Chronic pelvic pain syndrome in neurological practice. Etiology, differential diagnosis and treatment

Abstract

Introduction. Chronic pelvic pain is an interdisciplinary problem that affects not only the neurological field but also the gynecological and surgical fields. It is estimated that between 5-26% of women and 2-10% of men suffer from chronic pelvic pain syndrome globally. After many years of debates, in 1979 the International Association for the Study of Pain (IASP) adopted the definition of pain as a “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Materials and methods. This abstract presents the result of a detailed analysis of articles and research on chronic pelvic pain syndrome from the sources like PubMed, Google Scholar and others published in last 10 years. Results. CPPS manifests itself through hyperalgesia and allodynia. It is classified into 2 types: type 1 with unknown etiology and type 2, with known location of nerve injury. Risk factors include female gender, fibromyalgia, and rheumatoid arthritis. The pathogenesis is multifactorial. One of the pathways is neuropathic inflammation, a process in which peripheral C-fiber nociceptors are activated. Other one is that the genetic component also plays an important role. The psychosomatic factor was demonstrated by the connection between a history of stress disorder and confirmation of the diagnosis of CPPS. The therapeutic management has undergone many changes over the years. The use of steroids, bisphosphonates, gabapentin and ketamine have yielded short-term effects. Antioxidant treatment has also shown some effects. Other therapies include low-dose naltrexone and botulinum toxin A. Sympathetic blockade is used often but it is still not possible to create a definitive answer about the duration of its effect. Conclusion. In conclusion we can say that CPPS is a multi-etiological diagnosis but still not fully elucidated. It requires further studies to better understand the pathogenesis, epidemiology, genetic and psychological impact and effective treatment options, because this will help doctors in the prevention, diagnosis and more effective treatment of this syndrome.