Chronic Pain

Chronic pelvic pain

Management by Charbel Kortbawi, osteopath in Paris 16, at the Cabinet Victor Hugo — 7 rue Georges Ville (75016).

Chronic pelvic pain: definition, causes and management

Definition of chronic pelvic pain

Chronic pelvic pain (CPP) is a complex, persistent and often disabling condition that affects many women and men worldwide. It is characterised by pain located in the pelvic region, lasting for more than six months, and is associated with a significant impairment of patients' quality of life.

Symptoms of CPP

CPP is defined as non-cyclical pain in the pelvic region, persistent or recurrent, which cannot be fully explained by specific pathological causes such as an acute infection or cancer. It may be accompanied by urinary, digestive, sexual and musculoskeletal symptoms: lower abdominal pain, discomfort during sexual intercourse (dyspareunia), pain on urination or defaecation, and increased sensitivity in the pelvic region.

Risk factors for chronic pelvic pain

Risk factors increase when the patient:

• has a history of pelvic inflammatory disease
• has experienced a difficult pregnancy or delivery
• has undergone abdominal surgery or radiotherapy
• suffers from infertility problems
• has a history of physical or sexual abuse

Pathophysiology

The pathophysiology of CPP is complex and involves several mechanisms, including neuromuscular dysfunction, abnormalities of pain perception and psycho-emotional disorders. One of the central mechanisms is central sensitisation, a phenomenon in which the central nervous system amplifies pain signals, making non-painful stimuli painful. People with CPP may also suffer from pelvic muscular dysfunctions, visceral adhesions and myofascial restrictions.

Chronic pelvi-perineal pain is the sum of several clinical entities that are expressed to different degrees in each person; hence the value of a comprehensive, multidisciplinary management.

Within CPP, the following components can be distinguished:

• The neuropathic component
• The muscular component
• The osteo-articular component
• The psycho-emotional component
• Central sensitisation of pain

Treatment of chronic pelvic pain

Multidisciplinary approach to management

The management of CPP is multidisciplinary, including pharmacological treatments (analgesics, anti-inflammatories, muscle relaxants, antidepressants), psychological interventions (cognitive behavioural therapy), therapeutic patient education, and sometimes surgical interventions, in particular if mechanical causes such as endometriosis are identified.

Osteopathy and manual therapy in chronic pelvic pain

Treatment by osteopathy will have an effect on the myofascial and articular component of chronic pelvic pain.

Myofascial dysfunction of the pelvic floor is a source of pain frequently observed in women with chronic pelvic pain. Abdominal myofascial pain, pelvic girdle pain, low back pain, referred hip pain, joint hypermobility and postural imbalances can contribute to chronic pelvic pain.

Osteopathy and manual therapy are approaches increasingly recognised for the management of CPP, with studies showing a significant reduction in pain and an improvement in patients' quality of life. Osteopathic techniques include gentle and specific manipulations of the muscles, ligaments and organs of the pelvis, aimed at restoring mobility and reducing tension in the pelvic region.

Manual therapies, such as myofascial release, target the restrictions at muscular level which, in case of persistent tension, can intensify pelvic pain. These techniques also promote better blood circulation and reduce inflammation.