Musculoskeletal Causes of Chronic Pelvic Pain: A Systematic Review of Diagnosis: Part I*

Abstract

Chronic pelvic pain in women has multifactorial etiology, but pelvic musculoskeletal dysfunction is not routinely evaluated as a cause by gynecologists. Whether diagnostic tests can reliably identify women with such conditions is unclear. The objective of this study was to determine the level of support in the literature for diagnostic tests of pelvic musculoskeletal problems. We used a set of key words pertaining to pain and the pelvic musculoskeletal structures to initially review the PUBMED database. Study inclusion was restricted to English-language publications that reported a patient-related chronic pelvic pain diagnostic test. Relevant bibliographies were also searched, and outside consultation with a pain researcher was sought to identify additional needed studies. For each selected article, 2 investigators separately summarized relevant data on study characteristics, patient profiles, and test efficacy. Discrepancies were resolved by discussion. Six diagnostic studies were identified that met entry criteria. No gold standard diagnostic tests exist for pelvic musculoskeletal problems, and the methodologic quality of available studies is low. Studies defining such clinically useful tests are needed to further refine a rational approach to chronic pelvic pain management. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to describe the paucity of evidence-based literature and valid consensus of diagnostic criteria and modalities in defining the musculoskeletal causes of chronic pelvic pain in women, to recall that there is no gold standard diagnostic test for pelvic musculoskeletal problems, and to recall that the statistical evaluation of the methods described were wanting.