A physiatrist's understanding and application of the current literature on chronic pelvic pain: a narrative review

Allyson Shrikhande, Cory Ullger, Kyle Seko, Soha Patil, Janaki Natarajan, Yogita Tailor, Carolyn Thompson-Chudy, Allyson Shrikhande, Cory Ullger, Kyle Seko, Soha Patil, Janaki Natarajan, Yogita Tailor, Carolyn Thompson-Chudy

Abstract

Chronic pelvic pain (CPP) is a highly prevalent condition which is underdiagnosed and poorly understood. The purpose of this review is to outline the various aspects of the nature of CPP, including its etiologies, clinical presentation, and nonoperative treatment options. For data collection, a PubMed search was conducted using indexing terms such as chronic pelvic pain and pelvic pain. Literature reviews and studies focusing on etiologies, clinical presentation, and/or the diagnosis of CPP were compiled for review by a team of 3 physiatrists. Studies investigating conservative treatments, medications, and interventional procedures for CPP and related conditions with comparable etiologies were also included. Of the 502 articles retrieved, 116 were deemed suitable by the team for this study. Although CPP is a complex, multifaceted condition, a particular susceptibility to nociceptive stimuli was demonstrated as an underlying theme in its evolution. There are many treatment options currently used; however, more robust evidence, such as randomized controlled trials, are needed before creating comprehensive guidelines for treating CPP.

Keywords: Central sensitization; Chronic pelvic pain; Myofascial pain; Neurogenic pain; Pelvic pain; Peripheral sensitization.

Conflict of interest statement

The authors have no conflicts of interest to declare. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was approved by the Feinstein Institutes for Medical Research, IRB# 17–0761, and individual consent for this retrospective analysis was waived.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

Figures

Figure 1.
Figure 1.
Flow diagram: a summary of systematic search and review process.
Figure 2.
Figure 2.
Distribution of reported pain at study inclusion among women with and without chronic pelvic pain. Women with CPP are presented on the left side and those without CPP on the right side. Work by Torstensson et al. titled Referred pain patterns provoked on intra-pelvic structures among women with and without chronic pelvic pain: a descriptive study, copyright of Torstensson et al., 2015. Used under CC BY 4.0 License. https://creativecommons.org/licenses/by/4.0/.
Figure 3.
Figure 3.
Central sensitization and chronic overlapping pain conditions. Reprinted with permission from the Chronic Pain Research Alliance Initiative, the TMJ Association (TMJA), Ltd. Copyright TMJA. www.ChronicPainResearch.org. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.
Figure 4.
Figure 4.
The interactions between the various generators of chronic pelvic pain which cause a self-perpetuating cycle of pain and dysfunction. Work by Pelvic Rehabilitation Medicine. Reprinted with permission from Pelvic Rehabilitation Medicine. www.pelvicrehabilitation.com. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.
Figure 5.
Figure 5.
Diagram of dermatomes and innervation of the pelvic area, inferior view. From Ref. 11. Used by permission of Elsevier.
Figure 6.
Figure 6.
Inferior view of the anatomy of the female pelvis, focusing on the innervation of the pelvic floor musculature. Adapted from Paulsen F, Waschke J. Sobotta Atlas of Human Anatomy, 16th Edition. Elsevier GmbH, Urban and Fischer, Munich, Germany. Copyright 2018. Used by permission of Elsevier from the Copyright Clearance Center's Rights Link. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.
Figure 7.
Figure 7.
Inferior view of the anatomy of the male pelvis, focusing on the innervation of the pelvic floor musculature. Adapted from Paulsen F, Waschke J. Sobotta Atlas of Human Anatomy, 16th Edition. Elsevier GmbH, Urban and Fischer, Munich, Germany. Copyright 2018. Used by permission of Elsevier from the Copyright Clearance Center's Rights Link. Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.
Figure 8.
Figure 8.
Schematic sagittal view of sacral nerve roots and branches innervating male pelvic structures. From Ref. 60. Used under Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

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