[Chronic pelvic pain in women].
BACKGROUND
This paper reviews empirical and clinical evidence of the aetiology and treatment of medically unexplained chronic pelvic pain in women.


METHODS
Clinical experience from an ongoing randomised treatment trial supplemented by computer-assisted reviews of studies obtained by a Premedline and Medline search (1996 to February 2002) and data from the Cochrane Database of Systematic Reviews and the EBM database of Abstracts of Reviews of Effectiveness.


RESULTS
The aetiology of medically unexplained chronic pelvic pain is disputed but likely to be multifactorial. A history of interpersonal difficulties and a stressful life is common, and comorbid psychiatric disorders occur frequently. No treatment of choice emerges from the few controlled treatment trials, though a flexible biopsychosocial approach seems the most promising.


CONCLUSIONS
Empathic medical evaluation and follow-up within a biopsychosocial framework is recommended. Analgesic, hormonal and, if appropriate, surgical treatment can relieve pain. Additional benefits may be obtained by adding sensory awareness-directed physiotherapy aimed at changing painful muscle tensions, body attitude, movement pattern and dysfunctional respiration pattern. Co-morbid psychiatric disorders should be diagnosed and treated. Cognitive-behavioural stress management intervention aimed at improving coping with pain and current life-situation may be indicated in a subsample of patients.
Kirste
Unni
U
Kvinneklinikken, Rikshospitalet Sognsvannsveien 20 0027 Oslo. unni.merete.kirste@rikshospitalet.no
Haugstad
Gro Killi
GK
Leganger
Siv
S
Blomhoff
Svein
S
Malt
Ulrik Fredrik
UF
D002908:Chronic Disease; D002986:Clinical Trials as Topic; D018849:Controlled Clinical Trials as Topic; D005260:Female; D006801:Humans; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy; D011602:Psychophysiologic Disorders / Q000150:complications; D016032:Randomized Controlled Trials as Topic; D013001:Somatoform Disorders / Q000175:diagnosis / Q000628:therapy; D013315:Stress, Psychological / Q000150:complications