Chronic pelvic pain is a complex medical condition that affects approximately 20% of US women. It is associated with negative cognitive, behavioral, sexual, and emotional consequences and presents with symptoms suggestive of multiorgan involvement. In the Unites States, chronic pelvic pain accounts for 10% of all gynecology office visits, and 40% of laparoscopies. Nearly 60% of women with CPP have a laparoscopy, yet more than 2/3 of laparoscopies do not elucidate the cause of the pelvic pain. Although 12% of hysterectomies are performed for pain management, studies question the effectiveness of surgical intervention in the management of chronic pelvic pain. This lecture will review recent research on surgical outcomes in women with CPP. It will focus on systematic reviews and review the best evidence available to evaluate the effectiveness of surgery such as hysterectomy, pelvic adhesiolysis, and excision of endometriosis. For instance, there is no evidence that the method of endometriosis treatment, ablation vs. excision, is more effective in treating pelvic pain. We will discuss the utility of laparoscopy and when to perform a laparoscopy for diagnosis of chronic pelvic pain. The lecture will also review risk factor for surgical success and give practical information on how to identify these risk factors preoperatively. It will provide clinicians with the information needed to better educate patients and improve surgical outcomes. The lecture will also discuss evaluation and management of chronic pelvic pain, including identification of overlapping pain syndromes, central sensitization, and the effect that these health states have on surgical outcomes.
Learning Objectives:
List the basic epidemiology and risk factor for chronic pelvic pain in women
Discuss the evidence on surgical outcomes among patients with CPP
Explain the impact of central sensitization and overlapping pain syndromes on CPP
