Evaluation of an office-based protocol for pelvic pain and function in female patients with chronic pelvic pain

Chronic Pelvic Pain (CPP) is challenging to treat, with many patients living in pain for up to 15 years before finding suitable treatment. Patients frequently report sexual dysfunction, emergency room visits, opioid use, and impaired ability to work and perform everyday functions. Altogether, CPP is associated with reduced quality of life, presenting a need for additional treatment options.

We performed a retrospective cohort study in 1517 CPP patients who displayed trigger points, pelvic floor hypertonia, and tenderness of the levator ani sling. Patients also demonstrated tenderness along the pudendal nerve and posterior femoral cutaneous nerve at Alcock's canal and obturator canal bilaterally. These patients underwent a minimally invasive, office-based protocol involving six ultrasound-guided percutaneous pelvic peripheral nerve blocks and trigger point injections. Patients with data from an initial consult and a visit approximately three months following initiation of treatment were included. Patients with missing data were excluded.

Patients demonstrated a 48.8% reduction in pain and significant improvement across all functional domains (P < 0.001). The proportion of patients reporting emergency room visits and opioid use decreased by 88.5% and 44.8%, respectively (P < 0.001). Sexual function improved by 16.7% (P < 0.001). Patients reported a 45.4% increase in 0 workdays missed from pain and a 93.2% increase in 0 hours of impaired productivity (P < 0.001).

This procedure is associated with significant improvements in pain and quality of life metrics. Further analysis of its long-term efficacy, especially compared to a control group, is suggested.