Chronic pelvic pain: aetiology and therapy

Area of Science:

• Gynecology
• Pain Management
• Evidence-Based Medicine

Background:

• Chronic pelvic pain (CPP) is a prevalent condition affecting women's quality of life, with consultation rates comparable to asthma and migraine.
• A significant number of women with CPP remain undiagnosed or uninvestigated, highlighting challenges in community and tertiary care settings.
• Commonly associated conditions include irritable bowel syndrome in the community and endometriosis or adhesions in tertiary settings.

Purpose of the Study:

• To review current evidence on the etiology and management of chronic pelvic pain (CPP) in women.
• To focus on findings from randomized controlled trials (RCTs) to inform clinical practice.
• To identify effective interventions and areas requiring further research for CPP.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) related to chronic pelvic pain (CPP).
• Analysis of data from population-based and hospital setting studies.
• Evaluation of evidence for specific diagnostic and therapeutic interventions.

Main Results:

• Ultrasound scanning shows promise as an aid for counseling and reassurance in CPP management.
• Hormonal treatments like progestogen (medroxyprogesterone acetate) or goserelin may benefit pelvic congestion.
• A multidisciplinary approach is supported, while adhesiolysis is only beneficial for extensive adhesions. Presacral neurectomy (PSN) shows long-term benefits over laparoscopic utero-sacral nerve ablation (LUNA).

Conclusions:

• Current evidence supports specific interventions for CPP, including ultrasound, hormonal therapy, and multidisciplinary care.
• Adhesiolysis and presacral neurectomy (PSN) have specific indications and varying long-term efficacy.
• Selective serotonin reuptake inhibitor (SSRI) antidepressants have not demonstrated efficacy for CPP, and further replication studies are needed for existing findings.