The Management of Chronic Pelvic Pain

ABSTRACT

Chronic pelvic pain (CPP) is defined as lower abdominal pain lasting for at least 6 months. There are two forms of CPP: cyclic or continuous. The usual cyclic pain is dysmenorrhea. Dysmenorrhea is classified into primary and secondary. The primary dysmenorrhea is painful menstruation without any other pelvic disease. It can be treated by fat-free or omega-3-rich diet, quitting of smoking, nonsteroidal antiinflammatory drugs (NSAIDs), oral contraceptive pills, and long-acting injectable progestins. The most common origin of secondary dysmenorrhea and CPP is endometriosis. The management of pain of endometriosis can be controlled with stepby-step management of the original lesion by medical and surgical treatment, postoperative medical treatment, trigger point injection, NSAIDs, and immune therapy. Other etiologies of CPP are adenomyosis, pelvic congestion syndrome, abnormalities of uterus and ovary, psychological problems, gastrointestinal diseases (e.g. irritable bowel syndrome), urinary diseases (e.g. interstitial cystitis or chronic urethral syndrome), and musculoskeletal diseases. They can be treated by the management of the underlying diseases. The special form of CPP is chronic myofacial syndrome of the abdominal wall, which can be treated by trigger point injection. The other supportive treatments for CPP are laparoscopic adhesiolysis, uterine suspension, laparoscopic uterosacral nerve ablation (LUNA), presacral neurectomy, and hysterectomy. The treatment of CPP is very difficult. Therefore the exact diagnosis of its origin is necessary, and the combination treatment in various aspects is needed.