This issue of Obstetrics and Gynecology Clinics of North America attempts to provide an overview of the more common causes of chronic pelvic pain in women. It brings together experts in various fields of gynecology, gastroenterology, physical therapy, and urogynecology in an attempt to discuss the wide variety of common clinical conditions that can manifest as pain. The intent is to enable the physician to consider not only the common gynecologic causes but also the common nongynecologic causes based on certain symptom profiles and targeted clinical examination. Should the physician not feel comfortable in treating the nongynecologic causes, it would enable them to target their referral to a more appropriate physician rather than the patient being referred back to a general primary care physician. It is our hope that it will enable the reader to see the pelvis not as an ovary or a uterus but as a whole system of interacting organs, muscles, and nerves. In addtiion, there is very little in the Obstetrics and Gynecology literature about the treatment of the pain component with opioid and nonopioid medications. As one of my colleagues frequently states, we can treat the pain but not necessarily alleviate the suffering. The overview of complementary and alternative medications and opioid use will hopefully be useful to the practicing physician as it provides an evidence-based approach to the use of these therapies specifically for chronic pelvic pain.
By Mary T. McLennan, MD, St. Louis University, St. Louis, Missouri