Diagnosis, treatment and follow up of women undergoing conscious pain mapping for chronic pelvic pain: a prospective cohort study

Objective  To assess the efficacy of conscious pain mapping in diagnosing and treating chronic pelvic pain (CPP). Design  Prospective cohort study. Setting  Gynaecology Department, UK District General Hospital. Population  Forty-three women diagnosed with CPP. Methods  The cohort was followed up for 18–24 months after diagnosis and treatment based on conscious pain mapping. Main outcome measures  Improvement of pain assessed by using visual analogue scale (VAS) pain scores at 6-month follow up. Results  Thirty-nine women had successful conscious pain mapping. Pelvic pathology was identified in 18, pelvic congestion in 13 and 8 women had normal pelvic organs. In 35 women (90%), conscious pain mapping identified the cause of pain. Five out of eight women (63%) who were judged to have a normal pelvis had positive findings at pain mapping. VAS scores fell significantly from pre-treatment to post-treatment values at 6-month follow up (P < 0.01). Overall, 26 women (74%) felt that their symptoms had improved after treatment based on findings at pain mapping. However, we concluded that pain mapping only contributed to the diagnosis and treatment in seven women (27%), who may not have received appropriate diagnosis and treatment if they had a laparoscopy under general anaesthetic. Conclusions  Conscious pain mapping is a useful additional investigation in the management of women with CPP. It can be employed in women with a negative laparoscopy or with visible pathology where the conventional treatment has failed.