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Systematic review of therapies for noncyclic chronic pelvic pain in women.

Abstract
We synthesized the literature (articles published between 1990 and May 2011) on the treatment of noncyclic and mixed cyclic/noncyclic chronic pelvic pain (CPP) in adult women. Two reviewers assessed studies against predetermined inclusion/exclusion criteria, extracted data regarding participant and intervention characteristics and outcomes, and assigned overall quality and strength of evidence ratings. Of 2081 studies, 21 addressed surgical or nonsurgical interventions. Definitions of CPP and participant characteristics varied across studies, and most studies were of poor quality, which precluded data synthesis. Although surgical and nonsurgical approaches both improved pain, neither was more effective when directly compared in 3 studies. Laparoscopic adhesiolysis or laparoscopic uterosacral nerve ablation did not further improve pain scores over diagnostic laparoscopy. The evidence to conclude that surgical intervention is either effective or ineffective or that one technique is superior to another is insufficient. Most studies on nonsurgical approaches evaluated hormonal therapies in endometriosis-associated CPP and were not placebo controlled. Few studies addressed nonhormonal or nonpharmacologic approaches. Harms reporting was limited. Overall, no nonsurgical treatment was more or less effective than another, except for the clear negative effect of raloxifene. In general, the literature addressing therapies for CPP in women is of poor quality and inconclusive. Improved characterizations of the targeted condition and interventions in CPP research, including a uniform definition and standardized evaluation, are necessary to inform treatment choices.
AuthorsAmanda Yunker, Nila A Sathe, William Stuart Reynolds, Frances E Likis, Jeff Andrews
JournalObstetrical & gynecological survey (Obstet Gynecol Surv) Vol. 67 Issue 7 Pg. 417-25 (Jul 2012) ISSN: 1533-9866 [Electronic] United States
PMID22926248 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S., Review, Systematic Review)
Chemical References
  • Analgesics
  • Estrogens
  • Neuromuscular Agents
  • Progestins
Topics
  • Analgesics (therapeutic use)
  • Chronic Disease
  • Estrogens (therapeutic use)
  • Female
  • Humans
  • Hysterectomy
  • Laparoscopy
  • Neuromuscular Agents (therapeutic use)
  • Pain Management (methods)
  • Pain Measurement
  • Pelvic Pain (therapy)
  • Progestins (therapeutic use)
  • Treatment Outcome

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