A comprehensive treatment algorithm for chronic pelvic pain patients: A perspective review and future guidelines

Chronic pelvic pain is one of the most prevalent syndromes in family medicine, gynecology, and urology. Chronic pelvic pain patients are often misdiagnosed and have unnecessary prolonged suffering. Both misdiagnosis and delay in treatment negatively impact the health and well-being of chronic pelvic pain patients while additionally creating an economic burden on healthcare systems. This review aims to combine current treatment guidelines for managing chronic pelvic pain into a comprehensive algorithm for healthcare providers, with a focus on early diagnosis and treatment. The algorithm encompasses pathophysiology, assessment, organ system dysfunction management, overlapping pain syndromes, integrative management, pharmacological management, non-operative multidisciplinary care, and surgical interventions for chronic pelvic pain. A review of medical literature using the keyword "Chronic Pelvic Pain" between January 1, 1988 and December 31, 2023, was conducted using the PubMed database. Four hundred three articles from the PubMed database were eligible for detailed review. Each publication was evaluated utilizing a grading system adapted from the framework established by the Oxford Centre for Evidence-Based Medicine. For guideline development, a panel of experts specializing in pelvic pain determined how physicians can best optimize the diagnosis and treatment of chronic pelvic pain by integrating current treatment guidelines, best practice recommendations, and available data. The recommendations advocate for a multimodal approach to chronic pelvic pain treatment, emphasizing the importance of early disease recognition, coordinated care, and treatment protocols similar to those commonly employed for well-defined medical conditions such as asthma and diabetes.^1-5 This article introduces a comprehensive treatment algorithm designed to address the existing gaps in the management of patients suffering from chronic pelvic pain, as well as decrease the economic burden on the healthcare system that chronic pelvic pain currently places. The algorithm promotes a comprehensive multimodal approach to prevent the prolonged suffering that chronic pelvic pain patients currently must endure.