Treatment options for chronic pelvic pain in primary care
| Type of therapy | Examples or description | Comments |
|---|---|---|
| Medications | ||
| Simple analgesics | Acetaminophen, nonsteroidal anti- inflammatory drugs (NSAIDs) | Avoid prolonged use of NSAIDs due to potential toxicities |
| Neuropathics | Amitriptyline, gabapentin | Gabapentin may be more efficacious than amitriptyline |
| Hormonal therapies | Oral contraceptives, gonadotropin- releasing hormone (GnRH) analogues, progestogens, danazol | GnRH analogues are more effective for pain relief than oral contraceptive pills |
| Antispasmodics | Dicyclomine | May worsen constipation |
| Neuromodulators | Botulinum toxin A | Very effective for pelvic floor spasm |
| Other | Pentosan polysulfate sodium | First-line therapy for interstitial cystitis |
| Pelvic physical therapy | ||
| Strengthening (up-training) | Contracting the pelvic floor in isolation | Improves symptoms of pelvic heaviness and discomfort |
| Relaxation (down-training) | Stretching, meditation, internal and external manual release of involved muscle groups | Improves symptoms of chronic pelvic pain due to overactive pelvic muscles |
| Biofeedback | Surface electromyography in conjunction with strengthening and relaxation | Allows visual feedback on muscle control; useful for strengthening or relaxation and treatment of reflexive pelvic floor spasm |
| Vaginal dilators | Tool for stretching, pain-free vaginal insertion | Restores flexibility and coordination of pelvic floor |
| Psychosocial interventions | ||
| Collaborative goal-setting | Identify what has improved patients’ current symptoms to develop goals | Very individualized and specific Short-term goals Assess progress during each visit and modify goals as needed |
| Progressive muscle relaxation | Systematic tensing and relaxing of each large muscle group progressing from toes to head | Establish a practice goal (number of practices per week) Allows for partner participation Can be done with other relaxation techniques (eg, visualization, deep breathing) |