Clinician to Clinician: A program for managing chronic pelvic pain

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.

CLINICIAN to CLINICIAN offers the hard-won wisdom and expertise of physicians "in the trenches." We're looking for unusual case reports, anecdotes about innovative treatments, and practical solutions for professional problems from community physicians. Send your submission of 750 words or less to Editor in Chief Charles J. Lockwood, MD, by e-mail
fax (973-847-5340) or mail (5 Paragon Drive, Montvale, NJ 07645). All submissions are subject to peer review by the Contemporary OB/GYN Editorial Board. Neverth eless, the concepts discussed may be anecdotal in nature.

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. Fertil Steril. 2002;78:961-972.

2. Levy BS. Nonsurgical management of chronic pelvic pain. J Am Assoc Gynecol Laparosc. 1997;4:551-557.

3. Steege JA, Metzger DA, and Levy B. Chronic Pelvic Pain: An Integrated Approach. Philadelphia, Pa: W.B. Saunders Co.; 1998.

4. Howard FM, Perry CP, Carter JE, et al. Pelvic Pain: Diagnosis & Management. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000.

5. Howard FM. Chronic pelvic pain. Obstet Gynecol. 2003;101:594-611.

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