The current treatment methods for chronic pelvic pain include medication (herbal and western medicine treatment), psychotherapy, surgery and physical therapy, etc.
I. Drug treatment
1.Analgesic drugs
They are commonly used by patients with chronic pelvic pain, and their application should follow the principle of general pain treatment, both stepwise medication. Analgesic drugs mainly include non-steroidal anti-inflammatory drugs (including COX-2 inhibitors) and opioids, etc.
2.Anxiolytic drugs
For patients with chronic pelvic pain who have depression, they should be treated with antidepressants, commonly used are tricyclic antidepressants (such as amitriptyline and doxepin) and selective 5-hydroxytryptamine reuptake inhibitors (SSRIs, such as sertraline).
3.Trigger point local injection of anesthetics
The relationship between muscle and fascia trigger points and slow pelvic pain has been recognized. Studies have shown that local injection of anesthetics at trigger points in the abdominal wall, vagina, and sacrum can relieve 68% of chronic pelvic pain.
4., Combination of oral contraceptives
Oral contraceptives can significantly improve dysmenorrhea. The mechanisms may be: inhibition of ovulation, inhibition of involuntary uterine contractions, stabilization of estrogen and progesterone levels, and increase in prostaglandin levels, thus reducing pain associated with menstruation and relieving related symptoms. These mechanisms may be involved in the process of oral contraceptives for other gynecological pain at the same time.
5. Hypothalamic gonadotropin-releasing hormone analog (GnRHa)
Many clinical trials have demonstrated that GnRHa is comparable to danazol in relieving pelvic pain associated with EMs. However, one study showed good pain relief with GnRHa in patients suspected of having EMs, regardless of whether these patients in fact had EMs or not. Although GnRHa is generally considered by obstetricians and gynecologists to be particularly effective in the treatment of pain associated with EMs, it is actually equally effective in chronic pelvic stasis syndrome, interstitial cystitis, and irritable bowel syndrome.
6. Progesterone
Clinical trials have demonstrated the effectiveness of progesterone in the treatment of chronic pelvic pain associated with EMs and pelvic stasis syndrome. Long-acting medroxyprogesterone acetate, 30-100mg/day, can significantly relieve the associated pain, as can progesterone and ethinylestradiol for EMs and pelvic stasis syndrome.
7. Others
Anticonvulsants such as lamotrigine, carbamazepine and myorelaxants are also effective in chronic pelvic pain. Combination of drugs can be chosen for treatment, such as the combination of myorelaxants and non-steroidal anti-inflammatory drugs for better effect.
Second, surgical treatment
At present, it is generally believed that laparoscopic exploration should be preferred for patients with chronic pelvic pain, and the corresponding treatment should be carried out at the same time of diagnosis, so as to achieve the best diagnosis and treatment effect with minimum trauma. The mode of surgery and the scope of surgery depend on the patient’s age, etiology, symptoms, signs and whether there are fertility requirements.
III. Psychological treatment
Psychological factors play an important role in the development of chronic pelvic pain, and some patients with chronic pelvic pain have neuropsychiatric factors. Therefore, it has been suggested that neuropsychiatric evaluation and consultation should be the routine treatment for chronic pelvic pain. Treatments such as cognitive therapy and behavioral changes are helpful for patients with chronic pelvic pain. A follow-up study of patients with chronic pelvic pain caused by pelvic stasis syndrome found that psychotherapy, as an adjunct to treatment, could increase patients’ confidence and enhance the effectiveness of medication. For patients with long medical history, depression or anxiety, gynecologists should be patient and meticulous in the treatment process, with a sincere attitude and sympathy for the patients, and patiently answer their questions. If necessary, psychologists should be asked to assist in the diagnosis and treatment.
In conclusion, the cause of chronic pelvic pain is complex and not easy to diagnose, and sometimes no clear cause can be found even after laparoscopic examination. The degree of pain in patients does not necessarily correspond to the degree of lesion, and psychological factors play an important role in the pathogenesis of the disease, and patients are mostly accompanied by neuropsychiatric symptoms such as depression, paranoia, and anxiety. Therefore, the diagnosis and treatment of chronic pelvic pain are complicated, and there is no mature diagnosis and treatment experience, and many problems remain to be solved, requiring multidisciplinary departments such as obstetrics and gynecology, gastroenterology, urology, sports medicine, and psychoneurology, rehabilitation physiotherapy and pain medicine to jointly study the condition, make a diagnosis and develop a treatment plan.