期刊
GYNECOLOGICAL ENDOCRINOLOGY
卷 25, 期 4, 页码 208-221出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/09513590802530940
关键词
Chronic pelvic pain; post-operative adhesions; pelvic varices; interstitial cystitis; irritable bowel syndrome
资金
- University of Milan School of Medicine Research [12-01-5068118-00067]
- Centre for Research in Obstetrics and Gynecology, Milano, Italy
Several causes of chronic pelvic pain (CPP) are recognised, but in many women a definite diagnosis cannot be made. Few randomised controlled trials on treatment of CPP have been conducted. In a Cochrane systematic review, only medroxy-progesterone acetate, counselling, 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 non-invasive treatments have been proposed including exercise programmes, cognitive and behavioural medicine, physical therapy, dietary modification, massage and acupuncture. When the woman has completed her family and particularly when pelvic varices have been demonstrated, hysterectomy can be considered after a careful pre-operative 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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