Pain and Irritative Syndromes Therapy

Gamal M.Ghoniem

More than 9 million women have pelvic pain, and their management entails more than $2.8 billion in direct and greater than $555 million in indirect costs.1 The prevalence of chronic pelvic pain (CPP) in women is approximately 3.8%. Chronic pelvic pain is a symptom, not a disease, and it rarely reflects a single pathologic process.Various pelvic floor structures and disorders may be the cause of CPP.The origin of pain may be urologic,genital,gastrointestinal,mus-culoskeletal, or psychological. Therefore, systemic evaluation, and different and combined therapies are required for patients with CPP.Therapies include invasive and noninvasive modalities. Noninvasive therapies include behavioral therapy, nutrition, physical therapy, and acupunc-ture.Dietary modification might help,because certain types of food,such as acidic foods,caffeine, and alcohol are common triggers for interstitial cystitis and irritable bowel syndrome. Pain in the patients with these diseases might respond to an appropriate change in diet. Pharmacologic therapies include nonsteroidal antiinflammatory analgesics and opioids, or both. Patients using pain medication should be assessed and evaluated for side effects, response, and development of tolerance or addiction. Polymedication is not uncommon in pelvic pain therapy. Pharmacotherapy of pelvic pain may include tricyclic antidepressants, anticonvulsants, and antihistamines, particularly when it is associated with a neuropathic condition or interstitial cystitis. Invasive therapies include nerve blocks, neurostimulation, and surgical procedures.

Reference

1. Mathias SD,Kuppermann M,Liberman RF, Lipschutz RC,Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996;87:321-327.

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