Chronic Pelvic Pain
Chronic Pelvic Pain (CPP) is random in timing. CPP is Different from painful periods, or painful ovulation, or some monthly-type pain. CPP is NOT pain on intercourse. The diagnosis of CPP is made only after appropriate trials of oral contraceptives and/or Depo Provera, after leuprolide acetate, and in some cases laparoscopy. When the pain does NOT respond to any of those interventions, the diagnosis may be Chronic Pelvic Pain.
NON-Gynecologic Causes of Pelvic Pain
- Irritable bowel syndrome (IBS) or other bowel disorders can cause abdominal and pelvic pain.
- Interstitial cystitis (IC) can cause pelvic pain.
- Fibromyalgia can cause pelvic pain.
- Myofacial pain can cause pelvic pain.
- Depression can contribute to pelvic pain.
The diagnosis and treatment of these problems is usually PART of your evaluation and treatment. We will discuss these conditions, if appropriate, as we develop your treatment plan.
Many patients get to a point in their care where NOTHING has worked, and we have not actually FOUND anything with tests or surgery. This does NOT mean there is no pain, it simply means we can not “find” the source of the pain. There are ways to treat chronic pain, even when we cannot find the source. It is IMPORTANT to treat pain, because living with constant pain is difficult.
The goal is to find a combination of treatment to get you feeling “good enough.” You will continue to have some pain some of the time. It is not reasonable or possible to have “no pain.” But we will work hard to keep your pain out of the “too much” zone.
There are a number of medications used to treat chronic pain. None of these medicines have been specifically proven to work for CPP. Each medication has been borrowed from the treatments of OTHER types of chronic pain. Even so, these medicines were developed to treat seizures and mood problems, not to treat pain. We found that patients taking these medicines for OTHER reasons had less pain.
- Gabapentin (Neurontin) – a seizure medicine. Dose: 300 mg, one to five times per day.
- Amitriyptyline (Elavil) – a tri-cyclic antidepressant. Dose 75 to 300 mg each day.
- SSRIs (Prozac, Zoloft, Paxil, etc..) – antidepressants. Doses vary according to the medication.
- Narcotics (Percocet, Vicodin, etc..) – these are addictive pain medicines, and sometimes
- “Alternative medicine” – I do not prescribe alternative-medicines, but I do recognize that some patients will find these resources in the community, and more. It will be important to work together in finding a balance between “traditional” and “alternative” approaches to the problem.
The right medicine for you will depend upon a lot of things, including the side effects. We will discuss these medicines and their potential for helping you BEFORE deciding upon a prescription. Some patients benefit from evaluation and treatment by health care providers who specialize in treating chronic pain. We can discuss what role these specialists MAY play in your care.