Women's Health

Pelvic Pain & Vulvar Disease Center

Chronic Pelvic Pain

General Principles of Treatment

The ideal goal of treatment is cure of your pain. We never lose sight of this ideal goal. We know, however, with medical science’s current understanding of chronic pelvic pain that complete cure is not always possible. When cure is not possible, together we need to have several alternative goals: (a) reduce pain to the lowest level possible, (b) return to normal activities, and (c) help you control the pain rather than allowing the pain to control you..
Our treatment principles include treatment of all problems that may contribute to your pain. This often means treatment for more than one disease, with more than one medication or approach simultaneously. We then try to gradually taper off treatments as pain lessens. We find it extremely helpful to see our patients in the office on a regular basis. It is important to keep your appointments. If you are not seen at the intervals prescribed, your recovery will be slower and may even be jeopardized.

Tests and Treatments

We know that you may have already seen a number of other physicians and health care providers for the pain, and may have tried a number of medical and surgical treatments. Please be patient if we suggest trying treatments that you have tried before. We often find that prior treatments have been of too short a duration or have not been pushed to high enough doses of medications to achieve the best results. Except in unusual circumstances, medical therapy is instituted before surgery is suggested. This may include nonsteroidal anti-inflammatory drugs, anti-depressants, vitamin supplementation, anti-convulsant medications, anxiolytics, or opioid drugs. We appreciate the anxiety that you may have about these medications and hope that you will speak openly to us about your concerns.

Medications

Once, and if, we agree together that medications are appropriate for you, it is important that you take the medicine at the scheduled time, independent of the degree of pain you are experiencing. This is called time contingent dosing. It has been shown to be much more effective in controlling chronic pain than taking it on an as-needed basis. It is important that you follow explicitly the directions for each medication and not change your medicine or time of dosage without checking with us first. If you are running low on medication, please be sure to let us know at the time of your appointment so you will not have to call in for medicine. Always stay a little ahead with each medication and have enough to get you to your next appointment. It is our policy not to phone medication in to your pharmacy unless it is an emergency. In that case, you are usually directed to go to the emergency room. Please report any adverse reactions to the medications so that we can modify your medications as necessary.

Physical Therapy

We find that physical therapy is often a very important part of recovery from chronic pelvic pain. General posture, strengthening exercises, and flexibility need to be evaluated and treated. Low back exercises are often necessary as well as piriformis stretching in order to maximize your recovery. If pain relief is being obtained, but no attention is given to muscle conditioning, as soon as you begin to be more active you will have an increase in pain. We want to prevent this from happening through physical therapy, so we may refer you to see a physical therapist.

Support

Psychological support, behavior modification, and biofeedback are a very important parts of treating chronic pain. We will recommend such treatment at the appropriate stage of your recovery.

We may wish to speak with family members during the course of your treatment in order to let them know what contributing factors we have found and keep them abreast of your progress. It is very important for your recovery to have family support.