When treating chronic pelvic pain in women, consider peripheral
and central contributors
Adis Medical Writers
Published online: 13 July 2017
Ó Springer International Publishing AG 2017
Abstract The management of chronic pelvic pain (CPP) in
women requires a multimodal approach, as such pain is
often generated both centrally and peripherally. The role of
neurobiological and neuropsychological factors in con-
tributing to CPP should be considered. The comprehensive
management of CPP in women includes the use of phar-
macological options (e.g. analgesics, hormonal suppres-
sion, anaesthetics, antidepressants, membrane stabilizers
and anxiolytics) and non-pharmacological interventions
(pelvic ﬂoor physical therapy, cognitive behavioural ther-
apy, lifestyle modiﬁcations).
Chronic pelvic pain is complex and multifaceted…
Chronic pelvic pain (CPP) is deﬁned as non-cyclic pain
localized to the anatomic pelvis, anterior abdominal wall at
or below the umbilicus, the lumbosacral back or the but-
tocks that has lasted for [6 months and is severe enough to
cause functional disability or require medical care .
Thought to affect 15–20% of women in the USA, CPP is
often a cluster of symptoms arising from multiple organ
systems, and may be gynaecological (&30% of cases),
urological, gastrointestinal, myofascial or neuropathic in
origin. The treatment of CPP, therefore, requires collabo-
ration across a number of medical areas . This article
presents a summary of the pharmacological options for the
management of CPP, as outlined by Carey et al. , with a
focus on pain of gynaecological aetiology (e.g.
endometriosis, adenomyosis., uterine ﬁbroids).
… and potentially generated both centrally
Chronic pain differs from acute pain in that it often
involves both CNS and peripheral nervous system (PNS)
contributors; the pain experience is inﬂuenced by both the
local tissue response and altered CNS processing of pain
signals . Centralization (an ampliﬁed CNS response)
may lead to reduced inhibitory pathway activity or
increased ampliﬁcation pathway activity, intensifying the
original peripheral pain. Treatments for other centralized
pain disorders may inform the management of CPP, despite
there being limited data relating to their use in this con-
Pain may be classiﬁed as follows :
• Nociceptive pain Attributable to peripheral tissue injury
or inﬂammation, which stimulates the release of
neurotransmitters and neuroinﬂammatory substances.
Often responds to analgesics.
• Peripheral neuropathic pain Arises from PNS dys-
function, in which nerve reactivity is altered (as seen in
diabetic neuropathy). Typically responds to peripher-
ally and centrally acting drugs; a combination of both
may be most beneﬁcial.
• Central neuropathic pain Occurs when a continuous
pain signal produces a dysfunctional CNS response (i.e.
central pain ampliﬁcation). May be a crucial patho-
physiological component in almost any chronic pain
condition, including CPP. Can manifest as multifocal
& Adis Medical Writers
Springer, Private Bag 65901, Mairangi Bay, Auckland 0754,
Drugs Ther Perspect (2017) 33:418–423