • Startseva, N. V. (1980). Clinical immunological aspects of genital endometriosis [Russian]. Akusherstvo i Ginekologiia, 3, 23–26.

    PubMed  Google Scholar 

  • Stones, R. W., Selfe, S. A., Fransman, S., & Horn, S. A. (2000). Psychosocial and economic impact of chronic pelvic pain. Bailliere’s Best Practice & Research. Clinical Obstetrics & Gynaecology, 14, 415–431.

    Article  CAS  Google Scholar 

  • Taylor, D. C., Szatmari, P., Boyle, M. H., & Offord, D. R. (1996). Somatization and the vocabulary of everyday bodily experiences and concerns: A community study of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 491–499.

    Article  PubMed  CAS  Google Scholar 

  • Terre, L., & Ghiselli, W. (1997). A developmental perspective on family risk factors in somatization. Journal of Psychosomatic Research, 42, 197–208.

    Article  PubMed  CAS  Google Scholar 

  • Thomson, J. C., & Redwine, D. B. (2005). Chronic pelvic pain associated with autoimmunity and systemic and peritoneal inflammation and treatment with immune modification. The Journal of Reproductive Medicine, 50, 745–758.

    PubMed  Google Scholar 

  • Tu, F. F., As-Sanie, S., & Steege, J. F. (2006). Prevalence of pelvic musculoskeletal disorders in a female chronic pelvic pain clinic. The Journal of Reproductive Medicine, 51, 185–189.

    PubMed  Google Scholar 

  • Tu, F., Bettendorf, B., & Shay, S. (2007). Dysmenorrhea: Contemporary perspectives. Pain Clinical Updates, 15, 1–4.

    Google Scholar 

  • Venbrux, A. C., Chang, A. H., Kim, H. S., Montague, B. J., Hebert, J. B., Arepally, A., Rowe, P. C., Barron, D. F., Lambert, D., & Robinson, J. C. (2002). Pelvic congestion syndrome (pelvic venous incompetence): Impact of ovarian and internal iliac vein ­embolotherapy on menstrual cycle and chronic pelvic pain. Journal of Vascular and Interventional Radiology, 13, 171–178.

    Article  PubMed  Google Scholar 

  • Wadhwa, L., Sharma, J. B., Arora, R., Malhotra, M., & Sharma, S. (2004). Severity, affect, family and environment (SAFE) approach to evaluate chronic pelvic pain in adolescent girls. Indian Journal of Medical Sciences, 58, 275–282.

    PubMed  Google Scholar 

  • Waldinger, R. J., Schulz, M. S., Barsky, A. J., & Ahern, D. K. (2006). Mapping the road from childhood trauma to adult somatization: The role of attachment. Psychosomatic Medicine, 68, 129–135.

    Article  PubMed  Google Scholar 

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Wells, L. (2011). Chronic and Recurrent Pelvic Pain. In: McClain, B., Suresh, S. (eds) Handbook of Pediatric Chronic Pain. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0350-1_9

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