Abstract: Chronic pelvic pain is a common medical problem with significant social, psychologic, and economic implications. It accounts for 10% of all gynecologic referrals, 1 40% of laparoscopies, 2 and 12% of hysterectomies 3 performed in the United States. With the highest frequency in young adult women at the peak of their productivity (mean age 30 yrs), chronic pelvic pain is associated with long-term suffering and disability, often leading to marital discord and divorce, loss of employment, and numerous medical and surgical interventions that are frequently unsuccessful and occasionally compounded by untoward effects and complications. The annual medical cost of the disorder is estimated to exceed $2 billion. Chronic pain differs from acute pain not only in duration but also in behavioral, psychologic, and physiologic manifestations. Over the roughly 6 months when the transition from acute to chronic pain occurs, the relief provided by various treatments progressively diminishes both in degree and duration. As the pain becomes chronic, other organ systems may manifest progressive symptomatology, including irritable bowel, urinary bladder dysfunction, diminished sexual interest and response, and low back and pelvic floor pain syndromes. As the physical disability and emotional distress progress over time, the patient's role at work, in the family and in society is altered as support progressively erodes. Eventually, pain becomes the most important problem for both the woman and her family. Hence, the urgent expectation of the physician to cure it. Classic Cartesian teaching assumes that pain is the direct result of pathologic processes. The injured tissue activates neurosensory fibers that register pain sensation to a degree that corresponds to the severity of the pathology. Real pain is associated with observable pathology. In the absence of identifiable tissue injury, the pain must be spurious or psychogenic. Although the Cartesian model may hold true for acute pain, it does not apply for most cases for chronic pelvic pain, in which a somatic etiology is identified in less than 50% of patients, and when it is, it may not account for the symptoms. This lack of correlation between the severity of symptoms and objective pathologic findings is a frequent source of exasperation and frustration for both the woman and the physician. The assumption that in the absence of somatic pathology the disorder must be psychogenic is equally frustrating and not supported by scientific evidence. Although depression may be a consequence, especially
Publication Year: 1996
Publication Date: 1996-02-01
Language: en
Type: editorial
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 1
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