Chronic Pelvic Pain

Publication Date: February 29, 2020
Last Updated: March 14, 2022

Recommendations

The routine use of laparoscopic adhesiolysis is not recommended for the management of chronic pelvic pain.
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Referral for pelvic floor physical therapy, sex therapy, or cognitive behavioral therapy, alone or in combination, is recommended to manage the myofascial and psychosocial causes and consequences of chronic pelvic pain and associated dyspareunia.

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Based upon their effectiveness for other neuropathic pain syndromes, serotonin–norepinephrine reuptake inhibitors are recommended for patients with neuropathic chronic pelvic pain.
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Based upon their effectiveness for other neuropathic pain syndromes, gabapentin and pregabalin are recommended for the treatment of neuropathic chronic pelvic pain.
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Opioids are not recommended for the treatment of chronic pelvic pain. Patients already on opioids should be slowly weaned.

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Trigger point injections of saline, anesthetic, steroids, or opioids, in isolation or in combination with other treatment modalities, are recommended to improve pain and functional ability in patients with myofascial chronic pelvic pain.
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A detailed medical history and physical examination, with particular attention to the abdominal and pelvic neuromusculoskeletal examination, are recommended for the evaluation of chronic pelvic pain.
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Evaluation for common nonreproductive conditions that contribute to chronic pelvic pain should include screening for interstitial cystitis or painful bladder syndrome, irritable bowel syndrome, diverticulitis, and comorbid mood disorders (depression, anxiety). Additional testing or referral may be required for patients who screen positive for any of these conditions to rule out other causes of urinary, gastrointestinal, or constitutional symptoms in patients with risk factors.
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Referral to pain medicine specialists may be part of the multidisciplinary care of women with chronic pelvic pain. The timing of consultation or referral to multidisciplinary care should be individualized based upon the complexity of the patient’s condition, the primary clinician’s expertise, and the availability of resources.
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Based on evidence of benefit for the treatment of nongynecologic chronic pain, acupuncture and yoga can be considered for the management of chronic pelvic pain of musculoskeletal etiology.
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Recommendation Grading

Overview

Title

Chronic Pelvic Pain

Authoring Organization

American College of Obstetricians and Gynecologists

Publication Month/Year

February 29, 2020

Last Updated Month/Year

April 1, 2024

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D059350 - Chronic Pain, D010146 - Pain, D059388 - Pelvic Girdle Pain, D017699 - Pelvic Pain

Keywords

chronic pain, pelvic pain