Pelvic pain with no identifiable cause

Relatively common pelvic pain is difficult to treat. Chronic and very painful, they have a mysterious origin. After removing infectious or malignant causes, management should be multidisciplinary in order to better address the symptoms.

A global approach against pelvic perineal pain

The discrepancy between the pain in the pelvis and the perineum and the few anomalies revealed by the complementary examinations should lead doctors to think of mechanisms of dysregulation of pain. The goal is above all to provide a response to patients.

To leave the organ or the whole psychological

By definition, chronic pelvic perineal pain has affected all regions from the pelvis to the perineum for more than 6 months. They are also characterized by a strong dissociation between the extent of the complaint and the absence of lesional factors that could justify it. Due to their location, they may concern several organ specialties: urology, gynecology and gastroenterology. For a long time, the medical approach has favored organ pathology, infectious or inflammatory. But today, the more general concept of "functional pain" imposes a transdisciplinary approach.

This seems logical when we know that only half of the patients complain of isolated pain. A quarter also suffer from irritable bowel syndrome, 9% from a pollakiuria - urinary urgency (frequent desire to urinate) and 15% cumulate these three syndromes, explains Dr. Jérôme Rigaud (Center federative of pelvi-perineology and Clinic Urology, at the CHU in Nantes). The pains have several points in common

An origin that exams can not identify, other associated pain syndromes, hypersensitization ... These indices make it logical the need for a more comprehensive management of these pathologies, an approach developed in the report "Chronic pelvi-perineal pain in Urology: better understanding for better treatment "published by Dr. Rigaud and three of his colleagues.

The idea of ​​a more global concept of "functional pain" is recent and will require a different, transdisciplinary approach, which is that of chronic pain in its various dimensions, "explains Dr Rigaud. Specialist physicians must now focus more on pain and treatments to manage it than on its origins, and conversely, pain algologists need to improve their knowledge of the contexts of pelvic pain. " The future is therefore first and foremost training, "says Dr Rigaud.

In both cases, however, the diagnostic procedure must lead them to eliminate any organic cause and lead them to detect the underlying neurological abnormalities in the areas irradiated by the sympathetic system, to ensure not to perpetuate the pain by multiplying the examinations Invasive, and to identify central hypersensitivity factors. "All advances in chronic pain are likely to be applied to chronic pelvic perineal pain, which will require prior validation. The opening of medical research to new fields of application "enthuses Prof. Rigaud.

The results of this evaluation will depend on the management which may be based on non - specific treatments of pain (such as antiepileptics, antidepressants), infiltrations, but also rehabilitation and hypnotherapy which have proved successful in relaxation and The management of pain.

"This approach should make it possible to emerge from a frequent impasse based on the whole organ or the whole psychological one." However, Professor Rigaud insists, we will never promise never to hurt again. "
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Press conference of the French Association of Urology (AFU), on the occasion of the 104th French congress of urology organized in Paris from 17 to 20 November 2010.

They often occur in people who are vulnerable to pain because of other pathologies or antecedents that favor their expression (fibromyalgia, chronic fatigue syndrome, migraines, anxiety, depression, history of sexual abuse, etc.). Hypersensitivity and are often fluctuating and occur while the original cause has often disappeared.