DR. ECHENBERG is part of St. Luke?s Ob/Gyn Associates, a hospital based practice in Bethlehem, Pa. He also directs a program for chronic pelvic pain.

Robert J. Echenberg, MD

The first step is taking the time to do a detailed medical history, review previous medical records, and initially determine whether the patient fits the common profile of women with CPP (Table 1). We then have an in-depth discussion with the patient about chronic pain to ensure that she understands the physiology of her symptoms and the "triggers" that might be at work in her case. Finally, a careful and thorough physical and pelvic exam is performed, based on the International Pelvic Pain Society's model.  

To date, our outcomes with this approach have been very encouraging and most of our patients have incremental improvement in quality of life after only a few months of treatment. Because the program results in far fewer invasive surgical and diagnostic procedures, it has also helped to contain costs. In short, we believe that gynecologists can effectively treat common, painful symptom complexes. The key is an understanding of the neurophysiology of chronic pain and a multidisciplinary approach to therapy.  

*Defined as more than 6 months of a wide variety of painful  symptoms located anywhere between the umbilicus and mid-thigh and characterized by intermittent, non-cyclic, brief or prolonged episodes, often associated with urinary, intestinal, vaginal, and vulvar symptoms, and resulting in significant professional, social, interpersonal, and sexual dysfunctions.			

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REFERENCES				1. Gambone JC, Mittman BS, Munro MG, et al. Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process.

2. Levy BS. Nonsurgical management of chronic pelvic pain. 

 Chronic Pelvic Pain: An Integrated Approach.

 Philadelphia, Pa: W.B. Saunders Co.; 1998. 

4. Howard FM, Perry CP, Carter JE, et al.

 Philadelphia, Pa: Lippincott Williams & Wilkins; 2000. 

Robert J. Echenberg, MD

Articles

Clinician to Clinician: A program for managing chronic pelvic pain