Abdominopelvic pain syndromes

Abstract

Chronic abdominopelvic pain is a debilitating problem that presents challenges to patients and clinicians alike. Symptoms of abdominopelvic pain are among the most commo symptoms presenting to primary care and fall within the scope of a large number of medical specialities, especially gynaecology, gastroenterology, and urology. Such pain can be a warning sign of serious pathology, but chronic abdominopelvic pain must be recognized as a disease in its own right, since it can exist as a chronic condition without identifiable pathology. Traditionally, the management of pelvic pain has focused on biomedical mechanisms such as infective, inflammatory, or malignant conditions; it is now understood, however, that many of the mechanisms are attributable to modulation of pain processing within the nervous system. Although a peripheral stimulus such as inflammation may initiate pelvic pain, the condition or syndrome may become persistent as a result of these mechanisms. Chronic pain syndromes are associated with a variety of cognitive, behavioural, social, sexual, and functional phenomena. These form the basis for diagnosis and must be addressed through multidisciplinary care. Functional disorders, for the purpose of this article, are disorders characterized by disturbance of function (such as urinary urge/frequency in bladder pain syndrome). The term is not used in the sense of a psychiatric functional disorder. Associated psychological disturbances should be considered a result of the disease rather than a cause and there must be an associated conceptual shift, in healthcare providers who work with these patients, to acknowledge this. The authors acknowledge that ongoing organ pathology, such as endometriosis, can produce persistent pain, but the management of specific diseases is beyond the scope of this article. This article will focus on pain syndromes in which no identifiable cause can be found.