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  • Writer's pictureDr. Harold Pierre

Interventional Pain Procedures for Chronic Pelvic Pain In women

Updated: Jan 18

Breaking the Cycle of Chronic Pelvic Pain in Women: Interventional Pain Treatment Solutions

Chronic pelvic pain affects up to 1 in 4 women at some point in their lives. This severe, persistent pain in the pelvis and lower abdomen can be extremely debilitating. The good news? The much underutilized Interventional pain treatments are giving new hope to women trapped in the painful cycle of chronic pelvic pain.

Because so many women suffer in silence without knowing there are treatments for their pelvic pain syndrome, I wrote this article to provide what you need to know about getting to the root cause of chronic pelvic pain and finding real relief through cutting-edge solutions. I will tackle the common queries about pelvic pain and other symptoms:

  • Pelvic pain symptoms: "aching down there," "sharp pain in lower abdomen," "burning feeling in pelvis," "pain during sex"

  • Causes of pelvic pain: "reasons for pelvic pain," "what causes chronic pelvic pain," "conditions that cause pelvic pain"

  • Diagnosing Chronic Pelvic Pain: "tests for pelvic pain," "doctor for pelvic pain," "pelvic pain specialist"

  • Treatment options for CPP: "pelvic pain relief," "managing chronic pelvic pain," "best treatment for pelvic floor pain"

By getting the full picture and understanding all your options, you can work with your doctor to transform your quality of life. There is hope!

What Exactly is Chronic Pelvic Pain?

Woman having Stomach Pain. Ovarian and Cervical cancer, Cervix disorder, Endometriosis, Hysterectomy, Uterine fibroids, Reproductive system, menstruation, diarrhea, chronic pelvic pain and Pregnancy concept copy

Chronic pelvic pain refers to severe, constant pain felt anywhere from your belly button down to your hips that lasts for at least six months. This region is your pelvic area. The cause of your pain can originate from the reproductive organs like the uterus, ovaries, vagina and vulva as well as the bladder, colon and rectum. Pelvic pain syndrome in females ranges from dull and aching to sharp and stabbing, often spreading to the lower back and thighs.

Acute pelvic pain from menstrual cramps, a bladder infection or appendix attack typically goes away quicker with normal treatment. What makes this type of pain “chronic” is its persists at least 6 months without relief, continuously interfering with daily activities.

But when pelvic pain hangs on despite various therapies, the constant suffering and uncertainty take a tremendous toll both physically and emotionally. Daily life revolves around when the next wave of pain will strike.

The Far-Reaching Impact of Chronic Pelvic Pain

Coping with chronic pelvic pain is exhausting. As pain commands more focus, job performance suffers, relationships strain and depression can set in. A survey by the American College of Obstetricians and Gynecologists found:

  • 1 in 3 women with chronic pelvic pain require time off work due to their symptoms

  • 3 in 4 have trouble maintaining intimacy due to pain

  • Half of women dealing with chronic pelvic pain rate their quality of life as “fair,” “poor” or “very poor”

Yet this experience remains largely invisible since pelvic health issues still bear a stigma in our culture. 42% of women told ACOG they feel uncomfortable discussing pelvic pain with friends and family. Many suffer in silence for years before sharing their struggles with a doctor. Still today only 1 in 5 women with pelvic pain ever receive an official diagnosis explaining the cause.

Getting the right answers improves the odds of finding solutions. So being your own best advocate and speaking out despite discomfort or uncertainty is crucial.

Common Causes of Chronic Pelvic Pain in Women

Chronic pelvic pain often perplexes doctors because many overlapping conditions cause similar feelings of pain and pressure in the pelvis:

Endometriosis: When endometrial tissue spread beyond the uterus, clinging to organs in the pelvis and abdomen, it continues to bleed monthly. But without an escape route, trapped blood causes inflammation and scarring. The result: severe cramping, heavy irregular periods, painful sex, constant pelvic ache, and recurring infertility. This sinister condition hides and evades standard tests, often requiring laparoscopic surgery for diagnosis. Treatments aim to suppress growths, but sometimes this isn't enough to stop the pain.

Adenomyosis: This endometriosis cousin occurs when the endometrial lining grow deep into the uterine muscular wall. There it thickens and bleeds each menstrual cycle, but with no escape route, blood accumulates internally. An enlarged, tender uterus with thickened walls results, causing symptoms of heavy periods, severe cramps, painful intercourse and pelvic pressure. Conservative treatments can pare back problematic implants, but recurrences emerge if roots remain embedded in the uterus.

Uterine fibroids: These benign tumors sprout from inside the uterine smooth muscle. Whether fibroids are within uterine walls or dangling from the uterus, fibroids range in size and symptom severity. They distort the uterus and displace surrounding anatomy, causing unremitting pelvic pain, pressure and abnormal bleeding. While the smallest fibroids may be pain free and not an issue, the larger troublemaking ones usually require surgical removal.

Ovarian cysts: Fluid-filled cysts can develop in the ovaries during ovulation. Most cysts don’t display symptoms and disappear on their own. But large cysts may twist, rupture or leak fluid causing severe pelvic pain with nausea and vomiting that requires emergency surgery. Persistent ovarian cysts lead to recurring pelvic pain.

Interstitial cystitis (IC): This bladder inflammation causes unrelenting pelvic pain, urinary urgency and frequency. Often accompanying other pelvic disorders, flare ups may follow dietary triggers, stress or allergies. Therapies like bladder instillations, dietary changes, stress reduction and pelvic floor physical therapy aim to tame symptoms.

Irritable bowel syndrome (IBS): While not solely a source of pelvic pain itself, IBS can amplify existing discomfort through intense diarrhea, constipation and cramping. Any lasting relief of chronic pelvic pain should include an evaluation for IBS. Proper diet, probiotic support, antispasmodics and anti-diarrheal medications help stabilize IBS.

Pelvic floor dysfunction: The bowl-shaped pelvic floor muscles support reproductive and digestive organs. When these muscles weaken - often after childbirth or hysterectomy - organs can press down causing pelvic pain. Or the muscles may spasm from chronic tension. Pelvic floor physical therapy brings relief by stretching and strengthening pelvic muscles.

Pelvic congestion syndrome: Like varicose veins in the legs, enlarged pelvic veins become overloaded with blood. This provokes a dull, heavy ache, along with visible vulvar and thigh varicosities. Embolization procedures aim to relieve pain by blocking dysfunctional veins.

Nerve damage or compression: Any disruption along the complex network of nerves relaying pain signals from reproductive, urinary and digestive organs shows up as diffuse chronic pelvic pain. Past surgeries, diverticulitis or endometriosis can leave behind scar tissue pressing on pelvic nerves. Neuropathy numbs nerve endings while nerve blocks provide targeted pain relief.

Chronic pelvic inflammatory disease: Repeated pelvic infections from UTIs, STIs or PID (pelvic inflammatory disease) can damage tissue and nerves causing chronic pain long after infection clears. This pain may remain unless damaged areas heal completely. Physical therapy, nerve blocks and aminoglycoside antibiotics provide relief.

Getting to the root cause is challenging but essential for pinpointing proper treatment. A detailed pelvic exam, ultrasound, CT scan or MRI along with diagnostic laparoscopic surgery allows your doctor to thoroughly investigate all possible sources. Never accept that nothing can explain or treat your chronic pelvic pain - keep pressing for answers.

Why Chronic Pelvic Pain Often Defies Treatment

The complexity of the female pelvis with intertwined muscles, nerves, connective tissue and reproductive structures all occupying a compact space makes chronic pelvic pain difficult to resolve. Any imbalance or dysfunction in these structures reverberates through the pelvis causing chronic pain signals. Much like a snarl of holiday lights where one bad bulb makes the whole strand go dark, one issue threatens to short circuit the entire system.

Yet the problem runs deeper still. Long after identifiable disorders like endometriosis or fibroids get treated, chronic pelvic pain persists in up to 1 in 5 women. Why? Often painful central sensitization has developed.

With central sensitization, the constant influx of pelvic pain signals essentially rewires the central nervous system. Nerve receptors in the brain and spinal cord become hypersensitive, continuing to overreact to normal stimuli from reproductive and digestive organs long after initial injuries heal. Even minor triggers generate magnified pain.

This neurological disruption underlies many cases of stubborn chronic pelvic pain. But scientists are just now uncovering these key mechanisms behind central sensitization. Their findings are informing new targeted treatment strategies focusing on the root biological drivers of chronic pelvic pain.

Ending the Frustration: Innovative Chronic Pelvic Pain Treatment

Doctor model of the anatomy of hip joint in clinic. Pelvic bone pain causes, diagnosis and treatment concept

For those losing hope after endless ineffective treatments for chronic pelvic pain, a number of old interventional pain management techniques can provide cause for optimism. These cutting-edge therapies deliver both immediate relief from pain while also interrupting the relentless cycle of central sensitization for lasting results.

How Interventional Pain Treatments Work

These minimal invasive pain solutions addressing the transmission of chronic pelvic pain allowing for pain relief while your gynecologist, surgeon, or endocrinologist work on the cause of your pelvic pain. Interventional pain management leverages advanced imaging and pinpoint delivery systems to target treatment precisely where needed.

Your interventional pain specialist begins by thoroughly mapping your pelvic region using diagnostic tools like MRIs, x-rays, CT scans or ultrasound imaging. This reveals the exact anatomy guiding needles or narrow tubing called catheters directly to problem spots. Electrical stimulation and medications further defines specific nerves involved in pain signaling.

Medications like numbing agents, anti-inflammatories and analgesics then get injected right to sources of irritation fueling central sensitization. Other regenerative injections bathe oxygen-starved muscles in healing solutions to calm spasms and loosen knots also causing chronic pain.

The most cutting-edge pelvic pain treatments take advantage of your body’s innate restorative capacities. Gentle pulses of energy retrain overloaded nerves or circuits to resume normal function instead of overreacting with continual pain signals. This grounds oversensitive wiring driving central sensitization.

Innovative Interventional Treatments for Pelvic Pain Relief

It is surprising how few people know about these options which provide hope for resolving different causes of chronic pelvic pain:

Superior Hypogastric Plexus Block: This major relay point connecting pelvic organs with the brain drives pain signaling and central sensitization. Specialized injections block transmission along this nerve network, granting relief from chronic pelvic pain due to endometriosis, IC, IBS or the after-effects of cancer treatment.

Ganglion Impar Block: Key nerves within the sacrum signal rectal and genital pain up to the brain. This epidural injection bathes nerves surrounding the ganglion impar nexus with numbing medication to muffle referral pain caused by fissures, scar tissue irritation, radiation damage or central sensitization hypersensitivity.

Peripheral Nerve Hydrodissection: Endometriosis or surgical adhesions often trap nerves in scar tissue, provoking chronic inflammation and pain. Delicate injections lift away bindings around individual peripheral nerves with soothing fluid. Flushing trapped nerves with a dextrose solution aids regeneration to resolve nerve-related pelvic pain.

Trigger Point Injections: When pelvic floor muscles form contracted trigger points, they constantly relay cycles of pain which feed central sensitization. Targeted injections deliver anesthetics directly to spastic muscle fibers, along with anti-inflammatories to prevent tightness from returning quickly. This disruption of the pain pattern resets the central nervous system.

Pulsed Radiofrequency Therapy: Low-heat RF energy applied near irritated nerves or tissue retrains the nervous system not to keep driving chronic pelvic pain signals. Nondestructive pulses emitted near pinched nerves or a taut sacroiliac joint dampens their amplified messaging to the brain seen in central sensitization.

Neurolysis with Chemical Ablation: For severe nerve-related pelvic pain, injections of dilute alcohol or phenol ablate aggressively firing pain receptors on peripheral nerves and sympathetic ganglia. This neurological reset provides renewed pain-free intervals and relief from central sensitization when blocks or RF treatments fail.

Spinal Cord Stimulation: After years suffering chronic pelvic pain, constant signaling can overwhelm the central nervous system. Implanting a small electrical pulse generator under the skin bathes the spinal cord in mild stimuli to short circuit escalating pain signals. This grants women their lives back when all else fails.

Reclaiming Your Quality of Life from Chronic Pelvic Pain

Constant pelvic pain without solutions leaves many women feeling imprisoned in their own bodies - unable to work, socialize or enjoy intimacy pain-free. But enduring life-limiting pain is not your destiny or something you must tolerate. These solutions from interventional pain specialists are helping women reclaim their lives after all else falls short.

Stepping out from isolation and sharing your struggles is the first step toward relief. Although silence may feel safer, giving voice to battles with chronic pelvic pain opens doors to answers and unconventional treatments you may not know exist.

Today new possibilities are emerging thanks to major breakthroughs in decoding the key drivers of chronic pelvic pain on neurological and biological levels. Precision injections target and quiet these root causes where standard treatments only cover up symptoms.

Don't live with pelvic pain any longer. Once your doctor has maximize treatment for you chronic pelvic pain, ask your doctor for a referral to an interventional pain specialist. Your future no longer needs to be defined by pain.

  1. Gharaei, H., & Gholampoor, N. (2023). The Role of Interventional Pain Management Strategies for Neuropathic Pelvic Pain in Endometriosis. Pain Physician, 26, E487-E495. ISSN 2150-1149. Retrieved from Manuscript received: February 3, 2023; Revised: April 9, 2023; Accepted for publication: April 28, 2023​​​​.

  1. Hasoon, J., Urits, I., Orhurhu, V., Viswanath, O., & Aner, M. (2020). Role of interventional pain management in patients with chronic pelvic pain. Proceedings (Baylor University Medical Center), 33(3), 467–468.

About the author: 

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.

This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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