In most cases, those suffering from Pelvic Pain or Chronic Pelvic Pain are already under the care of either a OB/GYN or Urologist and only consult a Pain Management Physician afterward. Once they do it is imperative for the physician to obtain a thorough history and conduct a comprehensive physical (with a focuses abdominal examination) as many of the causes of Pelvic Pain can be reversible. Pelvic examination, lab testing, and ultrasounds or CT scans of the abdomen and pelvis are often utilized to rule out other more conventional causes.

Both diagnosis and management of patients with Pelvic Pain require good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric. A significant number of patients with Pelvic Pain may have a variety of associated problems including bladder or bowel dysfunction, sexual dysfunction, and other systemic or constitutional symptoms. Other associated problems, such as depression, anxiety, and drug addiction, may also coexist.

Cannibus (aka Medical Marijuana) – Cannibus has shown to be effective in a variety of different types of chronic pain conditions. Medical marijuana is a personalized treatment whereby the pharmacist will interview you to discuss your pain and your medical history to create the proper blend and ratio to suit you, individually. It is a safe medical option with a low side effect profile.

IV Infusion Therapy – A simple procedure commonly performed in the office. Your doctor will administer a small IV catheter, and then infuse special medications intravenously in an attempt to halt the pain process. 

Superior Hypogastric Plexus Block – This procedure is used as both a diagnostic and therapeutic tool. Under radiographic guidance, a thin needle is inserted through the skin and advanced toward the L5 vertebra – the location of the superior hypogastric plaexus. A blockade of the superior hypogastric plexus has been reported to decrease pelvic pain by 70%.[14]

Ganglion of Impar Block – Like the Superior Hypogastric Block, this procedure can also be used for both diagnostic and therapeutic purposes. This procedure is performed under radiographic guidance with the target being a small area directly in front of the coccyx (tailbone). This injection is extremely effective in treating pain originating from the cervix, colon, bladder, rectum and endometrium. Studies have reported 70-100% pain relief from this procedure.[13]

Sympathetic “Reset” – When the sympathetic nervous system becomes involved in your pain, it becomes exponentially harder to treat and may explain why your pain has stopped responding to conventional treatment options.  Resetting or rebooting the sympathetic nervous system is an old fashioned technique used for treating Complex Regional Pain Syndrome (CRPS) in the arms and legs whereby a small amount of local anesthetic is injected onto a specific part of the sympathetic nervous system to temporarily turn it off and give it the opportunity to recalibrate itself at a normal level.  Applying this age old concept to pelvic pain by adding growth factors from Amniotic Tissue, we are able to trick your Sympathetic Nervous System into slowing back down to a normal level.

Inferior Hypogastric Block – Similar to the Superior Hypogastric Plexus Block and the Impar blocks, this can be diagnostic and therapeutic. This procedure is typically considered when more lower and external pelvic pain and if the treating the impar is ineffective

Hypogastric Nerve Block – This is an unconventional block that not many are trained to perform due to the skill involved to reach this nerve selectively, while leaving other structures unharmed.  The hypogastric nerve connects the superior and inferior hypogastric plexuses which make it an excellent target for treating neuropathic pain.

Peripheral Nerve Block – A peripheral nerve block can be extremely effective way of treating many types pain, including CPP. There are an abundance of nerves providing innervation to the pelvic region and its organs – any of which can be targeted and blocked with a small amount of local anesthetic to provide dramatic pain relief. Many of these injections can be performed under ultrasound guidance.

• Pudendal Nerve Block
• Genitofemoral Nerve Block
• Ilioinguinal Nerve Block
• Iliohypogastric Nerve Block
• Lateral Femoral Cutaneous Nerve Block
• Obterator Nerve Block
• Subcostal Nerve Block

Neurolysis & Ablation – In many cases an injection will provide relief, but this is only a temporary solution. In cases such as these, neurolysis or neuroablation can be utilized to provide longer relief. There are several different techniques available:

• Radiofrequency Ablation (RFA) – Radio waves are applied to a nerve, subsequently stunning it and preventing from transmitting pain.  Pulsed is a popular variation of RFA whereby a more subtle type of energy is emitted that specifically targets pain fibers and leaves the rest of the nerve unharmed!
  
• Chemodenervation – Small amounts of either alcohol or phenol are injected, thus blocking the nerve’s ability to transmit a signal.

Selective S2/S3 Nerve Root Block – The hard part of treating pelvic pain is finding which nerve or nerves is/are either the cause of the pain or is/are responsible for transmitting the pain signals.  The S2 level is unique in that it captures all but 1 of the pelvic nerves thus making it an excellent target for hard to treat pelvic pain.  Blocking S2 and S3 at once increases the likelihood of also blocking the inferior hypogastric plexus, thus providing even more pain relief to the area.

Epidural Steroid Injection – These injections are more commonly used for neck and low back pain, however they can also be used to provide local pain relief to a specific dermatome – in the case of pelvic pain, a dermatome overlying pain in the pelvic region.

Differential Block – These procedures are routinely used to anesthetize a woman from the waist down during childbirth.  This treatment is now being used by pelvic pain specialists to diagnose complex pelvic pain to figure out where the pain is coming from in those patients who failed to respond to any treatment methods.

Spinal Cord Stimulation – This is a regularly performed procedure utilizing technology similar to that of cardiac pacemakers. This method involves placing small electrodes into the epidural space near the spinal cord. These electrodes produce a small electrical current over the spinal cord that your brain will interpret as a gentle massage or feeling of “champagne bubbles.” In the case of pelvic pain, the leads are placed over the sacral nerve roots, or in the thoracic region.[15-16]

DRG Stimulation – A variant of Spinal Cord Stimulation but way more effective.  This procedure involves placing leads a fraction of the size of traditional stimulator leads directly over the nerve levels that are transmitting the pain.  Our very own doctor discovered the use of DRG Stimulation for the use of pelvic pain by using unique lead combinations that isolate discomfort in the pelvic region.[17]

Intrathecal Pumps – This is a method whereby a small catheter is placed in the subarachnoid space and minuscule amounts of medication are delivered directly to the spinal cord and the rest of the CNS. This enables your physician to provide the same medications but at a fraction of the dose due to the proximity to the spinal cord.  More importantly, our doctors have been putting a revolutionary drug inside the pumps called ziconotide and are reported amazing successes!

Medication Management & Pharmacologic Therapy – There are a wide-variety of medications found to be effective in treating CPP – these include non-steroidal anti-inflammatories (i.e. ibuprofen or naproxen), membrane stabilizers (Lyrica or gabapentin), antidepressants (Cymbalta or amitriptyline), anticonvulsants (Keppra).  Opioids should be the last option.

Physical Therapy & Biofeedback – Exercises focusing on pelvic floor muscle relaxation, as well as ultrasounds and stretching have been shown to help relieve pelvic pain.