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Pelvic pain: A chronic visceral pain syndrome

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Abstract

Patients with chronic pelvic pain are usually evaluated and treated by gynecologists, gastroenterologists, urologists, and internists. In many patients with chronic pelvic pain the examination and work-up remain unrevealing and no specific cause of the pain can be identified. In these cases it is important to recognize that pain is not only a symptom of pelvic disease, but that the patient is suffering from a chronic pelvic pain syndrome. Once the diagnosis of chronic pelvic pain is made, treatment should be directed to symptomatic pain management. This article outlines treatment options currently available. Despite the challenge inherent in the management of chronic pelvic pain, many patients can be treated successfully using a multidisciplinary pain management approach. The first important step is to recognize that patients with chronic pelvic pain might suffer from a chronic visceral pain syndrome.

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References and Recommended Reading

  1. Wesselmann U: Guest Editorial: Pain—the neglected aspect of visceral disease. Eur J Pain 1999, 3:189–191. This editorial highlights the importance of recognizing and treating chronic visceral pain syndromes.

    Article  Google Scholar 

  2. Wesselmann U: Management of chronic pelvic pain. In Evaluation and Treatment of Chronic Pain, edn 3. Edited by Aronoff GM. Baltimore: Williams and Wilkins; 1998:269–279.

    Google Scholar 

  3. Merskey H, Bogduk N: Classification of Chronic Pain. Seattle: IASP Press; 1994.

    Google Scholar 

  4. Campbell F, Collett BJ: Chronic pelvic pain. Brit J Anaesth 1994, 73:571–573.

    Article  PubMed  CAS  Google Scholar 

  5. ACOG technical bulletin: Chronic pelvic pain, number 223—May 1996. Int J Gynecol Obstet 1996, 54:59–68. Recommendations of the American College of Obstetricians and Gynecologists for the treatment of chronic pelvic pain.

    Article  Google Scholar 

  6. Ryder RM: Chronic pelvic pain. Am Fam Physician 1996, 54:2225–2232.

    PubMed  CAS  Google Scholar 

  7. Mathias SD, Kuppermann M, Liberman RF, et al.: Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996, 87:321–327. This is the most extensive study to date in the United States determining the prevalence of chronic pelvic pain in women and examining its association with health-related quality of life, work productivity, and healthcare utilization.

    Article  PubMed  CAS  Google Scholar 

  8. Reiter RC: A profile of women with chronic pelvic pain. Clin Obstet Gynecol 1990, 33:130–136.

    Article  PubMed  CAS  Google Scholar 

  9. Howard FM: The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surv 1993, 48:357–387. This paper reviews the role of laparoscopy in the diagnosis and treatment of chronic pelvic pain.

    Article  PubMed  CAS  Google Scholar 

  10. Milburn A, Reiter RC, Rhomberg AT: Multidisciplinary approach to chronic pelvic pain. Obstet Gynecol Clin North Am 1993, 20:643–661. This article outlines the importance of a multidisciplinary approach to the treatment of chronic pelvic pain.

    PubMed  CAS  Google Scholar 

  11. Cervero F: Sensory innervation of the viscera: peripheral basis of visceral pain. Physiol Rev 1994, 74:95–138. Extensive review of visceral neurobiology as it relates to pain.

    PubMed  CAS  Google Scholar 

  12. Gebhart GF: Pathobiology of visceral pain: molecular mechanisms and therapeutic implications. IV. Visceral afferent contributions to the pathobiology of visceral pain. Am J Physiol Gastrointest Liver Physiol 2000, 278:G834-G838. This article highlights novel molecular mechanisms identified in visceral pain research and its implications for novel therapeutic avenues.

    PubMed  CAS  Google Scholar 

  13. Moore J, Barlow D, Jewell D, Kennedy S: Do gastrointestinal symptoms vary with the menstrual cycle? Br J Obstet Gynaecol 1998, 105:1322–1325.

    PubMed  CAS  Google Scholar 

  14. Fitzpatrick CC, Delancey JOL, Elkins TE, McGuire EJ: Vulvar vestibulitis and interstitial cystitis: a disorder of urogenital sinus-derived epithelium? Obstet Gynecol 1993, 81:860–862.

    PubMed  CAS  Google Scholar 

  15. Fry RPW, Crisp AH, Beard RW: Sociopsychological factors in chronic pelvic pain: a review. J Psychosom Res 1997, 42:1–15.

    Article  PubMed  CAS  Google Scholar 

  16. Grace VM: Mind/body dualism in medicine: the case of chronic pelvic pain without organic pathology. Int J Health Serv 1998, 28:127–151.

    Article  PubMed  CAS  Google Scholar 

  17. Wesselmann U, Burnett AL, Heinberg LJ: The urogenital and rectal pain syndromes. Pain 1997, 73:269–294.

    Article  PubMed  CAS  Google Scholar 

  18. Parsons LH, Stovall TG: Surgical management of chronic pelvic pain. Obstet Gynecol Clin North Am 1993, 20:765–778.

    PubMed  CAS  Google Scholar 

  19. Galer BS: Neuropathic pain of peripheral origin: advances in pharmacologic treatment. Neurology 1995, 45:S17-S25. This review article summarizes pharmacologic treatment strategies for chronic neuropathic pain. Many of these treatment approaches can also be applied to chronic pelvic pain, as outlined previously.

    PubMed  CAS  Google Scholar 

  20. Beresin E: Imipramine in the treatment of chronic pelvic pain. Psychosomatics 1986, 27:294–296.

    PubMed  CAS  Google Scholar 

  21. Walker EA, Roy-Byrne PR, Katon WJ, Jemelka R: An open trial of nortriptyline in women with chronic pelvic pain. Int J Psychiatry Med 1991, 21:245–252.

    Article  PubMed  CAS  Google Scholar 

  22. Plancarte R, de Leon-Casasola OA, El-Helaly M, et al.: Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth 1997, 22:562–568.

    PubMed  CAS  Google Scholar 

  23. Wesselmann U, Raja SN: Reflex sympathetic dystrophy/causalgia. Anesth Clin North Am 1997, 15:407–427.

    Article  Google Scholar 

  24. McDonald JS: Management of chronic pelvic pain. Obstet Gynecol Clin North Am 1993, 20:817–838.

    PubMed  CAS  Google Scholar 

  25. Wechsler RJ, Maurer PM, Halpern EJ, Frank ED: Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis. CT techniques and results. Radiology 1995, 196:103–106. This study describes experiences with the superior hypogastric plexus block for the treatment of chronic pelvic pain.

    CAS  Google Scholar 

  26. Slocumb JC: Neurological factors in chronic pelvic pain: trigger points and the abdominal pelvic pain syndrome. Am J Obstet Gynecol 1984, 149:536–543.

    PubMed  CAS  Google Scholar 

  27. Kames LD, Rapkin AJ, Naliboff BD, et al.: Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain. Pain 1990, 41:41–46.

    Article  PubMed  CAS  Google Scholar 

  28. Beard RW, Highman JW, Pearce S, Reginald PW: Diagnosis of pelvic varicosities in women with chronic pelvic pain. Lancet 1984, 2:946–949.

    Article  PubMed  CAS  Google Scholar 

  29. Sichlau MJ, Yao JST, Vogelzang RL: Transcatheter embolotherapy for the treatment of pelvic congestion syndrome. Obstet Gynecol 1994, 83:892–896.

    PubMed  CAS  Google Scholar 

  30. Capasso P, Simons C, Trotteur G, et al.: Treatment of symptomatic pelvic varices by ovarian vein embolization. Cardiovasc Intervent Radiol 1997, 20:107–111. This study highlights the technique of ovarian vein embolization for the treatment of chronic pelvic pain in selected patients.

    Article  PubMed  CAS  Google Scholar 

  31. Steege JF: Superior hypogastric block during microlaparascopic pain mapping. J Am Assoc Gynecol Lap 1998, 5:265–267.

    Article  CAS  Google Scholar 

  32. Robert R, Brunet C, Faure A, et al.: Surgery of the pudendal nerve in various types of perineal pain: course & results [in French]. Chirurgie 1993, 119:535–539.

    PubMed  Google Scholar 

  33. Hirshberg RM, Al-Chaer ED, Lawand NB, et al.: Is there a pathway in the posterior funiculus that signals visceral pain? Pain 1996, 67:291–305. This article discusses initial clinical studies using dorsal column lesions for the treatment of chronic pelvic pain due to cancer.

    Article  PubMed  CAS  Google Scholar 

  34. Gybels JM: Commissural myelotomy revisited. Pain 1997, 70:1–2.

    Article  PubMed  CAS  Google Scholar 

  35. Rosenthal RH: Psychology of chronic pelvic pain. Obstet Gynecol Clin North Am 1993, 20:627–642.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Johns Hopkins University School of Medicine, Traylor Building 604, 720 Rutland Avenue, 21205, Baltimore, MD, USA

    Ursula Wesselmann MD

  2. Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Traylor Building 604, 720 Rutland Avenue, 21205, Baltimore, MD, USA

    Peter P. Czakanski MD

Authors
  1. Ursula Wesselmann MD
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  2. Peter P. Czakanski MD
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Wesselmann, U., Czakanski, P.P. Pelvic pain: A chronic visceral pain syndrome. Current Science Inc 5, 13–19 (2001). https://doi.org/10.1007/s11916-001-0005-2

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  • DOI: https://doi.org/10.1007/s11916-001-0005-2

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