Pelvic Pain

Chronic pelvic pain can be defined as nonmenstrual pelvic pain with or without pain in the abdomen, hip, thighs, buttocks and rectum that has persisted for 3 or more months. It may occur in the presence of known or suspected pathology, or in the absence of an appreciable underlying cause. This entity has been labeled with various terminologies, which has contributed to much confusion regarding its diagnosis and management. In addition, since a high percentage of patients with pelvic pain report a history of physical or sexual abuse (up to 50% in some studies), a tendency exists for pelvic pain to be dismissed as psychosomatic. There are specific syndromes which can result in chronic pain, such as endometriosis, endometritis, and pelvic inflammatory disease, as well as pelvic oncologic disease.

Treatment options for chronic pelvic pain includes pharmacologic options, such as neuropathic pain medications, NSAID's, and, with careful paitent selection, narcotics. Failure of oral agents may then lead to trials of neural blockade, as with a superior hypogastric plexus block, or Ganglion Impar block. Recently, more aggressive interventions, such as spinal cord stimulation at the sacral nerve roots, has met with some degree of success in select patients. Regardless of the modality chosen to treat pelvic pain, careful psychologic screening and support is indicated given the high prevalence of abuse noted in these patients.