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CHRONIC PELVIC PAIN IN WOMEN: MEDICAL, SURGICAL, AND ALTERNATIVE TREATMENTS

Vercellini, Paolo; ViganĂ², Paola; Somigliana, Edgardo; Abbiati, Annalisa; Barbara, Giussy; Fedele, Luigi

Several causes of chronic pelvic pain (CPP) are recognized, but in many women a definite diagnosis cannot be made. Few randomized controlled trials on treatment of CPP have been conducted. In a Cochrane systematic review, only medroxy-progesterone acetate, counseling, a multidisciplinary approach, and lysis of deep adhesions had a proven benefit. The aim of this descriptive review is to describe the management of CPP, which can focus on treating the pain itself, the underlying cause, or both. Combination drug therapy with medications with different mechanisms of action may improve therapeutic results. Pelvic denervating procedures should be indicated in selected circumstances, as the magnitude of the effect is undefined. Several alternative noninvasive treatments have been proposed including exercise programs, cognitive and behavioral medicine, physical therapy, dietary modification, massage, and acupuncture. When the woman has completed her family and especially when pelvic varices have been demonstrated, hysterectomy can be considered after a careful preoperative assessment. However, substantial pain relief may be achieved in no more than 60-70% of the cases. A minority of patients (3-5%) will experience worsening of pain or will develop new symptoms after surgery. Treatment of CPP generally requires acceptance of the concept of managing rather than curing symptoms.

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