How to treat pelvic pain syndrome

I believe everyone is familiar with the disease of pelvic pain syndrome. It is quite common in our lives and endangers the health of many people. So how is pelvic pain syndrome treated? Let’s take a look at the following content to find out.

(1) Analgesics: including nonsteroidal anti-inflammatory drugs (NSAIDs), combinations of NSAIDs and milder anesthetics, and pure anesthetics. NSAIDs have side effects of gastric mucosal damage and kidney damage, while the addictiveness of anesthetics is even more worrying. However, when the tolerance is good, all three drugs can achieve good therapeutic effects for suitable patients (those who can consciously control their medication and have no history of drug abuse).

(2) Antidepressants: About half of chronic pain patients suffer from depression. Antidepressants can not only fight depression, but also have analgesic effects with unknown mechanisms. The efficacy of antidepressants in treating chronic pain is not very reliable, but they are widely used because they can be used as a substitute for anesthetics, are not easily abused, and have low dependence.

Tricyclic antidepressants have been used to treat chronic pain for decades. Amitriptyline is a representative drug, and its efficacy has been confirmed by a large number of clinical practices. Its dosage is 50-75 mg/d, which only accounts for 1/3 to 1/2 of the conventional treatment dosage for depression. The biggest side effects are constipation and morning drowsiness. For patients with irritable bowel syndrome or obvious bladder sensitivity, its anticholine side effects can have a beneficial effect.

Selective serotonin reuptake inhibitors (SSRIs) are a new type of antidepressant that is more effective than tricyclics and has less side effects such as constipation. Due to the effect of overexcited smooth muscles, it can cause mild diarrhea and intestinal cramps. Currently, the SSRIs used in clinical practice include fluoxetine, paroxetine, and sertraline.

(3) Organ-specific drugs: In the process of treating CPP, you need to be familiar with the use of antispasmodics and muscle relaxants for gastrointestinal symptoms, bladder irritation symptoms, and skeletal muscle pain. However, you can also consult a specialist and provide guidance on medication. For patients with sexual dysfunction, you also need guidance on the use of topical vaginal lubricants.

(4) Other drugs: Medroxyprogesterone acetate (progesterone acetate) can reduce pelvic congestion by inhibiting ovarian function to relieve related pain. GnRH-a has been suggested to be used to differentiate between gynecological and non-gynecological causes of pain. It is worth noting that it also has a relieving effect on irritable bowel syndrome, which may be due to the reduction of serum relaxin.

Conservative laparoscopic surgery is represented by the treatment of EM. While preserving fertility, ovarian cystectomy, adhesion lysis, and lesion resection or cauterization can be performed. Prospective studies have shown that 2/3 of patients can achieve longer relief in this way, but the problem of long-term recurrence cannot be ignored.

Studies have shown that when presacral neurectomy (PSN) is performed on top of conservative surgery, dysmenorrhea and dyspareunia are significantly relieved in 75% to 95% of patients, which is significantly better than those who undergo conservative surgery alone (25%). However, some studies have not shown optimistic results. PSN has high technical requirements for the surgeon and has complications such as aggravated constipation (37%) and urinary urgency (8%). Its main indication is intractable mid-pelvic pain that has not responded to systematic medical treatment. Chronic pain from the lateral pelvic area or other tissues is difficult to relieve. Therefore, adequate preoperative evaluation, skill preparation and communication with the patient should be done before considering this procedure.

The above content lets us know how to treat pelvic pain syndrome. If you feel there is something you don’t understand, you can always call the number at the bottom of the screen to consult our experts. I believe they will give you a satisfactory answer.