Chronic abdominal pain may arise from many contributing factors. Frequently the cause for the pain is known and treatments by a primary care, gastroenterology or surgical team may be directed toward treating the cause and, subsequently, the pain. Sometimes, despite an extensive work-up by these teams, the cause of the pain may not be clear, but the pain may be debilitating just the same. Patients with abdominal pain may then be referred to a pain management clinic for evaluation and treatment of their pain, whether from a known or unknown.
Chronic pelvic pain (CPP) is defined as nonmenstrual pelvic pain of more than three months duration that is severe enough to cause functional disability and require medical or surgical treatment. Its hallmark is deep-seated, aching pain that often interferes with sleep and work, leads to urinary urgency and frequency and causes pain with sex and/or urination.
Although 70 to 80 percent of CPP cases are women, men can be affected too, especially if they have chronic prostatitis. In women, CPP is often linked to reproductive causes (e.g. endometriosis), urologic causes (particularly interstitial cystitis), gastrointestinal causes (e.g. irritable bowel syndrome) or psychosexual complaints, although many other causes can be at play, including vascular, neurologic and spinal issues. Notably, 30 to 50 percent of CPP cases are classified as having no obvious pathology, which often makes diagnosis and management difficult.
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