A Woman Who Suffers Always and Forever: Management of Chronic Pelvic Pain
Chronic pelvic pain (CPP) in women is a long-lasting condition and affects about 5–26 % of women in the general population. The pathogenesis is poorly understood. The role of various somatic factors, such as endometriosis and adhesions, as a cause of pelv
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P.T.M. Weijenborg and Moniek M. ter Kuile
11.1 Introduction and Aims Chronic pelvic pain (CPP) in women affects about a quarter of women in the general population. The pathogenesis is poorly understood. The aim of this chapter is to provide insight into the role of various somatic factors and psychosocial variables as possible causal or contributing factors to pelvic pain. Cognitive behavioral approach of CPP women is advocated and illustrated.
11.2 Definition in Lay Terms Chronic pelvic pain (CPP) in women is commonly described as a continuous or intermittent pain in the lower abdomen not exclusively related to menstrual period (dysmenorrhea) or sexual intercourse (dyspareunia) and which lasts for at least 3 months [1]. This description does not go into what the experience of pain might be. Fortunately, the definition of chronic pain by the International Association for the Study of Pain (IASP) gives some more information, as chronic pain is characterized as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
P.T.M. Weijenborg, MD, PhD (*) • M.M. ter Kuile, PhD Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2017 K.M. Paarlberg, H.B.M. van de Wiel (eds.), Bio-Psycho-Social Obstetrics and Gynecology, DOI 10.1007/978-3-319-40404-2_11
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P.T.M. Weijenborg and M.M. ter Kuile
11.3 Didactic Goals After reading this chapter, you: • • • •
Will be familiar with the definition of chronic pelvic pain and chronic pain Will be familiar with the epidemiology of chronic pelvic pain in women Will be familiar with the etiologies of chronic pelvic pain in women Will be familiar with the results of different treatment modalities and its effectiveness in women with CPP • Will be familiar with a structured interview according to the “model of consequences” to address the complaint and its impact in everyday life • Will be familiar with those specific conversational skills to motivate a CPP patient for pain management
Case History
Renata Emerald is 43 years old and has suffered from pelvic pain for 2 years. She lives with her husband and two daughters, 11 and 9 years old. The complaint started following a common urinary tract infection. Pain persisted despite two additional courses of antibiotics. Renata consulted three medical professionals: urologist, gastroenterologist, and gynecologist. Blood and urine analyses were done as well as abdominal and vaginal ultrasound, cystoscopy, laparoscopy, coloscopy, gastroscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI) with contrast. So far, these investigations have not shown any abnormality that could be associated with the complaint. Only a small uterus myomatosus was found. Now, Renata asks for a second opinion because she wants a hysterectomy to solve her chronic pelvic pain.
11.4 F acts and Figures: Definitions, Classific
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