Take Home Points
1. Chronic pelvic pain
is a difficult problem to manage, and the longer the duration of the problem the
longer it takes to deal with it.
irritable bowel syndrome and interstitial cystitis are the three most common
causes of chronic pelvic pain, either separately or in combinations. This explains the need for combined efforts of a multidisciplinary team to deal
with these problems.
3. A psychological
element is usually involved either as a cause or an effect, and should be
addressed accordingly to help with the patientsí recovery. Patients concerns
regarding fertility issues and the possibility of cancer should be addressed
professionally and not just brushed a side. Thorough explanations are needed,
as most of these patients usually had some unqualified statements from other
source, mainly the Internet.
4. Adult onset
progressive dysmenorrhoea and deep dyspareunia are more likely to have a pelvic
pathological origin. However, teenage girls with chronic pelvic pain should not
be neglected, as they are not immune against endometriosis.
5. Doctors should set
attainable outcome targets with their patients. Pain control and improved
quality of life may be more realistic than complete cure.
6. Objective criteria
should be used for patientsí assessment and for auditing outcome of treatment.
This should include pain calendars and pain questionnaire with an objective
pain scoring system.
7. Specific criteria
should be set for using invasive investigations especially diagnostic
8. As many patients
with endometriosis have no chronic pelvic pain, the mere presence of
endometriosis does not prove causation of symptoms.
9. 33-85% of patients
with chronic pelvic pain may have interstitial cystitis, which should not be
neglected as a diagnostic entity in the gynaecology clinic.
bowel syndrome symptoms have been reported in almost 80% of women with chronic
pelvic pain. This is most probably a falsely high figure, as diagnostic laparoscopy
can offer a different diagnosis in some of these cases especially bowel
involvement with endometriosis.
of patients with chronic pelvic pain were reported to have had physical or
sexual abuse at one time or another during their lives.
and myofascial causes of pelvic pain should not be neglected, and the services
of a trained physiotherapist are most important in dealing with them.
intervention, when indicated, is very important to prevent the development of the
chronic pelvic pain syndrome.
pain may complicate other known pathological entities and can interfere
with treatment outcome if not specifically addressed.
use of antidepressants, neuroleptics and local anaesthetic injections, when
necessary, should replace the use of the non-effective NSAIDs for the treatment
of chronic pelvic pain syndrome.
should be avoided as much as possible to avoid the possibility of addiction, but
drugs with low dependence tendency like tramadol can be used.
with all other types of medication, the risk and benefit of all drugs should be
weighed in each individual case.
of causes or treatment outcome, a good line of communication should be kept
with the patient, her family and general practitioner.