Abstract
Objective
To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based
guidelines of value to primary care health professionals, general obstetricians and
gynaecologists, and those who specialize in chronic pain.
Burden of Suffering
CPP is a common, debilitating condition affecting women. It accounts for substantial
personal suffering and health care expenditure for interventions, including multiple
consultations and medical and surgical therapies. Because the underlying pathophysiology
of this complex condition is poorly understood, these treatments have met with variable
success rates.
Outcomes
Effectiveness of diagnostic and therapeutic options, including assessment of myofascial
dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving
higher function with some pain rather than a cure, and appropriate use of opiates
for the chronic pain state.
Evidence
Medline and the Cochrane Database from 1982 to 2004 were searched for articles in
English on subjects related to CPP, including acute care management, myofascial dysfunction,
and medical and surgical therapeutic options. The committee reviewed the literature
and available data from a needs assessment of subjects with CPP, using a consensus
approach to develop recommendations.
Values
The quality of the evidence was rated using the criteria described in the Report of
the Canadian Task Force on the Periodic Health Examination. Recommendations for practice
were ranked according to the method described in that report (Table 1).
Recommendations
The recommendations are directed to the following areas: (a) an understanding of the
needs of women with CPP; (b) general clinical assessment; (c) practical assessment
of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d)
principles of opiate management; (f) increased use of magnetic resonance imaging (MRI);
(g) documentation of the surgically observed extent of disease; (h) alternative therapies;
(i) access to multidisciplinary care models that have components of physical therapy
(such as exercise and posture) and psychology (such as cognitive-behavioural therapy),
along with other medical disciplines, such as gynaecology and anesthesia; G) increased
attention to CPP in the training of health care professionals; and (k) increased attention
to CPP in formal, high-calibre research. The committee recommends that provincial
ministries of health pursue the creation of multidisciplinary teams to manage the
condition.
Key Words
- Pelvic pain
- myofascial pain syndromes
- endometriosis
- endosalpingiosis
- adenomyosis
- pelvic peritoneal defects
- pelvic inflammatory disease
- adhesions
- ovarian cysts
- residual ovary syndrome
- ovarian remnant syndrome
- pelvic congestion syndrome
- hysterectomy
- uterine fibroids
- adnexal torsion
- diagnostic imaging
- laparoscopy
- hormonal treatment
- complementary therapies
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Article info
Publication history
No 164, August 2005 (Reaffirmed November 2018)
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
All people have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate and tailored to their needs.
This guideline was written using language that places women at the centre of care. That said, the SOGC is committed to respecting the rights of all people - including transgender, gender non-binary, and intersex people - for whom the guideline may apply. We encourage healthcare providers to engage in respectful conversation with patients regarding their gender identity as a critical part of providing safe and appropriate care. The values, beliefs and individual needs of each patient and their family should be sought and the final decision about the care and treatment options chosen by the patient should be respected.
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© 2018 Published by Elsevier Inc. on behalf of Society of Obstetricians and Gynaecologists of Canada.
