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Chronic Pelvic Pain

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Female Pelvic Medicine and Reconstructive Pelvic Surgery

Abstract

Chronic pelvic pain (CPP) is defined as a general symptom of persistent pain located in the pelvis of at least 6 months’ duration [1]. CPP is considered a confusing entity because the pain is often unrelated to underlying gynecological pathology. Some patients with severe pathology may report little pain while others with mild to moderate tissue deformation may experience severe pain [2,3]. According to several studies of laparoscopy performed for CPP, approximately one-third of patients have endometriosis, one-third have adhesions, and one-third have unclear pathology [4–7]. Moreover, pain experienced by patients can range from the intermittent, such as with dysmenorrhea, to the kind that may be chronic and continuous [8]. Because of the lack of association to organic or physiologic change, CPP is often labeled as a functional somatic syndrome.

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References

  1. Steege JF. Scope of the problem. In: Steege JF, Metzger DA, Levy BS, editors. Chronic Pelvic Pain: An Integrated Approach. Philadelphia: WB Saunders, 1998;1–4.

    Google Scholar 

  2. Guzinski GM. Advances in the diagnosis and treatment of chronic pelvic pain. Adv Psychosom Med 1985;12:124–35.

    PubMed  CAS  Google Scholar 

  3. Rapkin AJ. Adhesions and pelvic pain: A retrospective study. Obstet Gynecol 1986;68:13–15.

    PubMed  CAS  Google Scholar 

  4. Kresch AJ, Seifer DB, Sachs LB, Barrese I. Laparoscopy in 100 women with chronic pelvic pain. Obstet Gynecol 1984;64:672–4.

    PubMed  CAS  Google Scholar 

  5. Lindberg WI, Wall JE, Mathers JE. Laparoscopy in the evaluation of pelvic pain. Obstet Gynecol 1973;42:872–6.

    Google Scholar 

  6. Liston WA, Bradford WP, Downie J. Laparoscopy in a general gynecology unit. Am J Obstet Gynecol 1972;113:672–7.

    PubMed  CAS  Google Scholar 

  7. Renaer M. Chronic Pelvic Pain in Women. New York: Springer, 1981.

    Google Scholar 

  8. Kames LD, Rapkin AJ, Naliboff BD, Afifi A, Ferrer-Brechner T. Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain. Pain 1990;41:41–6.

    Article  PubMed  CAS  Google Scholar 

  9. Kirmayer LJ, Robbins JM. Functional somatic syndromes. In: Kirmayer LJ, Robbins JM, editors, Current Concepts of Somatization. Washington, DC: American Psychiatric Association Press, 1991.

    Google Scholar 

  10. Fabrega H Jr. Somatization in cultural and historical perspective. In: Kirmayer L, Robbins JM, editors, Current Concepts of Somatization. Washington, DC: American Psychiatric Association Press, 1991.

    Google Scholar 

  11. Toner BB. Cognitive-behavioral treatment of functional somatic syndromes: Integrating gender issues. Cognitive and Behavioral Practice 1994;1:157–78.

    Article  Google Scholar 

  12. Lips HM. Sex and Gender: An Introduction. Mountain View, CA: Mayfield, 1997.

    Google Scholar 

  13. Toner BB, Segal Z, Emmott S, Myran D. Cognitive-Behavioral Treatment of Irritable Bowel Syndrome: The Brain-Gut Connection. New York: Guilford Publications, 2000.

    Google Scholar 

  14. Steege JF, Metzger DA, Levy BS. Chronic Pelvic Pain: An Integrated Approach. Philadelphia: WB Saunders, 1998.

    Google Scholar 

  15. Steege JF. Basic philosophy of the integrated approach: Overcoming the mind-body split. In: Steege JF, Metzger DA, Levy BS, editors. Chronic Pelvic Pain: An Integrated Approach. Philadelphia: WB Saunders, 1998;5–12.

    Google Scholar 

  16. Toner BB. Challenging myths associated with IBS. 4 part series published in Participate, newsletter of the International Foundation of Functional Gastrointestinal Disorders, 1998–1999;7(4); 8(1); 8(2); 8(3).

    Google Scholar 

  17. 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;87:321–7.

    Article  PubMed  CAS  Google Scholar 

  18. Fry RPW, Crisp AH, Beard RW. Sociopsychological factors in chronic pelvic pain: A review. J Psychosom Res 1997;42(1):1–15.

    Article  PubMed  CAS  Google Scholar 

  19. Steege JF, Stout AL, Somkuti S. Chronic pelvic pain in women: Toward an integrative model. Obstet Gynecol Surv 1993;48:95–110.

    Article  PubMed  CAS  Google Scholar 

  20. Renaer M, Vertommen H, Nijs P, Wagemans L, van Hemelrijck T. Psychological aspects of chronic pelvic pain in women. Am J Obstet Gynecol 1979;134:75–80.

    PubMed  CAS  Google Scholar 

  21. Collett BJ, Cordle CJ, Stewart CR, Jagger C. A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners. Br J Obstet Gynaecol 1998;105:87–92.

    PubMed  CAS  Google Scholar 

  22. Gillibrand PN. The investigation of pelvic pain. In Chronic Pelvic Pain — A Gynaecological Headache. London: RCOG, 1981.

    Google Scholar 

  23. Reiter RC, Gambone JC. Demographic and historic variables in women with idiopathic chronic pelvic pain. Obstet Gynecol 1990;75:428–32.

    PubMed  CAS  Google Scholar 

  24. Walker EA, Katon WJ, Alfrey H, Bowers M, Stenchever MA. The prevalence of chronic pelvic pain and irritable bowel syndrome in two university clinics. J Psychosom Obstet Gynecol 1991;12:65–75.

    Google Scholar 

  25. Jamieson DJ, Steege JF. The association of sexual abuse with pelvic pain complaints in the primary care population. Am J Obstet Gynecol 1997;177(6):1408–12.

    Article  PubMed  CAS  Google Scholar 

  26. Hulka JF, Peterson JB, Phillips JM, Surrey MW. Operative laparoscopy: American Association of Gynecologic Laparoscopists 1991 membership survey. J Reprod Med 1993;38:569–71.

    PubMed  CAS  Google Scholar 

  27. National Center for Health Statistics, Graves, EJ. National hospital discharge survey: Annual summary, 1990. Vital Health Statistics. Series 13, No. 112. Washington, DC: Government Printing Office, 1992. (DHHS Publication No. (PHS) 92-1773).

    Google Scholar 

  28. Steege JF. Office assessment of chronic pelvic pain. Clin Obstet Gynecol 1997;40(3):554–63.

    Article  PubMed  CAS  Google Scholar 

  29. Melzack R. Neurophysiologic foundations of pain. In: Sternbach RA, editor. The Psychology of Pain. New York: Raven Press, 1986;1.

    Google Scholar 

  30. Savidge CJ, Slade P. Psychological aspects of chronic pelvic pain. J Psychosom Res 1997;42(5):433–44.

    Article  PubMed  CAS  Google Scholar 

  31. Magni C, Andreoli C, de Leo D, Martinotti G, Rossi C. Psychological profile of women with chronic pelvic pain. Arch Gynecol 1986;237:165–8.

    Article  PubMed  CAS  Google Scholar 

  32. Magni C, Salmi A, de Leo D, Ceola A. Chronic pelvic pain and depression. Psychopathology 1984;17:132–6.

    Article  PubMed  CAS  Google Scholar 

  33. Beard RW, Belsey EM, Lieberman BA, Wilkinson JC. Pelvic pain in women. Am J Obstet Gynecol 1977;128:566–570.

    PubMed  CAS  Google Scholar 

  34. Pearce S. A psychological investigation of chronic pelvic pain in women. Unpublished Doctoral Thesis, University of London, 1986.

    Google Scholar 

  35. Benson RC, Hanson KH, Matarazzo JD. A typical pelvic pain in women: Gynecologic-psychiatric considerations. Am J Obstet Gynecol 1959;77:806–25.

    PubMed  CAS  Google Scholar 

  36. Castelnuovo-Tedesco P, Krout BM. Psychosomatic aspects of chronic pelvic pain. Int J Psychiatry Med 1970;1:109–26.

    Article  CAS  Google Scholar 

  37. Gidro-Frank L, Gordon T, Taylor HC. Pelvic pain and female identity. Am J Obstet Gynecol 1960;79:1184–202.

    PubMed  CAS  Google Scholar 

  38. Grandi S, Fava GA, Trombini G, Orlandi C, Bernardi M, Gubbini G, Michelacci L. Depression and anxiety in patients with pelvic pain. Psychiatr Med 1988;6:1–7.

    PubMed  CAS  Google Scholar 

  39. Gross RJ, Doerr H, Caldirola D, Guzinski G, Ripley H. Borderline syndrome and incest in chronic pelvic pain patients. Int J Psychiatry Med 1981;10:79–96.

    Article  CAS  Google Scholar 

  40. Slocumb JC, Kellner R, Rosenfeld RC, Pathak D. Anxiety and depression in patients with the abdominal pelvic pain syndrome. Gen Hosp Psychiatry, 1989;11:48–53.

    Article  PubMed  CAS  Google Scholar 

  41. Walker EA, Katon W, Harrop-Griffiths J, Holm L, Russo J, Hickok L. Chronic pelvic pain: The relationship to psychiatric diagnoses and childhood sexual abuse. Am J Psychiatry, 1988;145:75–80.

    PubMed  CAS  Google Scholar 

  42. Duncan CH, Taylor HC. A psychosomatic study of pelvic congestion. Am J Obstet Gynecol 1952;64:1–12.

    PubMed  CAS  Google Scholar 

  43. Reiter RC, Shakerin LR, Gambone JC, Milburn AR. Correlation between sexual abuse and somatization in women with somatic and nonsomatic chronic pelvic pain. Am J Obstet Gynecol 1991;165:104–9.

    PubMed  CAS  Google Scholar 

  44. Rapkin AJ, Kames LD, Darke LL, Stampler FM, Naliboff BD. History of physical and sexual abuse in women with chronic pelvic pain. Obstet Gynecol 1990;76:92–6.

    PubMed  CAS  Google Scholar 

  45. Walker EA, Gelfand AN, Gelfand MD, Green C, Katon WJ. Chronic pelvic pain and gynecological symptoms in women with irritable bowel syndrome. J Psychosom Obstet Gynecol 1996;17:39–46.

    Article  CAS  Google Scholar 

  46. Longstreth GF. Irritable bowel syndrome and chronic pelvic pain. Obstet Gynecol Surv 1994;49(7):505–7.

    Article  PubMed  CAS  Google Scholar 

  47. Jensen MP, Karoly P. Control beliefs, coping efforts and adjustment to chronic pain. J Consult Clin Psychol 1991;59:431–8.

    Article  PubMed  CAS  Google Scholar 

  48. Nicholas MK. Self-efficacy and chronic pain. Paper presented at the annual conference of the British Psychological Society, 1989.

    Google Scholar 

  49. Longstreth GF, Preskill DB, Youkeles L. Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy. Dig Dis Sci 1990;35:1285–90.

    Article  PubMed  CAS  Google Scholar 

  50. Heitkemper MM, Jarrett M. Pattern of gastrointestinal and somatic symptoms across the menstrual cycle. Gastroenterology 1992;102:504.

    Google Scholar 

  51. Whitehead WE, Cheskin LJ, Heller BR et al. Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology 1990;98:1485.

    PubMed  CAS  Google Scholar 

  52. Longstreth GF, Wolde-Tsadik G. Irritable bowel-type symptoms in HMO examinees. Dig Dis Sci 1993;38:1581.

    Article  PubMed  CAS  Google Scholar 

  53. Harrop-Griffiths J, Katon W, Walker E, Holm L, Russo J, Hickok L. The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse. Obstet Gynecol 1988;71:589–93.

    PubMed  CAS  Google Scholar 

  54. Gambone JC, Reiter RC. Nonsurgical management of chronic pelvic pain. A multidisciplinary approach. Clin Obstet Gynecol 1990;33:205–11.

    Article  PubMed  CAS  Google Scholar 

  55. Peters AAW, van Dorst E, Jellis B, van Zuuren E, Hermans J, Trimbos JB. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstet Gynecol 1991;77:740–4.

    PubMed  CAS  Google Scholar 

  56. Flor H, Dydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: A meta-analytical flow. Pain 1992;49:221–39.

    Article  PubMed  CAS  Google Scholar 

  57. Reiter RC. Evidence-based management of chronic pelvic pain. Clin Obstet Gynecol 1998;41(2):422–35.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Women’s Mental Health Research Section, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Dr Brenda B. Toner (Professor and Head) & Dr Taryn N. Tang (Research Associate)

Authors
  1. Dr Brenda B. Toner
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  2. Dr Taryn N. Tang
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Editors and Affiliations

  1. Urogynecology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada

    H. P. Drutz BA, MD, FRC(C), FACOG, FSOGC

  2. Division of Urology, University of Toronto, Toronto, Ontario, Canada

    S. Herschorn BSc, MDCM, FRCSC

  3. Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto Hospital, Toronto, Ontario, Canada

    N. E. Diamant MD, FRCP(C)

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© 2003 Springer-Verlag London Limited

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Toner, B.B., Tang, T.N. (2003). Chronic Pelvic Pain. In: Drutz, H.P., Herschorn, S., Diamant, N.E. (eds) Female Pelvic Medicine and Reconstructive Pelvic Surgery. Springer, London. https://doi.org/10.1007/1-84628-238-1_22

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  • DOI: https://doi.org/10.1007/1-84628-238-1_22

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-237-9

  • Online ISBN: 978-1-84628-238-6

  • eBook Packages: Springer Book Archive

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