Chronic Pelvic Pain Syndrome among women - challenge in diagnostics and management. Current literature review
DOI:
https://doi.org/10.12775/JEHS.2024.55.011Keywords
Chronic Pelvic Pain Syndrome, Chronic pain, gynecology, therapeutic interventionsAbstract
Introduction and purpose:
Chronic Pelvic Pain Syndrome (CPPS) is characterized as intermittent or constant pain located in the lower abdomen or pelvis, persisting continuously for at least 6 months [1]. Reports on the prevalence of chronic pelvic pain indicate the occurrence of this condition at a level of 5.7–26.6% in women of reproductive age. However, only a third of women suffering from chronic pelvic pain, seek medical care [2].
Clinical picture of CPPS consists of various patterns and symptoms, often as the intersection of the multiple systems, which additionally complicates and delays the diagnostic process.
The aim of this review is to summarize existing literature about the diagnostics and management of Chronic Pelvic Pain Syndrome among women and create an awareness about the challenges which this condition poses for healthcare professionals.
A brief description of the state of knowledge:
Chronic Pelvic Pain Syndrome is a multifaceted condition and the pathophysiology of it has not yet been comprehensively studied. Clinical picture often involves dysfunctions in pelvic floor, urinary tract, or gastrointestinal system. Treatment involves a multidisciplinary approach including non-pharmacological and pharmacological interventions.
Summary (conclusions):
Chronic Pelvic Pain is a complex condition involving symptoms affecting the psychological, gastrointestinal, musculoskeletal systems. The most successful treatment approach emphasizes the role of collaboration among a diverse team of specialists such as gynecologists, gastroenterologists, psychiatrists, psychologists, and physiotherapists. More research focused on multimodal strategies in management of the CPP is needed to match patients most effectively with the most suitable combination of treatment and reduce the systemic consequences of chronic pain.
References
Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. A classification of chronic pain for ICD-11. Pain. 2015 Jun;156(6):1003–7.
Dydyk AM, Gupta N. Chronic Pelvic Pain. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 1, 2023.
Siqueira-Campos VM, de Deus MSC, Poli-Neto OB, Rosa-E-Silva JC, de Deus JM, Conde DM. Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside. Int J Womens Health. 2022;14:225–44.
Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. 2006 Apr 1;332(7544):749–55.
Nicolson K, Gillespie G. Chronic pelvic pain in women. InnovAiT. 2022;15(4):209-216. doi:10.1177/17557380211073165
Hooten WM. Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment. Mayo Clin Proc. 2016 Jul 1;91(7):955–70.
Bryant C, Cockburn R, Plante AF, Chia A. The psychological profile of women presenting to a multidisciplinary clinic for chronic pelvic pain: high levels of psychological dysfunction and implications for practice. J Pain Res. 2016;9:1049–56.
Rabinowitz EP, Sayer MA, Delahanty DL. The role of catastrophizing in chronic cyclical pelvic pain: A systematic review and meta-analysis. Womens Health. 2023 Sep 27;19:17455057231199949.
van Lankveld JJDM, Granot M, Weijmar Schultz WCM, Binik YM, Wesselmann U, Pukall CF, et al. Women’s sexual pain disorders. J Sex Med. 2010 Jan;7(1 Pt 2):615–31.
Heddini U, Bohm‐Starke N, Nilsson KW, Johannesson U. Provoked Vestibulodynia—Medical Factors and Comorbidity Associated with Treatment Outcome. J Sex Med. 2012 May 1;9(5):1400–6.
Cheong Y, William Stones R. Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol. 2006 Oct 1;20(5):695–711.
Grinberg K, Sela Y, Nissanholtz-Gannot R. New Insights about Chronic Pelvic Pain Syndrome (CPPS). Int J Environ Res Public Health. 2020 May;17(9):3005.
Till SR, As-Sanie S, Schrepf A. Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clin Obstet Gynecol. 2019 Mar;62(1):22–36.
Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic Pelvic Pain in Women: A Review. JAMA. 2021 Jun 15;325(23):2381–91.
Ghanavatian S, Leslie SW, Derian A. Pudendal Nerve Block. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 4, 2023.
Caruso S, Cianci A, Iraci M, Fava V, Di Pasqua S, Cianci S. Does Nomegestrol Acetate Plus 17β-Estradiol Oral Contraceptive Improve Endometriosis-Associated Chronic Pelvic Pain in Women? J Womens Health. 2020 Sep 1;29(9):1184–91.
El Taha L, Abu Musa A, Khalifeh D, Khalil A, Abbasi S, Nassif J. Efficacy of dienogest vs combined oral contraceptive on pain associated with endometriosis: Randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2021 Dec;267:205–12.
Cheong YC, Smotra G, Williams AC de C. Non-surgical interventions for the management of chronic pelvic pain. Cochrane Database Syst Rev. 2014 Mar 5;(3):CD008797.
Gallagher JS, Missmer SA, Hornstein MD, Laufer MR, Gordon CM, DiVasta AD. Long-Term Effects of Gonadotropin-Releasing Hormone Agonists and Add-Back in Adolescent Endometriosis. J Pediatr Adolesc Gynecol. 2018 Aug;31(4):376–81.
Cross AL, Viswanath O, Sherman AL. Pregabalin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 14, 2022.
Fan XM, Ren YF, Fu X, Wu H, Ye X, Jiang YF, et al. Gabapentin has Longer-Term Efficacy for the Treatment of Chronic Pelvic Pain in Women: A Systematic Review and Pilot Meta-analysis. Pain Ther. 2021 Dec;10(2):1673–89.
Caruso R, Ostuzzi G, Turrini G, Ballette F, Recla E, Dall’Olio R, et al. Beyond pain: can antidepressants improve depressive symptoms and quality of life in patients with neuropathic pain? A systematic review and meta-analysis. Pain. 2019 Oct;160(10):2186–98.
Lunn MPT, Hughes RAC, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD007115. DOI: 10.1002/14651858.CD007115.
Siemaszko ER, Jakubów P, Kobylec M, Kondracka J. Chronic pelvic pain in women – what do we know about the effectiveness of the treatment? Ból 2022 231 26-36.
FitzGerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, et al. Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for the Treatment of Urological Chronic Pelvic Pain Syndromes. J Urol. 2009 Aug;182(2):570–80.
Urits I, Callan J, Moore WC, Fuller MC, Renschler JS, Fisher P, et al. Cognitive behavioral therapy for the treatment of chronic pelvic pain. Best Pract Res Clin Anaesthesiol. 2020 Sep 1;34(3):409–26.
Kang SB, Chung HH, Lee HP, Lee JY, Chang YS. Impact of diagnostic laparoscopy on the management of chronic pelvic pain. Surg Endosc. 2007;21(6):916-919. doi:10.1007/s00464-006-9047-1
Lamvu G. Role of hysterectomy in the treatment of chronic pelvic pain. Obstet Gynecol. 2011;117(5):1175-1178. doi:10.1097/AOG.0b013e31821646e1
Hansrani V, Abbas A, Bhandari S, Caress AL, Seif M, McCollum CN. Trans-venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2015;185:156-163. doi:10.1016/j.ejogrb.2014.12.011
Lamvu G. Role of hysterectomy in the treatment of chronic pelvic pain. Obstet Gynecol. 2011;117(5):1175-1178. doi:10.1097/AOG.0b013e31821646e1
Oh-Oka H. Clinical Efficacy of 1-Year Intensive Systematic Dietary Manipulation as Complementary and Alternative Medicine Therapies on Female Patients With Interstitial Cystitis/Bladder Pain Syndrome. Urology. 2017;106:50-54. doi:10.1016/j.urology.2017.02.053
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Copyright (c) 2024 Zuzanna Zielińska, Karolina Nowak, Zuzanna Olejarz, Zuzanna Drygała, Julia Wyrwał, Magdalena Słowik, Karolina Nowak, Maria Nieć, Katarzyna Gierlach , Martyna Krasuska
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