Systematic Review of Therapies for Noncyclic Chronic Pelvic Pain in Women

Abstract

We synthesized the literature (articles published between 1990 and May 2011) on the treatment of noncyclic and mixed cyclic/noncyclic chronic pelvic pain (CPP) in adult women. Two reviewers assessed studies against predetermined inclusion/exclusion criteria, extracted data regarding participant and intervention characteristics and outcomes, and assigned overall quality and strength of evidence ratings. Of 2081 studies, 21 addressed surgical or nonsurgical interventions. Definitions of CPP and participant characteristics varied across studies, and most studies were of poor quality, which precluded data synthesis. Although surgical and nonsurgical approaches both improved pain, neither was more effective when directly compared in 3 studies. Laparoscopic adhesiolysis or laparoscopic uterosacral nerve ablation did not further improve pain scores over diagnostic laparoscopy. The evidence to conclude that surgical intervention is either effective or ineffective or that one technique is superior to another is insufficient. Most studies on nonsurgical approaches evaluated hormonal therapies in endometriosis-associated CPP and were not placebo controlled. Few studies addressed nonhormonal or nonpharmacologic approaches. Harms reporting was limited. Overall, no nonsurgical treatment was more or less effective than another, except for the clear negative effect of raloxifene. In general, the literature addressing therapies for CPP in women is of poor quality and inconclusive. Improved characterizations of the targeted condition and interventions in CPP research, including a uniform definition and standardized evaluation, are necessary to inform treatment choices.

Analysis of 230 women with chronic pelvic pain assisted at a public hospital

“…As observed in our study, the superiority of non-surgical treatment (clinical/psychotherapeutic) may be considered in the care of females with CPP, since surgical treatment does not contribute to decrease VAS and adds more cost and morbidity. Other recent reports endorse this opinion 9,14 . Only 5.2% (12 people) had ambulatory discharge (VAS≤2 for more than one year without medication).…”

“…This is endorsed by a multicenter study where 100 patients with CPP and pelvic adhesions were randomized for adhesion lysis (n=52) or non lysis (n=42), by videolaparoscopy and no difference in pain improvement was observed between groups 19 . A recent systematic review 14 points to the inefficacy of surgical approach to treat CPP. Laparoscopy is a surgery and, as such, poses risks and costs inherent to the procedure and should only be indicated after careful clinical and image evaluation.…”

“…In his book called "Essential is Simple", he addresses the use of family constellation for different symptoms/ diseases, among them chronic pains syndrome 11,12 . Surgical treatment, especially with laparoscopy, has been indicated for diagnosis and treatment of endometriosis and pelvic adhesions 1,2 , but is being increasingly challenged 13,14 . CPP ambulatory of the Gynecology Service, Clinicas Hospital, Federal University of Goiás (HC-UFG) aims at receiving, investigating and treating females with CPP.…”

Bekkensmerter fram i lyset

“…Det kom ein oversiktsartikkel om behandling for kroniske, ikkjesykliske bekkensmerter i tidsskriftet Obstetrical and Gynecological Survey i 2012 (1). Cecilie Hagemann gjorde i samband med sin disputas ved Norges teknisk-naturvitenskapelige universitet også ei god oppsummering av det same.…”

Efficacy of paraspinal anesthetic block in patients with chronic pelvic pain refractory to drug therapy: a randomized clinical trial

“…A hyperactive state of one segment reacting to a source of irritation that is constantly stimulating the dorsal ganglia translates into pain and hyperalgesia 6 . Various treatments are available for CPP [10][11][12] . To ensure the progress is made in treating chronic pain, therapy that targets the mechanisms of hypersensitivity must be used to try to alleviate symptoms.…”