Chronic Pain in the Young: Pelvic Pain, Treatment

By | March 26, 2012

 

Sometimes treatment for chronic pelvic pain can be as simple as a series of superior hypogastric plexus blocks.

The treatment of chronic pelvic pain in the young is as challenging as anything that I do. Let me start by saying that oral opiates have no place in the treatment of chronic pelvic pain. I can’t tell you how many patients have come to see me at Schlesinger Pain Centers, who once had one difficult problem (pelvic pain) and now have two (pelvic pain and opioid dependence). As we said in yesterday’s blog, blockade of the autonomic ganglia, usually a superior hypogastric block, can sometimes give lasting relief to these patients and when and if this form of therapy fails it often gives useful prognostic information about responses to other therapies. More often than not, effective treatment will depend on neuromodulation techniques with spinal cord stimulation (SCS) being effective more often than intrathecal drug delivery systems (IDDS, Pain Pump). In cases where autonomic blockade has been helpful stimulation over the area of the conus at the bottom of the spinal cord is often helpful in picking up these autonomic fibers, in addition to stimulation higher up in the area of the lower thoracic and upper lumbar cord to pick up the visceral and somatically mediated pain.  While one of the most difficult, a multimodal approach such as this can make chronic pelvic pain one of the most rewarding syndrome of chronic pain in the young to treat.


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