From the Guidelines
Ovarian vein embolization is the most effective interventional technique for chronic pelvic pain, with early substantial pain relief observed in 75% of women undergoing embolization, and sustained over time 1. When considering interventional techniques for chronic pelvic pain, it is essential to evaluate the available options based on their efficacy and safety.
Available Techniques
- Ovarian vein embolization: This technique has been shown to provide significant symptomatic improvement, with approximately 75% of women experiencing substantial pain relief 1.
- Sclerotherapy: Often used in conjunction with ovarian vein embolization, sclerotherapy can provide additional pain relief.
Key Considerations
- The success rates for endovascular treatment of pelvic venous disease have been favorable, with low complication rates 1.
- Complications of embolization procedures, such as thrombophlebitis and embolization of nontarget vessels, have been noted in up to 9% of patients 1.
- Post-embolization abdominal discomfort is usually self-limited or treated with analgesic or anti-inflammatory medications 1.
Important Notes
- Excluding other causes, such as nutcracker syndrome, is crucial before proceeding with ovarian vein embolization 1.
- While the evidence is limited to single-center case series, the available data suggest that ovarian vein embolization is a effective treatment option for chronic pelvic pain 1.
From the Research
Interventional Techniques for Chronic Pelvic Pain
The following interventional techniques are available for chronic pelvic pain:
- Superior and inferior hypogastric plexus blocks 2
- Ganglion impar blocks 2
- Transversus abdominis plane blocks 2
- Ilioinguinal, iliohypogastric and genitofemoral blocks 2
- Pudendal nerve blocks 2
- Selective nerve root blocks 2
- Trigger point injections 2, 3
- Sacroiliac joint injections 2
- Neuromodulation approaches 2
- Pelvic floor physical therapy 4, 3
- Pelvic floor trigger point injections with anesthetics or botulinum toxin A 3
- Cryotherapy 3
- Muscle relaxants and intravaginal benzodiazepines 3
Multidisciplinary Approach
A multidisciplinary approach to managing chronic pelvic pain is recommended, including:
- Patient education 3, 5
- Pelvic floor physical therapy 4, 3, 5
- Multidisciplinary care teams 4, 5
- Rehabilitation models that emphasize achieving higher function with some pain rather than a cure 5
- Appropriate use of opiates for the chronic pain state 5
- Alternative therapies 5
- Cognitive-behavioral therapy 5
- Exercise and posture therapy 5
Medical and Surgical Therapies
Medical and surgical therapies for chronic pelvic pain include:
- Hormonal treatment of chronic pelvic pain of gynaecologic origin, including oral contraceptives, progestins, danazol, and gonadotropin-releasing hormone agonists 5
- Adjuvant medications, such as antidepressants and antibiotics 5
- Opioid therapy for pain control under adequate supervision 5
- Appendectomy and presacral neurectomy for endometriosis-related pain 5