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Pain Medicine

Chronic Pelvic Pain in WomenA Review

Educational Objective
To review the clinical management of patients with chronic pelvic pain.

1 Credit CME

JAMA

Published Online: June 15, 2021

Review

Article Information and Disclosures

Georgine Lamvu, MD, MPH^1,2;

Jorge Carrillo, MD^1,2;

Chensi Ouyang, MD^1,2;

et al

Andrea Rapkin, MD³

Author Affiliations

¹Division of Surgery, Gynecology Section, Veterans Affairs Medical Center, Orlando VA Healthcare System, Orlando, Florida
²Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando
³Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles

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Abstract

Importance Chronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world’s female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions.

Observations Chronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process.

Conclusions and Relevance Chronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.

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Article Information

Corresponding Author: Georgine Lamvu, MD, MPH, Orlando VA Healthcare System, 13800 Veteran’s Way, Ste 4C-906, Orlando, FL 32827 (georginelamvu@gmail.com).

Accepted for Publication: February 12, 2021.

Author Contributions: Dr Lamvu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Lamvu, Ouyang.

Drafting of the manuscript: Lamvu.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Lamvu, Ouyang, Rapkin.

Supervision: Lamvu, Carrillo.

Conflict of Interest Disclosures: Drs Lamvu and Carrillo reported serving as consultants for AbbVie and on the board of directors for the International Pelvic Pain Society. In addition, Dr Lamvu reported serving as consulting scientific officer for Uroshape LLC. Dr Ouyang reported being an employee of the federal government (Department of Veterans Affairs). Dr Rapkin reported serving as a member of the speaker’s bureau for AbbVie; serving as co-chair for the International Pelvic Pain Society patient education committee; and receiving personal fees from Bayer. No other disclosures were reported.

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