Management of chronic pelvic pain

Abstract Chronic pelvic pain has a considerable impact on the general well being of women. A detailed history including emotional and childhood experiences is important. Laparoscopy is the gold standard investigation, although abnormal findings are not detected in all women with chronic pelvic pain. Conscious pain mapping is a useful additional investigation in those women where the diagnosis has not been established or the treatment has been unsuccessful. Pain caused by trigger points and nerve entrapment could be treated by local anesthetic infiltration, while the role of LUNA and presacral neurectomy is still debated. Ovarian suppression is effective in pelvic congestion and endometriosis. Some women who respond to ovarian suppression would benefit from a hysterectomy and bilateral salpingo-oopherectomy for recurrent pain. These women need to be appropriately selected after careful counselling. A multidisciplinary approach involving the gynaecologist, psychologist and pain therapist would be a way forward.