by Lisa Pavese, FNP, Paul Lynch, MD, and Tory McJunkin, MD.
Pelvic Pain will affect approximately 33% of all women at least one time in their lives. For 12-20% of these women, pelvic pain may progress to being chronic. There are many different causes of pelvic pain, including infection, ectopic pregnancy, ovarian cysts, and endometriosis. A common type of pelvic infection is pelvic inflammatory disease (PID). PID is an infection of the uterus, ovaries, or fallopian tubes, and may be caused by sexually transmitted disease. Infections of the kidneys, bladder, or urethra can also cause pelvic pain. If an infection is suspected, treatment with antibiotics is necessary in order to alleviate this type of pelvic pain. Ectopic pregnancy is a pregnancy that occurs outside of the uterus, typically in the fallopian tubes, and can be very painful. Ectopic pregnancy can lead to serious complications, and warrants surgical intervention. Ovarian cysts are fluid-filled sacs within the ovaries, and typically cause pain during mid-menstrual cycle. These cysts usually resolve spontaneously, but sometimes require surgery for removal. Endometriosis is a condition in which uterine tissue grows on other reproductive organs, and can cause severe pain and cramping during menses. Certain medications and surgical procedures can help to lessen the pain associated with endometriosis.
Diagnosis and Treatment
Pelvic pain can also be neuropathic. It is extremely important to establish an accurate diagnosis, because some of the causes for pelvic pain can be reversible. The diagnosis is usually made by an OB/GYN, and involves pelvic examination, lab testing, and ultrasounds or CT scans of the abdomen and pelvis. Treatment is based on the underlying cause, and can include medications, physical therapy, biofeedback, and nerve blocks. Common types of medications used to treat pelvic pain include anti-inflammatories (ibuprofen, naproxen), anti-depressants (Cymbalta, amitriptyline), neuropathic medications (gabapentin, Lyrica), and occasionally opioids (hydrocodone, oxycodone). Physical therapy for pelvic pain can include pelvic floor muscle training, hot and cold applications, ultrasound therapy, and stretching. Biofeedback is a technique in which a person learns to control pain through thoughts, and can be very helpful for treating pelvic pain. A licensed therapist can teach biofeedback, relaxation techniques, and guided imagery, all of which are very effective techniques in controlling chronic pain. Neuropathic pelvic pain responds very well to various nerve blocks. Nerve blocks are determined by location of pelvic pain and symptomatology. A study by Weschler, Maurer, Harpern, and Frank (1995) showed that superior hypogastric plexus blocks are very effective in treating chronic pelvic pain related to endometriosis. Another type of nerve block used to treat pelvic pain is an ilioinguinal nerve block, especially useful in treating pain in the lower pelvic region and groin. For pelvic pain that does not respond to more conservative treatment modalities, a spinal cord stimulator may be beneficial. Spinal Cord Stimulation (SCS) is often described as a “pacemaker for pain” and uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of chronic pain impulses. Under a local anesthetic and minimal sedation your doctor will first place the trial SCS leads into the epidural space. The SCS lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the epidural space. The trial stimulator is typically worn for 5-7 days as the lead is taped to your back and connected to a stimulating device. If the trial successfully relieves your pain you can decide to undergo a permanent SCS if desired. If you suffer from chronic pelvic pain, Arizona Pain Specialists can help. We offer advanced and comprehensive treatment options that encompass all of your pain management needs. Call us today to schedule an appointment!
Bennett, D. (2005). Interventional Approaches to Pain Management. Retrieved on February 17, 2010 from: http://cme.medscape.com/viewarticle/502018 National Pain Foundation (2010). Pelvic Pain: Facts and Statistics. Retrieved on February 17, 2010 from: http://www.nationalpainfoundation.org/articles/835/facts-and-statistics Singh, M. and E. Puscheck (2009). Chronic Pelvic Pain: Treatment & Medication. Retrieved on February 17, 2010 from: http://emedicine.medscape.com/article/258334-treatment The American Congress of Obstetricians and Gynecologists (2006). Pelvic Pain. Retrieved on February 17, 2010 from: http://www.acog.org/publications/patient_education/bp099.cfm Weschler, R. , Maurer, P., Harpern, E., and E. Frank (1995). Superior Hypogastric Plexus Block for Chronic Pelvic Pain in the Presence of Endometriosis: CT Techniques and Results. Radiology 1995; 196: 103-106.