|December 2003 · Vol. 15, No. 12
The enigma of chronic pelvic pain:
Systematically tracing the cause
Is the pain due to endometriosis? Pelvic inflammatory disease? Psychosomatic factors? The search for an answer is aided by consensus guidelines, key data, and an expert’s clinical experience.
Dr. Gambone is professor, department of obstetrics and gynecology, David Geffen School of Medicine at UCLA, Los Angeles, Calif. E-mail: JGambone@ucla.edu
If thorough investigation yields no diagnosis or indications for immediate surgery, empiric medical therapy for endometriosis is appropriate without laparoscopic confirmation. If empiric medical therapy fails, proceed to diagnostic laparoscopy.
Referral to a multidisciplinary pain clinic has been shown to be more effective than episodic gynecologic management of patients, especially those with significant psychological issues.
Schedule regular follow-ups. Do not instruct patients to call only during a pain crisis—this practice may create pain behaviors directed at obtaining sympathy and dramatic medical attention.
One woman complains of daily pain that worsens premenstrually. Another reports frequent aches radiating through her lower back and abdomen. A third says intercourse exacerbates her pain. And the list goes on.
Chronic pelvic pain (CPP) can manifest in dozens of ways, and the words patients use to describe it vary just as widely. Its multifaceted nature poses one of the biggest challenges to accurate diagnosis and appropriate management. Success is most likely when a compassionate attitude is combined with a systematic assessment to identify and understand the underlying cause—a blend of artful practice and scientific reasoning.