Pelvic pain from a chronic pain perspective

Chronic pelvic pain (CPP) refers to persistent pain in the lower abdomen or pelvis of a woman of at least 3 months in duration. It is common, affecting around one in six women. Chronic pelvic pain can be extremely debilitating, and has an impact on physical, psychological and social function. While CPP is often associated with various underlying pathologies (e.g. endometriosis, adenomyosis, pelvic inflammatory disease and polycystic ovaries), it can also exist without any identifiable underlying condition. Furthermore, pain is often poorly correlated to the extent, location and type of the underlying pathology. Therefore, CPP is complex, and can be extremely challenging to understand and effectively manage. In recognition of the complexity of this condition, guidelines suggest that management needs to reflect a biopsychosocial approach, i.e. one that considers and manages the physical, psychological and social factors that drive and influence CPP. This paper provides an overview of CPP, and draws from evidence and clinical practice to describe key considerations when applying a biopsychosocial approach to its management.