Female Pelvic Pain Common But Often Underdiagnosed

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LISBON—Visceral pelvic pain is a common yet underdiagnosed problem in women, according to an Italian researcher.

At the Sixth Congress of the European Federation of the International Association for the Study of Pain Chapters, Maria Adele Giamberardino, MD, told attendees that the pelvic-cavity viscera are among the most frequent sites of pain in women. “Nevertheless, pain from this area can be difficult to diagnose.

Hence, clinicians should routinely perform a thorough examination in order to decipher the causes and formulate a treatment plan,” said Dr. Giamberardino, Associate Professor of Internal Medicine, and Head of the Fibromyalgia and Headache Center; Director of the Pathophysiology of Pain Laboratory, of the Department of Medicine and Science of Aging at G. D'Annunzio University of Chieti in Italy.

Pelvic pain can originate in the urinary, reproductive, or digestive organs in the pelvic region or it can be referred from abdominal visceral organs, Dr. Giamberardino said. Primary dysmenorrhea is a common source of pelvic pain among women. About 30% of patients treated for this condition do not show any improvement and about 50% have comorbidities associated with pain such as irritable bowel syndrome, interstitial cystitis, headache, and fibromyalgia, she added.

Another common cause of pelvic pain in women is endometriosis. It affects 7%-10% of women of reproductive age around the world, Dr. Giamberardino observed.

In addition, about 20% of women with endometriosis have comorbid pain conditions such as irritable bowel syndrome, interstitial cystitis, vulvodynia, and fibromyalgia, she noted. The extent of endometrial lesions does not always correlate with the amount of pain associated with them, she said. In some cases, small lesions can produce chronic pain.

Other common forms of pelvic pain in women include chronic pelvic pain (both visceral and non-visceral in origin) and “viscero-visceral” hyperalgesia, Dr. Giamberardino said. The latter is an amplification of pain due to interaction between two different viscera that share at least part of their central sensory projection. This can include irritable bowel syndrome with dysmenorrhea, dysmenorrhea  with urinary calculosis, and endometriosis with urinary calculosis.

“The high rate of comorbidity of different forms of visceral pelvic pain in women and other pain conditions such as migraine, tension-type headache and fibromyalgia likely involves different levels of central sensitization in women, combined with different types of pain syndromes that are responsible for progressively increasing clinical pain,” Dr. Giamberardino concluded. “The implication for therapy is that effective treatment of one condition may reduce symptoms from one or more of the others.”

Thus, physicians must perform a thorough examination of women with visceral pelvic pain, she said. This should take into account not only the visceral organ that is clearly involved, but also possible influences from other pelvic and abdominal organs and non-visceral structures that may be implicated.

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