Abstract
Chronic pelvic pain (CPP) is a vast and complex condition with many potential etiologies. The urogenital, gynecological, musculoskeletal, and gastroenterologic systems are most commonly involved. Timely evaluation, diagnosis, and treatment are important to prevent frustration for both the provider and patient. Physical modalities, medications, psychotherapy, and alternative medicine can be used to treat both specific causes of CPP or to alleviate general symptoms. Commonly used interventional treatments include superior and inferior hypogastric plexus blocks as well as the ganglion impar block. Often, multidisciplinary treatment plans yield superior results.
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References
Green IC, Cohen SL, Finkenzeller D, et al. Interventional therapies for controlling pelvic pain: what is the evidence? Curr Pain Headache Rep. 2010;14:22–32.
Mathis SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence health related quality of life, and economic correlates. Obstet Gynecol. 1996;87(3):321–7.
Garry R. Diagnosis of endometriosis and pelvic pain. Fertil Steril. 2006;86:1307–9.
Reiter RC, Gambone JC. Demographic and historic variables in women with idiopathic chronic pelvic pain. Obstet Gynecol. 1990;75:428–32.
Berger MY. Chronic abdominal pain in children. BMJ. 2007;334:997–1002.
Stein SL. Chronic pelvic pain. Gastroenterol Clin N Am. 2013;42:785–800.
International Pelvic Pain Society – Pelvic pain assessment form. http://www.pelvicpain.org/docs/resources/forms/History-and-Physical-Form-English.aspx.
Dwarkasing RS, Schouten WR, Geeraedts TE, et al. Chronic anal and perianal pain resolved with MRI. AJR Am J Roentgenol. 2012;200(5):1034–41.
Zondervan KT, Yudkin PL, Vessey MP, et al. Chronic pelvic pain in the community: symptoms, investigations, and diagnoses. Am J Obstet Gynecol. 2001;164:1149.
Rao SS, Paulson J, Mata M, et al. Clinical trial: effects of botulinum toxin on levator ani syndrome – a double-blind, placebo controlled study. Aliment Pharmacol Ther. 2009;29:985–91.
Mazza L, Formento E, Fonda G. Anorectal and perineal pain: new pathophysiological hypothesis. Tech Coloproctol. 2004;8:77–83.
Shin JH, Howard FM. Management of chronic pelvic pain. Curr Pain Headache Rep. 2011;15:377–85.
Hogston P. Irritable bowel syndrome as a cause of chronic pain in women attending a gynaecology clinic. Br Med J. 1987;294(6577):934–5.
Clemons JL, Arya LA, Myers DL. Diagnosing interstitial cystitis in women with chronic pelvic pain. Obstet Gynecol. 2002;100:337–41.
Farquhar C. Endometriosis. Endometriosis Br Med J. 2007;334:249–53.
Patijn J, Janssen M, Hayek S, et al. Coccygodynia. Pain Pract. 2010;10(6):554–9.
Janicki TI. Chronic pelvic pain as a form of complex regional pain syndrome. Clin Obstet Gynecol. 2003;46(4):797–803.
Potts JM. Therapeutic options for chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2005;6(4):313–7.
Howard FM, Perry CP, Carter JE, et al. Pelvic pain diagnosis and management. Philadelphia: Lippincott Williams & Wilkins; 2000. ISBN 0-7817-1724-8.
Newman DK. Pelvic floor muscle rehabilitation using biofeedback. Urol Nurs. 2014;34(4):193–202.
Poterucha TJ, Murphy SL, Rho RH, et al. Topical amitriptyline-ketamine for treatment of rectal, genital, and perineal pain and discomfort. Pain Physician. 2012;15(6):485–8.
Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Pyschiatry. 2009;31:206–19.
Van Ophoven A, Hertle L. Long-term results of amitriptyline treatment of interstitial cystitis. J Urol. 2005;174:1837–40.
Dawson TE, Jamison J. Intravesical treatments for painful bladder syndrome/interstitial cystitis. Cochrane Database Syst Rev. 2007;4:CD006113.
Cervigni M, Natale F, Natasa L, et al. A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2008;19:943–7.
Toft BR, Nordling J. Recent developments of intravesical therapy of painful bladder syndrome/interstitial cystitis: a review. Curr Opin Urol. 2006;16:268–72.
American Urological Association Guideline. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. 2014. https://www.auanet.org/education/guidelines/ic-bladder-pain-syndrome.cfm.
Plancarte R, Amescua C, Patt RB, et al. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990;73:236–9.
de Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993;54(2):145–51.
Ghoneim AA, Mansour SM. Comparative study between computed tomography guided superior hypogastric plexus block and the classic posterior approach: a prospective randomized study. Saudi J Anaesth. 2014;8(3):378–83.
Mishra S, Bhatnagar S, Rana SP, et al. Efficacy of the anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients. Pain Med. 2013;14(6):837–42.
Plancarte R, de Leon-Casacola OA, El-Helaly M, et al. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22:562–8.
Schutz DM. Inferior hypogastric plexus blockade: a transsacral approach. Pain Physician. 2007;10(6):757–63.
Foye P, Buttaci C, Stitik T. Successful injection for coccyx pain. Am J Phys Med Rehabil. 2006;85(9):783–4.
Johnston PJ, Michalek P. Blockade of the ganglion impar (walther), using ultrasound and a loss of resistance technique. Prague Med Rep. 2012;113(1):53–7.
Wemm Jr K, Saberski L. Modified approach to block the ganglion impar (ganglion of Walther). Reg Anesth. 1995;20(6):544–5.
Ahmed DG, Mohamad MF, Mohamad SA. Superior hypogastric plexus combined with ganglion impar neurolytic blocks for pelvic and/or perineal cancer pain relief. Pain Physician. 2015;18:E49–56.
Whitemore KE, Payne CK, Diokno AC, et al. Sacral neuromodulation in patient with interstitial cystitis: a multicenter clinical trial. Int Urogynecol J. 2003;14:305–9.
Seigel S, Paszkiewicz E, Kirkpatrick C, et al. Sacral nerve stimulation in patient with chronic intractable pelvic pain. J Urol. 2001;166:1742–5.
Everaert K, Devulder J, De Muynk M, et al. The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:9–14.
Peters KM, Killineger KA, Boguslawski BM, et al. Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn. 2010;29(7):1267–71.
Bolash R, Vrooman B. Chapter sympathetic blocks for chronic abdominal pain. In: Kapural L, editor. Chronic abdominal pain: an evidence based, comprehensive guide to clinical management. New York: Springer; 2015. p. 143–52.
Scott-Warren JT, Hill V, Rajasekaran A. Ganglion impar blockade: a review. Curr Pain Headache Rep. 2013;17:306.
Reissing ED, Brown C, Lord MJ, et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynecol. 2005;26(2):107–13.
Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction. Urol Nurs. 2011;31(5):279–84.
Crisp CC, Vacarro CM, Estanol MV, et al. Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J. 2013;24(11):1915–23.
Rogalski MJ, Kellog-Spadt S, Hoffman AR, et al. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J. 2010;21(7):895–9.
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Ramsook, R.R., Nampiaparampil, D.E., Mogilevksy, M. (2017). Rehabilitation of the Pelvis and Pelvic Floor. In: Sabia, M., Sehdev, J., Bentley, W. (eds) Urogenital Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-45794-9_9
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DOI: https://doi.org/10.1007/978-3-319-45794-9_9
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