Chronic pelvic pain: an integrated approach to diagnosis and treatment.
Chronic pelvic pain affects upward of 15% of women and is a frustrating condition for both patients and physicians. Chronic pelvic pain is not a disease, but a syndrome that results from a complex interaction between neurologic, musculoskeletal, and endocrine systems that is further influenced by behavioral and psychologic factors. Traditional approaches to this disorder have been surgical, although long-term success rates have been disappointing. Placebo response to surgery is common, and many conditions that contribute to the pain cannot be identified or treated with a surgical approach. Many patients will require a combination of both pharmacologic and nonpharmacologic treatments in addition to various types of invasive procedures. It is now recognized that many disorders contribute to the chronic pelvic pain symptom complex; thus, an integrated multidisciplinary approach to diagnosis and treatment is essential to achieve the greatest success.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader will be able to describe the pathophysiology of chronic pelvic pain, to outline the evaluation of a patient with chronic pelvic pain, and to explain the treatment options for patients with chronic pelvic pain.
Gunter
Jennifer
J
Department of Obstetrics and Gynecology, The University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, Colorado 80262, USA. jennifer.gunter@uchsc.edu
D000700:Analgesics / Q000008:administration & dosage; D002908:Chronic Disease; D005260:Female; D006801:Humans; D010535:Laparoscopy; D017699:Pelvic Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000503:physiopathology
D000700:Analgesics