From the Guidelines
For a 52-year-old woman with chronic pelvic pain syndrome who hasn't found relief with opioids, the next steps should focus on a holistic, multimodal approach that involves a comprehensive interdisciplinary team, as recommended by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain 1. This approach may include patient education on the neurophysiology of pain, physical therapy, occupational therapy, and behavioral therapy.
- The goal of treatment is to restore function and improve quality of life, rather than just decreasing pain severity.
- Pain assessments should focus on achieving functional goals, decreasing pain severity, and identifying and addressing any treatment-related adverse events or behaviors.
- A new report of pain by a patient being treated for chronic pain must be reevaluated to determine whether a new painful symptom is related to worsening of current pathology or the development of new pathology. Some key considerations for this patient include:
- Consulting with a multidisciplinary pain management team that includes gynecologists, pain specialists, and physical therapists to develop a comprehensive treatment plan.
- Alternative medication options, such as tricyclic antidepressants or anticonvulsants, may be considered to help manage pain.
- Pelvic floor physical therapy is essential and should be pursued for at least 8-12 sessions.
- Lifestyle modifications, including gentle exercise, stress reduction techniques, and dietary changes to reduce inflammatory foods, may also provide benefit as part of a comprehensive treatment plan, as suggested by the concept of a holistic approach to pain management 1.
From the Research
Next Steps for Chronic Pelvic Pain Syndrome
The next steps for a 52-year-old woman with chronic pelvic pain syndrome who hasn't found relief with opioids include:
- A comprehensive evaluation to identify underlying conditions that may be contributing to the pain, such as endometriosis, interstitial cystitis, or irritable bowel syndrome 2
- A multidisciplinary approach to management, involving a team of clinicians including primary care physicians, subspecialty physicians, physical therapists, and behavioral health specialists 2, 3
- Consideration of non-pharmacologic interventions, such as:
- Evaluation of the patient's psychosocial history, including screening for depression, anxiety, posttraumatic stress disorder, and physical and sexual abuse 2, 6
- Consideration of non-opioid medications, such as analgesics, hormone modulating agents, antidepressants, and anticonvulsants 4
- A discussion of expectations for long-term care and involvement of the patient in shared decision-making and functional goal setting 6