Chronic pelvic pain in women


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Treatments and drugs

By Mayo Clinic staff

Pain Management Advisor

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If your doctor can pinpoint a specific cause, your treatment will focus on eliminating that cause. However, if the cause of your pelvic pain can't be found, treatment will focus on managing your pain.

Medications
Depending on the cause, your doctor may recommend a number of medications to treat your condition, such as:

  • Pain relievers. Over-the-counter pain remedies, such as aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others), may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. Pain medication alone, however, rarely solves the problem of chronic pain.
  • Hormone treatments. The days when you have pelvic pain may coincide with a particular phase of your menstrual cycle and the hormonal changes that control ovulation and menstruation. Birth control pills or other hormonal medications may help relieve cyclic pelvic pain.
  • Antibiotics. If an infection is the source of your pain, your doctor may prescribe antibiotics.
  • Antidepressants. Certain types of antidepressants can be helpful for a variety of chronic pain syndromes. Tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and others, seem to have pain-relieving as well as antidepressant effects. They may help improve chronic pelvic pain even in women who don't have depression.

Therapies
Your doctor may recommend specific therapies or procedures as a part of your treatment for chronic pelvic pain. These may include:

  • Physical therapy. Applications of heat and cold to your abdomen, stretching exercises, massage and other relaxation techniques may improve your chronic pelvic pain. Your doctor might also recommend exercises to strengthen your pelvic floor muscles. A physical therapist can assist you with these therapies and help you develop coping strategies for the pain. Sometimes physical therapists target specific points of pain using transcutaneous electrical nerve stimulation (TENS), in which electrodes deliver electrical impulses to nearby nerve pathways, or by teaching biofeedback, a technique that helps you identify areas of tight muscles so you can learn to relax those areas.
  • Neurostimulation (spinal cord stimulation). This treatment involves implanting a device that blocks nerve pathways so the pain signal can't reach the brain. It may be helpful, depending on the cause of your pelvic pain.
  • Trigger point injections. If your doctor finds a specific point where you feel pain, you may benefit from direct injection of a numbing medicine into a painful spot (trigger point). The medicine, usually a long-acting local anesthetic, can block pain and ease discomfort.
  • Counseling. Your pain could be intertwined with depression, sexual abuse, a personality disorder, a troubled marriage or a family crisis. Getting help for psychological, social, spiritual and emotional challenges may be an essential part of your treatment plan.

Surgery
To correct an underlying problem that causes chronic pelvic pain, your doctor may recommend a surgical procedure, such as:

  • Laparoscopic surgery. If you have endometriosis, doctors can remove the adhesions or endometrial tissue using laparoscopic surgery. During laparoscopic surgery, your surgeon inserts a slender viewing instrument (laparoscope) through a small incision near your navel and inserts instruments to remove endometrial tissue through one or more additional small incisions.
  • Hysterectomy. Relatively rarely, your doctor might recommend a hysterectomy and bilateral oophorectomy — surgery to remove your uterus and ovaries. Removing the ovaries deprives endometriosis of estrogen, which it needs in order to grow. Hysterectomy and oophorectomy may be an option for certain causes of pelvic pain in women past childbearing age, but usually isn't recommended.

Pain rehabilitation programs
You may need to try a combination of treatment approaches before you find what works best for you. If appropriate, you might consider entering a pain rehabilitation program. These types of programs, such as the Pain Rehabilitation Center at Mayo Clinic, typically provide a team approach to treatment, including medical and psychiatric aspects.

Lifestyle and home remedies Tests and diagnosis
References
  1. Howard F. Causes of chronic pelvic pain in women. http://www.uptodate.com/home. Accessed April 7, 2013.
  2. Howard F. Treatment of chronic pelvic pain in women. http://www.uptodate.com/home. Accessed April 7, 2013.
  3. Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. April 19, 2012.
  4. Rakel RE. Textbook of Family Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191205553-4/0/1481/0.html#. Accessed April 7, 2013.
  5. Chronic pelvic pain. The American Congress of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq099.pdf?dmc=1&ts=20130418T1809515975. Accessed April 18, 2013.
  6. Howard F. Evaluation of chronic pelvic pain in women. http://www.uptodate.com/home. Accessed April 7, 2013.
  7. Interstitial cystitis/painful bladder syndrome. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/index.htm. Accessed April 7, 2013.
  8. Carinci AJ. Complementary and alternative treatments for chronic pelvic pain. Current Pain and Headache Reports. 2013;17:316.
  9. Stones W, et al. Interventions for treating chronic pelvic pain in women. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000387/abstract. Accessed April 7, 2013.
  10. Relaxation techniques for health: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/sites/nccam.nih.gov/files/relaxation_introduction.pdf.Accessed April 14, 2013.
  11. Noncyclic chronic pelvic pain therapies for women: Comparative Effectiveness Review No. 41. AHRQ Publication No. 11(12)-EHC088-EF. https://www.ncbi.nlm.nih.gov/books/NBK84586. Accessed April 28, 2013.
  12. Martinez B. Management of patients with chronic pelvic pain associated with endometriosis refractory to conventional treatment. Pain Practice. 2013;13:53.
  13. George SE, et al. Physical therapy management of female chronic pelvic pain: anatomic considerations. Clinical Anatomy. 2013;26:77.
  14. 14. Kotarinos RK. Pelvic floor physical therapy for management of myofascial pelvic pain syndrome in women. http://www.uptodate.com/home. Accessed April 8, 2013.
  15. Hunter C, et al. Neuromodulation of pelvic visceral pain: Review of the literature and case series of potential novel targets for treatment. Pain Practice. 2013;13:3.
  16. Acupuncture for pain. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/acupuncture/acupuncture-for-pain.htm. Accessed April 14, 2013.
DS00571 May 18, 2013

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