Medication Summary
Pharmacotherapy in chronic pelvic pain (CPP) consists of symptomatic abortive therapy to stop or reduce the severity of acute exacerbation of pain and long-term therapy for chronic pain.
Analgesics
Class Summary
These agents are generally used in mild-to-moderate pain; however, they may also be effective for severe pain.
Acetaminophen (Tylenol)
First choice for pain, especially during pregnancy and breastfeeding.
Ibuprofen (Advil, Motrin)
Inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis.
Naproxen (Aleve, Naprosyn, Naprelan)
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Opioids
Class Summary
These agents are commonly used for many pain syndromes.
Fentanyl (Duragesic patch)
Potent narcotic analgesic with much shorter half-life than morphine sulfate. DOC for conscious sedation analgesia. Ideal for analgesic action of short duration during anesthesia and immediate postoperative period. Excellent choice for pain management and sedation; short duration (30-60 min) and easy to titrate.
Easily and quickly reversed by naloxone. When using transdermal dosage form, most patients are controlled with 72-h dosing intervals.
However, some patients require dosing intervals of 48 h.
Available in 12, 25, 50, 75, and 100 mcg doses.
Anticonvulsants
Class Summary
Certain antiepileptic drugs (eg, the GABA analogue gabapentin and pregabulin [Lyrica]) have proven helpful in some cases of neuropathic pain. Other anticonvulsant agents (eg, clonazepam, topiramate, lamotrigine, zonisamide, tiagabine) have also been tried in chronic pelvic pain (CPP).
Gabapentin (Neurontin)
Has anticonvulsant properties and antineuralgic effects; however, exact mechanism of action is unknown.
Structurally related to GABA but does not interact with GABA receptors.
Pregabalin (Lyrica)
Structural derivative of GABA. Mechanism of action unknown. Binds with high affinity to alpha2 -delta site (a calcium channel subunit). In vitro, reduces calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function. FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures.
Tricyclic antidepressants and SNRIs
Class Summary
These agents increase synaptic concentration of serotonin and/or norepinephrine in the CNS by inhibiting reuptake by the presynaptic neuronal membrane (eg, duloxetine [Cymbalta], venlafaxine [Effexor]).
Nortriptyline (Pamelor)
Demonstrated effectiveness in the treatment of chronic pain.
Amitriptyline (Elavil)
Analgesic for certain chronic and neuropathic pain.
Selective serotonin reuptake inhibitors
Class Summary
These agents selectively inhibit presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine. SSRIs can be used in second-line or third-line treatment of painful diabetic neuropathy. They are used in patients who are already depressed.
Fluoxetine (Prozac)
Considered an alternative to TCAs, with fewer adverse anticholinergic and cardiovascular effects.
Sertraline (Zoloft)
Considered an alternative to TCAs, with fewer adverse anticholinergic and cardiovascular effects.
Paroxetine (Paxil)
Considered an alternative to TCAs, with fewer adverse anticholinergic and cardiovascular effects.
-
Transabdominal longitudinal view of the female pelvis.
-
Transabdominal transverse view of the female pelvis: The bladder is rectangular. The ovaries are seen bilaterally in the adnexa.
