Below the belt: approach to chronic pelvic pain.
OBJECTIVE
To present a practical approach to the symptom complex called chronic pelvic pain (CPP). Chronic pelvic pain is defined as nonmenstrual pain lasting 6 months or more that is severe enough to cause functional disability or require medical or surgical treatment.


METHODS
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from January 1996 to December 2004.


RESULTS
While the source of pain in CPP can be gynecologic, urologic, gastrointestinal, musculoskeletal, or psychoneurologic, 4 conditions account for most CPP: endometriosis, adhesions, interstitial cystitis, and irritable bowel syndrome. More than one source of pain can be found in the same patient. Management involves treating the underlying condition, the pain itself, or both. Nonnarcotic analgesics are first-line therapy for pain relief; hormonal therapies are beneficial if the pain has a cyclical component. A multidisciplinary approach addressing environmental factors and incorporating medical management with physiotherapy, psychotherapy, and dietary modifications works best.


CONCLUSIONS
Although caring for patients with CPP can be challenging and frustrating, family physicians are in an ideal position to manage and coordinate their care.
Bordman
Risa
R
Benign Uterine Conditions Project, Centre for Effective Practice, Department of Family and Community Medicine, University of Toronto, Ontario, Canada. rbordman@rogers.com
Jackson
Bethany
B
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D002908:Chronic Disease; D018856:Cystitis, Interstitial / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D017699:Pelvic Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D010808:Physical Examination