Chronic pelvic pain can have many sources. Successfully treating and curing this condition requires determining the exact causes for the pain and addressing each cause individually and completely. A shotgun approach rarely results in an adequate relief of pain and a return to a normal lifestyle for the individual who suffers from this condition. Putting “bandaids” on the pain by prescribing chronic narcotic therapy and other “chronic pain management” solutions only masks the pain and does not cure it.
My approach to treating the patient with pelvic pain is an initial, detailed history that includes, but is not limited to, when the pain first began, how it has changed with time, the exact nature, location, and intensity of the pain, whether the pain radiates, what makes the pain better and what makes the pain worse. What are the other symptoms that are associated with the pain. What is the timing of the pain to the menstrual cycle. Are there any other associated symptoms or conditions that the patient feels may be associated with or be contributing to the pain. I then perform a general physical examination including a detailed examination of the areas that are involved with the pain. Initially, I prefer to gather all of this data at a time when the patient is not in pain. This tends to permit a more complete gathering of the historical information regarding the pain while at the same time permits me to establish baseline physical findings.
The second step to successfully evaluating and treating pelvic pain is to have the opportunity to evaluate the patient while she is in her classic pelvic pain with their classic symptoms. These do not have to be the most intense of the symptoms, but they have to be of the same nature and in the same location as when the patient routinely experiences this pain.
During this acute episode of pain, I want to establish that this is the same pain as the patient has been experiencing chronically. This is done by taking a detailed history of the current episode of the pain. I then proceed with a focused, detailed physical examination which generally entails an examination of the back, abdomen, pelvic examination, including digital examination, and a vaginal ultrasound.
Following this evaluation of the patient in an acute pain episode, I generally have a very good idea as regards the source of the pain. I then discuss this with the patient and, if they are required, order further laboratory or radiologic studies that may be useful in further confirming the diagnosis.
Once all of these studies and evaluations are performed, I sit down with the patient and review all the findings. We then discuss what I feel are these origins of the pain and what are the therapeutic options to treat the pain. I feel that my obligation is to present all of the therapeutic options openly, fairly, and evenly to the patient, including realistic expectations of the chances for pain relief with the different treatments. It is then the patient’s responsibility to let me know how they would like to proceed.
Twenty eight years of experience using this approach to the evaluation and treatment of chronic pelvic pain has permitted me to achieve a very high success rate with either a complete alleviation of the pain or a dramatic modification of the pain such that the patient is able to resume their normal, happy, functional lifestyle. I do not believe in putting “bandaids” on the pain with narcotics or “chronic pain management” solutions. Instead, I look to cure the pain.
If you have any questions about my approach to the assessment and treatment of chronic pelvic pain, please do not hesitate to contact me.