Medical treatment of chronic pelvic pain

Abstract

Chronic pelvic pain (CPP) is a common disorder with a significant health burden, yet is poorly understood with regard to its aetiology and management. Traditional treatments for CPP are directed at disease-based pathology; however, the evidence for effectiveness is weak at best. The scope of this chapter is to appraise the reader of the medicines used in CPP and aims to correlate knowledge about persistent pain mechanisms in general and apply that to pain conditions in gynaecology, the most common being CPP. To address this it is essential that the multidimensional management of CPP is emphasised since no medicine can work in isolation; indeed medicines are just one small part of management of these conditions. No matter what the biological cause of the pain the way the person responds and presents is modified by environmental, psychological, cognitive and social influences i.e. the biopsychosocial model. We believe contemporary variation in care is attributed to a poor understanding of this model and the aetiology and mechanisms of CPP. This chapter will advise on a pragmatic pathway of care including the medicines prescribed to women for this condition.