title: Pharmacological treatment and regional anesthesia techniques for pain management after completion of both conservative and surgical treatment of endometriosis and pelvic adhesions in women with chronic pelvic pain as a mandated treatment strategy.
abstract: BACKGROUND
  Chronic pelvic pain syndrome occurs in 4-14% of women. Pain pathomechanism in this syndrome is complex, as it is common to observe the features of nociceptive, inflammatory, neuropathic and psychogenic pain. The common findings in women with pelvic pain are endometriosis and pelvic adhesions.
  
  
  OBJECTIVE
  Aim of the study was to test the effectiveness of pharmacological treatment and regional anesthesia techniques for pain control as the next step of treatment after the lack of clinical results of surgical and pharmacological methods normally used in the management of endometriosis and pelvic adhesions.
  
  
  METHODS
  18 women were treated between January 2010 - October 2013 in the Pain Clinic of the Department of Anaesthesiology and Intensive Care at the Centre for Postgraduate Education in Warsaw due to chronic pelvic pain syndrome related to either endometriosis or pelvic adhesions. During the previous step of management, both conservative and surgical treatments were completed without achieving satisfactory results. Initial constant pain severity was 3-9 points on the Numeric Rating Scale, while the reported paroxysmal pain level was 7-10. The pharmacological treatment implemented was based on oral gabapentinoids and antidepressants, aided by neurolytic block of ganglion of Walther, pudendal nerve blocks and topical treatment (5% lidocaine, 10% amitriptyline, 10% gabapentin).
  
  
  RESULTS
  In 17 women, a significant reduction of both constant and paroxysmal pain was achieved, of which complete and permanent cessation of pain occurred in 6 cases. One patient experienced no improvement in the severity of her symptoms.
  
  
  CONCLUSIONS
  The combination of pain management with pharmacological treatment, pudendal nerve blocks, neurolysis of ganglion impar (Walther) and topical preparations in cases of chronic pelvic pain syndrome seems to be adequate medical conduct after failed or otherwise ineffective causative therapy.
authors.affiliation: Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Malec-Milewska
authors.affiliation: Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Horosz
authors.affiliation: Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sękowska
authors.affiliation: Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Kolęda
authors.affiliation: Pain Clinic, Department of Anaesthesiology and Intensive Care, Medical Centre for Postgraduate Education, Warsaw, Poland; Department of Continuous Education in Anaesthesiology and Intensive Care, Medical University, Warsaw, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Kosson
authors.affiliation: 1 st Department of Obstetrics and Gynaecology, Medical Centre for Postgraduate Education, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Jakiel
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001340:Autonomic Nerve Block / Q000295:instrumentation; D059350:Chronic Pain / Q000188:drug therapy / Q000628:therapy*; D004715:Endometriosis / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D059408:Pain Management / Q000295:instrumentation / Q000379:methods*; D017699:Pelvic Pain / Q000188:drug therapy / Q000628:therapy*; D010388:Pelvis / Q000601:surgery; D011044:Poland; D000267:Tissue Adhesions / Q000601:surgery / Q000628:therapy; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000928:Antidepressive Agents