Abstract
Pain is a perplexing phenomenon. Treating a patient with chronic pain brings up many complicated questions, including: the difference between physical and emotional pain, the subjective nature of pain, and the interplay between pain and pleasure. In this chapter, we will discuss the pathologic etiologies that account for chronic pelvic pain, focusing primarily on pelvic pain in women. We will then cover the interesting and complex neuroscience and biology of pain, including central and peripheral nervous system processing of painful stimuli. Finally, we will discuss the importance of the experience of pleasure for patients who suffer from chronic pain.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Schappert SM. National Ambulatory medical care survey: 1989 summary. Natl Vital Stat Rep. 1992;13:1–80.
Knapp DA, Koch H. The Management of new pain in office-based ambulatory care: national ambulatory medical care survey, 1980 and 1981. Adv Data. 1984;97:1–9.
Engeler D, Baranowski AP, Elneil S, Hughes J, Messelink EJ, Olivera P, et al. Guidelines on Chronic Pelvic Pain European Association of Urology. 2012. Available from: http://www.uroweb.org/gls/pdf/24_chronic_Pelvic_Pain_LRMarch 23th.pdf.
Reiter R. A profile of women with chronic pelvic pain. Clin Obstet Gynecol. 1990;33(1):130.
Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. Patterns of diagnosis and referral in women consulting for chronic pelvic pain in the UK primary care. Br J Obstet Gynaecol. 1999;106(11):1156.
Demir F, Ozcimen EE, Oral HB. The role of gynecological, urological, and psychiatric factors in chronic pelvic pain. Arch Gynecol Obstet. 2012;286(5):1215–20.
Neis K, Neis K. Chronic pelvic pain: cause, diagnosis, and therapy from a gynaecologist’s and an endoscopist’s point of view. Gynecol Endrocrinol. 2009;25(11):757–61.
Rock J, Jones H. Te Linde’s operative gynecology. 10th ed. Lippincott Williams and Wilkins; 2008.
Zondervan KT, Yudkin PL, Vessey MP, Jenkinson CP, Dawes MG, Barlow DH, et al. Chronic pelvic pain in the community - symptoms, investigations, and diagnoses. Am J Obstet Gynceol. 2001;184(6):1149.
Merksey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle International Association for the study of Pain; 1994.
Pain and disability: clinical, behavioral, and public policy perspectives. Osterweis M, Kleinman A, Mechanic D, editors. Washington: National Academy Press; 1987.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington: American Psychiatric Association; 1980.
American Psychiatric Association: diagnostic and statistical manual of mental disorders. 3rd ed. Revised ed. Washington: American Psychiatric Association; 1987.
Merksey H, Spear FG. The concept of pain. J Psychosom Res. 1967;11(1):59–67.
American Psychiatric Association: diagnostic and statistical manual of mental disorders. 4th ed. Text Revision ed. Washington: American Psychiatric Association; 2000.
Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med. 2002;64:773–86.
Howard F. The role of laparoscopy in the evaluation of chronic pelvic pain: pitfalls with a negative laparoscopy. J Am Assoc Gynecol Laparosc. 1996;4(1):85.
Stones RW. Female genital pain. In: Fillingim RB, editor. Sex, gender and pain. Seattle: IASP Press; 2000.
Gradison M. Pelvic inflammatory disease. Am Fam Physician. 2012;85(8):791–6.
Eschenbach DA. Acute pelvic inflammatory disease: etiology, risk factors and pathogenesis. Clin Obstet Gynecol. 1976;19(1):147.
Medicine Pcotasfr. Pathogenesis, consequences, and control of peritoneal adhesions in gynecological surgery. Fertil Steril. 2007;88(1):21.
Howard FM, El-Minawi AM, Sanchez RA. Conscious pain mapping by laparscopy in women with chronic pelvic pain. Obstet Gynecol. 2000;96(6):934.
Stewart EA. Uterine fibroids. Lancet. 2001;357:293.
Friedrich EGJ. Vulvar vestibulitis syndrome. J Reprod Med. 1987;32(2):110.
Baggish MS, Miklos JR. Vulvar pain syndrome: a review. Obstet Gynecol Surv. 1995;50(8):618.
Leiblum SR, Nathan SG. Persistent sexual arousal syndrome: a newly discovered pattern of female sexuality. J Sex Marital Ther. 2001;27:365–80.
Leiblum SR, Seehus M. FSFI Scores of women with persistent genital arousal disorder compared with published scores of women with female sexual arousal disorder and healthy controls. J Sex Med. 2009;6:469–73.
Leiblum SR. Persistant genital arousal disorder. In: Leiblum SR, editor. Perplexing, distressing, and under recognized. 4th ed. New York: The Guildford Press; 2007.
Komisaruk BR, Lee HJ. Prevalence of sacral spinal (Tarlov) cysts in persistant genital arousal disorder. J Sex Med. 2012;9:2047–56.
Beard RW, Reginald PW, Wadsworth J. Clinical features of women with chronic lower abdominal pain and pelvic congestion. Br J Obstet Gynaecol. 1988;95(2):153.
Lippman SA, Warner M, Samuels S, Olive D. Uterine fibroids and gynecologic pain symptoms in a population based study. Fertil Steril. 2003;80(6):1488.
Stanford EJ, Dell JR, Parsons CL. The emerging presence of interstitial cystitis in gynecologic patients with chronic pelvic pain. Urology. 2007;69(4 supplement):53.
Dell JR. Interstitial cystitis/painful bladder syndrome: appropriate diagnosis and management. J Women’s Health. 2007;16(8):1181–7.
Mayson BE, Teichman JM. The relationship between sexual abuse and interstitial cystitis/painful bladder syndrome. Curr Urol Rep. 2009;10(6):441–7.
Williams RE, Hartmann KE, Sandler RS. Recognition and treatment of irritable bowel syndrome among women with chronic pelvic pain. Am J Obstet Gynceol. 2005;192(3):761.
Sarzi-Puttini P, Atzeni F, Mease PJ. Chronic widespread pain: from peripheral to central evolution. Best Pract Res Clin Rheumatol. 2011;25(2):133–9.
Schimdt-Wilcke T, Clauw DJ. Fibromyalgia: from pathophysiology to therapy. Nat Rev Rheumatol. 2011;7(9):518.
Staud R. Abnormal pain modulation in patients with spatially distributed chronic pain: fibromyalgia. Rheum Dis Clin North Am. 2009;35(2):263.
Dadabhoy D, Crofford LJ, Spaeth M, Russell IJ. Biology and therapy of fibromyalgia: evidence based biomarkers for fibromyalgia syndrome. Arthritis Res Ther. 2008;10(4):211.
Tu FF, Fitzgerald CM, Kuiken T, Farrell T, Harden RN, Norman HR. Comparative measurement of pelvic floor pain sensitivity in chronic pelvic pain. Obstet Gynecol. 2007;110(6):1244.
Loos MJ, Scheltinga MR, Mulders LG, Roumen RM. The Pfannenstiel incision as a source of chronic pain. Obstet Gynecol. 2008;111(4):839.
Sharp HT. Myofascial pain syndrome of the abdominal wall for the busy clinician. Clin Obstet Gynecol. 2003;46(4):783.
Srinivasan AK, Kaye JD, Moldwin R. Myofascial dysfunction associated with chronic pelvic floor pain: management strategies. Curr Pain Headache Rep. 2007;11(5):359.
Rosenbaum TY. Muscloskeletal Pain and sexual function in women. J Sex Med. 2010;7(2 Pt 1):645–53.
Schultz WW, Basson R, Binik Y, Eschenbach D, Wesselmann U, Lankveld JV. Women’s sexual pain and its management. J Sex Med. 2005;2(3):301–16.
Binik YM, Bergeron S, Khalife S. Dysparuenia and vaginismus: so called sexual pain. In: Leiblum SR, editor. Principles and practice of sex therapy. 4th ed. New York: The Guildford Press; 2007.
American Psychiatric association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: American Psychiatric Association; 2013.
Binik YM. Should dyspareunia be retained as a sexual dysfunction in DSM-V? A painful classification decision. Arch Sex Behav. 2005;34(1):11–21.
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(1):92.
Walling MK, Reiter RC, O’Hara MW, Milburn AK. Abuse history and chronic pain in women: prevalences of sexual abuse and physical abuse. Obstet Gynecol. 1994;84(2):193.
Meltzer-Brody S, Leserman J, Zolnoun D, Steege J, Green E, Teich A. Trauma and posttraumatic stress disorder in women with chronic pelvic pain. Obstet Gynecol. 2007;109(4):902.
Lorencatto C, Petta CA, Navarro MJ, Bahamondes L, Matos A. Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol Scand. 2006;85(1):88.
Blumer D, Heilbronn M. Chronic pain as a variant of depressive disease: the pain prone-disorder. J Nerv Ment Dis. 1982;170(7):381.
Walker E, Katon W, Harrop-Griffiths J, Holm L, Russo J, Hickok LR. Relationship of chronic pelvic pain to psychiatric diagnosis and childhood sexual abuse. Am J Psychiatry. 1988;145(1):75.
Randolph ME, Reddy DM. Sexual functioning in women with chronic pelvic pain: the impact of depression, support, and abuse. J Sex Res. 2006;43(1):38.
Pontari M, Ruggieri M. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. 2004;272:830–45.
Basbaum AI, Jessell TM. Pain. 5th ed. In: Kandel ER, editor. McGraw-Hill Professional; 2012.
Komisaruk BR, Adler NT, Hutchison J. Genital sensory field: enlargement by estrogen treatment in female rats. Science. 1972;178:1295–8.
Komisaruk BR, Whipple B. The role of vaginal stimulation-produced analgesia in reproductive processes. In: Genazzani AR, Nappi G, Facchinetti F, Martignoni E, editors. Pain and reproduction. Casterton Hall, UK: The Parthenon Publishing Group; 1988.
Rodriguez-Sierra JF, Skofitsch G, Komisaruk BR, Jacobowitz DM. Abolition of vagino-cervical stimulation-induced analgesia by capsaicin administered to neonatal, but not adult rats. Physiol Behav. 1988;44:267–72.
Kolb B, Whishaw IQ. An introduction to brain and behavior. 4th ed. New York: Worth Publishers; 2014.
Janicki TI. Chronic pelvic pain as a form of complex regional pain syndrome. Clin Obstet Gynecol. 2003;46:797–803.
Nijs J, Houdenhove BV, Oostendorp RA. Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice. Man Ther. 2010;15:135–41.
Meyer R, Campbell JN, Raja SN. Peripheral neural mechanisms of nociception. In: Wall P, Melzack R, editors. Textbook of pain. 3rd ed. Edinburgh: Churchill Livingstone; 2012 1995.
As-Sanie S, Harris RE, Napadow V, Kim J, Neshewat G, Kairys A, et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel based morphometry study. Pain. 2012;153:1006–14.
Neziri AY, Haesler S, Peterson-Felix S, Muller M, Arendt-Nielsen L, Manresa JB, et al. Generalized expansion of nociceptive reflex receptive fields in chronic pain patients. Pain. 2010;151:798–805.
Baranowski AP. Chronic pelvic pain. Best Pract Res Clin Gastroenterol. 2009;23:593–610.
Serap K, Hermans L, Willems T, Roussel N, Meeus M. Central sensitization in urogynecological chronic pelvic pain: a systematic literature review. Pain Physician. 2013;16:291–308.
Lazarus RA, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
Vingerhoets AJ, Heck GIV. Gender, coping and psychosomatic symptoms. Psychol Med. 1990;20(1):125–35.
Geisser ME, Robinson ME. Catastrophizing, depression, and the sensory, affective and evaluative aspects of chronic pain. Pain. 1994;58:79–83.
Jensen I. Coping with long-term musculoskeletal pain and its consequences: is gender a factor? Pain. 1994;57:167–72.
Magni G. Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain. Pain. 1990;56:289–97.
Deguara CS, Pepas L, Davis C. Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? Curr Opin Obstet Gynecol. 2012;24(4):241–4.
Scully D, Bart P. A funny thing happened on the way to the orifice: women in gynecology textbooks. In: Huber J, editor. Changing women in a changing society. Chicago IL: University of Chicago Press; 1973
Lostein LM. Female sexuality and feminine development: Freud and his legacy. Adv Psychsom Med. 1985;12:57–70.
Goldstein I, De EJB, Johnson J. Persistent sexual arousal syndrome and clitoral priapism. In: Goldstein I, Meston C, Davis S, Traish AM, editors. Women’s sexual function and dysfunction: study, diagnosis and treatment. London: Taylor and Francis; 2006.
Grace VM. Problems of communication, diagnosis, and treatment experienced by women using the New Zealand health service for chronic pelvic pain: a qualitative analysis. Heath Care Women Int. 1995;16(6):521–35.
Tracey I. Nociceptive processing in the human brain. Curr Opin Neurobiol. 2005;15:478–87.
Komisaruk BR, Whipple B. The suppression of pain by genital stimulation in females. Ann Rev Sex Res. 1995;6:151–86.
Whipple B, Komisaruk BR. Analgesia produced in women by genital self-stimulation. J Sex Res. 1988;24:130–40.
Meana M, Binik YM. Painful coitus: a review of female dyspareunia. J Nerv Ment Dis. 1994;182:264–72.
Komisaruk BR, Whipple B. How does Vaginal stimulation produced pleasure, pain and analgesia. In: Fillingim RB, editor. Seattle; 2000.
Komisaruk BR, Whipple B, Crawford A, Grimes S, Liu WC, Kalnin A, et al. Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves. Brain Res. 2004;1024:77–88.
Casey KL, Morrow TJ, Lorenz J, Minoshima S. Temporal and spatial dynamics of human forebrain activity during heat pain: analysis by positron emission tomography. J Neurophysiol. 2001;85:951–9.
Montanari G, Donato ND, Benfenati A, Giovanardi G, Zannoni L, Vicenzi C, et al. Women with deep infiltrating endometriosis: sexual satisfaction, desire, orgasm and pelvic problem interference with sex. J Sex Med. 2013;10(6):1559–66.
Palmore EB. Predictor of longevity difference: a 25 year follow-up. Gerontologist. 1982;22:513–8.
Abramov LA. Sexual life and sexual frigidity among women developing acute myocardial infarction. Psychosom Med. 1976;38:418–25.
Davey-smith G, Frankel S, Yarnell J. Sex and death: are they related? Findings from Caerphilly Cohort Study. BMJ. 1997;315:1641–4.
Giles GG, Severi G, English DR, McCredie MR, Borland R, Boyle P, et al. Sexual factors and prostate cancer. Br J Urol. 2003;92:211–6.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer Science+Business Media New York
About this chapter
Cite this chapter
Lakshmin, P., Gordon, D.A. (2017). Biology of Pain and Pathophysiology of Pelvic Pain Syndrome. In: Gordon, D., Katlic, M. (eds) Pelvic Floor Dysfunction and Pelvic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6554-0_18
Download citation
DOI: https://doi.org/10.1007/978-1-4939-6554-0_18
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-6552-6
Online ISBN: 978-1-4939-6554-0
eBook Packages: MedicineMedicine (R0)