Chronic Pelvic Pain

Understanding the Principles of Chronic Pelvic Pain

Chronic Pelvic Pain (CPP) is one of the most common medical problems affecting women today. One in seven of all American women, ages 18-50, suffer from CPP. Yet of these 9.2 million sufferers, 61% still have no diagnosis. Jewish Hospital Medical Center East Center for Gender-Specific Medicine has partnered with The Pelvic Pain Regional Specialty Center, PLLC in order to bring diagnosis and treatment to the millions of women suffering from CPP.

Diagnosis and treatment of CPP accounts for 10% of all outpatient gynecologic visits, 20% of laparoscopies and 12-16% of hysterectomies at a cost of as high as $2.8 billion annually. The personal cost to those suffering from CPP is even greater, affecting all aspects of their lives. The pain of CPP makes one fourth of affected women bedridden for almost three days a month; 58% of those women must at least cut down on their usual daily activity one or more days a month. Mild depression is also a side effect, as well as a significant drop in intercourse.

In order to determine if the problem you have is truly Chronic Pelvic Pain or another type of pain problem, you must first understand the definition of CPP. In Chronic Pelvic Pain, the pain itself has become the disease and is the diagnosis. The initial physical problem lessens or disappears, but the pain continues because of changes in the nervous system, muscles or other tissues.

There are six features common to all patients with Chronic Pelvic Pain Syndrome:

• The pain has been present for six months or more;
• Conventional treatments have yielded little relief;
• The degree of pain perceived seems out of proportion to the degree of tissue damage detected by conventional means;
• Physical appearance of depression is present (e.g., sleep disturbance, constipation, diminished appetite, “slow motion” body movements and reactions);
• Physical activity has become increasingly limited; and
• Emotional roles in the family are altered; the patient is displaced from her accustomed role (e.g., wife, mother, employee).

There are three basic elements to chronic pain that should be considered:

Pathology at the site of Origin

If the original source of tissue injury remains, pain will continue. This is called pathology at the site of origin (e.g., endometriosis, adhesions, infection, etc.).

Referred (Antidromic) Pain

Two types of nerves exist: visceral nerves carry impulses from intra-abdominal and thoracic structures into the spinal cord, while somatic nerves innervate superficial tissues, muscle and skin. Both of these type of nerve may meet (synapse) with the same nerve cell in the spinal cord and in this way have an influence on each other. When the visceral nerves are chronically stimulated with pain, the impulse will spill over to the somatic nerve, causing pain in the abdominal wall, pelvic muscles and superficial tissues. Specific areas of tenderness develop at those sites termed trigger points. The trigger points may eventually evolve into the patient’s main source of pain and in some cases treatment of those trigger points will reduce the pain. In other cases, the main tissue injury must also be treated (surgical removal of endometriosis, adhesions, etc).

Central Modulation by the Brain

The brain influences emotions and behavior and interacts with the spinal cord, modifying the perception of the visceral and referred pain. For instance, depression may allow more pain signals through to the brain. This is called central modulation by the brain. Central influences must also be treated with various psychological, physical and pharmacologic therapies.

All three elements must be treated simultaneously in order for there to be any hope of successful treatment of Chronic Pelvic Pain.

Please call Jewish Hospital Medical Center East Center for Gender-Specific Medicine to find out more information or schedule an appointment at (502) 259-6000.