Chronic Pelvic Pain (CPP) Flashcards
What is the feminist approach to addressing chronic pelvic pain (CPP)?
It challenges the automatic focus on gynecologic pathology, advocating for a holistic, multidisciplinary approach.
How is pelvic pain broadly classified?
-Acute: Pain lasting less than 3 months, intense, sudden, sharp.
-Chronic (CPP): Pain lasting more than 6 months, originating from pelvic organs or structures, often associated with negative behavioral consequences.
What is the global prevalence of CPP?
Affects 6%–27% of women aged 14–80, with 10%–40% visiting clinics for CPP.
What are the two primary sources of pelvic pain?
-Visceral pain: From internal organs, often linked to strong muscle contractions.
-Somatic pain: Superficial (body surface) or deep (muscles, joints, bones, connective tissue).
Differentiate nociceptive and neuropathic pain.
-Nociceptive pain: “Pain with a purpose,” arises from tissue damage, activating nociceptors.
-Neuropathic pain: “Pain without purpose,” caused by lesions or diseases affecting the somatosensory system.
What psychological factors are relevant to CPP?
Psychosocial stress, depression, and abuse can exacerbate or contribute to CPP.
What are the characteristics of acute pelvic pain?
Rapid onset, sharp intensity, lasting less than 7 days, and may be cyclic or noncyclic.
How does CPP impact daily life?
Severe CPP can impair normal functioning, often delaying treatment until activities of daily living are significantly affected.
What is the mnemonic OLD CAARTS used for in CPP assessment?
O: Onset
L: Location
D: Duration
C: Characteristics
A: Alleviating or aggravating factors
A: Associated symptoms
R: Radiation
T: Temporal
S: Severity
What histories are important to take during CPP assessment?
Detailed obstetric, surgical, sexual, psychosocial histories, and substance use (narcotics, alcohol, recreational drugs).
How does the physical exam contribute to CPP diagnosis?
Connects history with physical findings, using observation (gait, movement), palpation, pain mapping, and tenderness-guided endovaginal ultrasound.
What diagnostic tests are useful for CPP?
-Lab tests: CBC, ESR, TSH, pregnancy test, STI cultures, stool guaiac.
-Imaging: Ultrasound, CT scan, barium enema, laparoscopy.
What are common gynecologic causes of CPP?
-Endometriosis: Pain before/during menses.
-Adhesions: Abnormal tissue connections between organs.
-Pelvic congestion syndrome: Chronic uterine blood vessel dilation.
-Vulvodynia: Chronic vulvar pain lasting ≥3 months.
What are common nongynecologic causes of CPP?
-IBS: Recurrent pain/discomfort with constipation or diarrhea.
-Interstitial cystitis: Urinary frequency, urgency, pelvic pain.
-Musculoskeletal disorders: Myofascial pain.
What are nonpharmacologic treatments for CPP?
Physical therapy. Aerobic and nonaerobic exercise.
What pharmacologic treatments are available for CPP?
-Pain relief: Oral analgesics, COX-2 inhibitors, opioids.
-Hormonal: COCs, GnRH agonists (goserelin), progestogens.
-Neuropathic pain: Tricyclic antidepressants (amitriptyline, nortriptyline).
What surgical treatments are used for CPP?
Excision/ablation of endometrial tissue, hysterectomy, vaginal mesh placement.
What complementary and alternative therapies help manage CPP?
Acupuncture, biofeedback, herbal supplements.
TENS therapy for dysmenorrhea or myofascial pain.
What special considerations are there for adolescents with CPP?
CPP is often gynecologic in origin (e.g., PID).
Rapport building is crucial; follow legal statutes for minors.
How should CPP in women of reproductive age be approached?
Treatment depends on pregnancy plans and addressing infertility risks (e.g., endometriosis, elevated CA-125).
What considerations apply to older women with CPP?
Symptom management is key. Minorities may experience healthcare disparities, and cultural factors influence treatment options.
What cultural factors influence CPP management?
Culture affects symptom reporting and diagnosis.
Women from different backgrounds express pain differently, and abuse history may increase pain-related disability.
What are examples of emerging CPP therapies?
-Vaginal diazepam suppositories for myofascial pain.
-Topical capsaicin therapy.
-Cannabinoids, modified opioids (tapentadol).
-Nerve stimulation and yoga for pain relief.
What role does education play in CPP management?
Providing resources like the International Pelvic Pain Society booklet helps patients understand and manage their condition.
