Chronic pain in women: new perspectives on pathophysiology and management

Abstract

Over the last fifty years the understanding of a number of symptomatic gynaecological conditions has crystallized to the point where a coherent framework of pathogenesis and a systematic approach to treatment can be discerned. Examples are endometriosis, menorrhagia, premenstrual syndrome and the symptoms associated with the climacteric. Chronic pelvic pain is only now reaching the stage of similar systematization, and it is interesting to speculate why this has taken so long. Two factors can perhaps be cited as relevant: in the conditions listed above, either reasonably plausible models for causation based on visible pathology have been available, as with endometriosis, or effective treatments have been readily available, for example hormone replacement therapy (HRT) for estrogen deficiency symptoms. In the case of pelvic pain, models of causation have often been speculative rather than based on research, and simple effective treatments have proved elusive. In this review current concepts of pain physiology and therapy are discussed with a view to placing in perspective the clinical problem of pelvic pain. The condition is best seen from a bio-psycho-social perspective but the main focus of the present review is the neurobiological aspect.