Chronic pelvic pain: 11 critical questions about causes and care
An expert explores anatomic and mechanistic bases of chronic pelvic pain in women to clarify optimal diagnosis, management, and treatment
IN THIS ARTICLE
11. How is treatment affected by multiple diagnoses?
The presence of multiple diagnoses often reflects neuropathic changes and neuropathic pain. An accurate diagnosis of all pain generators, including neuropathic pain, seems vital to improving our management and treatment of women who have CPP.
For example, in Sara B.’s case, I prescribed norethindrone acetate to suppress menses, based on her history of endometriosis-associated pelvic pain and menstrual exacerbation of her symptoms. I prescribed oral pentosan polysulfate sodium and intravesical lidocaine and heparin for interstitial cystitis/painful bladder syndrome. And I gave Sara amitriptyline for both fibromyalgia and interstitial cystitis/painful bladder syndrome (as well as suspected neuropathic pain).
I also recommended a low-fat, high-fiber diet to help alleviate her irritable bowel syndrome.
