Nonhormonal and nonpharmacologic management of noncyclic chronic pelvic pain (CPP) remains understudied, say authors of a systematic review that also found little evidence to demonstrate the effectiveness of surgical approaches for this "commonly occurring and poorly understood condition."
Researchers from Vanderbilt Evidence-based Practice Center systematically reviewed evidence on therapies for women aged 18 and older with CPP, focusing on the prevalence of conditions thought to occur commonly with CPP—change in pain, functional status, quality of life, and patient satisfaction resulting from surgical and nonsurgical treatment approaches; harms of nonsurgical approaches; evidence for differences in surgical outcomes if an etiology for CPP is identified postsurgery; and evidence for selecting 1 intervention over another after an approach fails.
Of 36 included studies, 18 were randomized controlled trials, most of which were of poor quality; 15 were cross-sectional studies addressing the prevalence of comorbidities in which quality varied by comorbidity. Nine studies of nonsurgical approaches assessed hormonal therapies for endometriosis-associated CPP and reported similar effectiveness among active agents. One exception was an RCT comparing raloxifene with placebo, which reported more rapid return of pain in the raloxifene group. Few studies assessed nonhormonal medical or nonpharmacologic management; benefits were reported in single studies of a pelvic physical therapy approach, botulinum toxin, pelvic ultrasonography, and an integrated management approach.
"Improved characterization of the targeted condition, intervention, and population in CPP research is necessary to inform treatment choices for this commonly reported entity," the authors conclude, noting the lack of a uniform definition of CPP and standardized evaluation of participants in the literature.