Pelvic Pain Program
Chronic pelvic pain can be a life altering condition that involves physical discomfort and emotional distress. Although pelvic pain is more common in women, this condition also affects men and receiving effective treatment, regardless of gender, can be a challenge. MAPS multidisciplinary professionals are expert at diagnosing the causes of chronic pelvic pain and work closely together to develop a treatment plan tailored to the patient’s individual needs. We value an integrated, multi-disciplinary approach to the management of pelvic pain and patients who are referred to our pelvic pain program may receive care by our nurse practitioners, physician assistants, physicians, physical therapists and licensed psychologists, all professionals with expertise in this area.
The first step in effectively treating pelvic pain is a comprehensive and thorough evaluation. Our multidisciplinary team of professionals includes MAPS physicians, nurse practitioners, physician assistants, physical therapists and behavioral health specialists. Our evaluation process includes an interview and review of outside medical records as well as a physical examination. We recommend that female patients have a gynecological examination by their gynecologist and male patients have a prostate examination by their urologist or primary physician within 60 days of starting our pelvic pain program to ensure that all patients have been screened for any treatable, organic diseases that may be contributing to pain in the pelvic region.
The patient will fill out an intake questionnaire in order to outline past medical history as well as describe specific pelvic pain complaints and associated symptoms. Our intake questionnaire will also include questions that will allow us to measure treatment outcomes and help us monitor improvement as treatment progresses.
Review of medical records
Knowing what other methods have been used to treat a patient’s pain helps to develop the most individualized and effective treatment plan possible. Outside medical records should include notes from previous primary care providers, medical specialists and others who have provided care as well as the results from any diagnostic tests or imaging studies.
Our physical examination includes a musculoskeletal assessment to measure range of motion, strength, reflexes, sensation, muscle tone and tenderness. We also assess skin and tissue integrity in the pelvic region, identify tender points in and around the pelvis and determine strength in the pelvic floor muscles that support the genito-urinary organs and assist with bowel and bladder function.
Pelvic pain treatment options
Chronic pelvic pain is usually a multi-factorial problem manifested by a variety of symptoms in addition to pain. MAPS pelvic pain specialists recognize the importance of a multidisciplinary approach when treating pelvic pain and effectively tailor a treatment plan for the individual patient. The goals of treatment are focused on reduction of pain, restoration of normal function and improved quality of life.
We often prescribe non-steroidal anti-inflammatories (NSAIDS) and nerve stabilizing medications in addition to transdermal skin patches and/or other novel medications to reduce pelvic pain. We occasionally prescribe opioids, but are very cautious with these medications because of the potential for mental side effects and addiction.
MAPS physical therapists have specialized training in pelvic pain management and are experts in the diagnosis and treatment of pelvic floor tension disorders which may be associated with urinary incontinence, fecal incontinence, constipation, pudendal neuralgia, interstitial cystitic and dyspareunia. We have a patient-centered approach and hope to, restore a sense of control by providing patients with self-management pain-relief strategies. MAPS physical therapists are skilled in the use of biofeedback, manual therapy, therapeutic exercise and other techniques to reduce pain and improve function.
Cognitive and behavioral therapies
Pelvic pain problems are difficult for patients to discuss, cause emotional and mental stress and are often associated with anxiety and depression. MAPS psychologists understand the emotional and mental stressors that exist for patients who have a chronic pelvic pain diagnosis and provide tools such as relaxation training, hypnosis and group support to help patients cope. We also offer individual and couples counseling to decrease the effects that pelvic pain may have on an individual’s personal relationships.
There are a variety of injections and nerve blocks that may be used to treat pelvic pain and our pain specialist physicians may recommend one or a series of injections depending on the exact nature of symptoms. Interventional pain procedures may help to facilitate physical therapy treatments by “putting out the fire of inflammation” and/or reversing the sensitivity of the “wound up” pain-sensing nervous system. Injection therapies can usually be provided with minimal discomfort by our expert physicians using local anesthesia although IV sedation is always available for any patient who has anxiety about needles.
Neurostimulation is a high-tech intervention that is increasingly being used to treat refractory pelvic pain and bladder dysfunction syndromes such interstitial cystitis. With neurostimulation, our pain specialist physician first places a set of temporary neurostimulator electrodes using fluroscopic guidance and IV sedation in the outpatient clinic in order to provide a trial of this therapy lasting several days and up to one week as necessary. This trial allows the patient to experience first-hand what neurostimulation feels like and to make an informed decision about whether to have a neurostimulator system implanted permanently.
Diagnostic Testing for Pelvic Pain
An important part of pelvic pain evaluation involves sophisticated diagnostic testing. We review the results of any previous tests a patient may have undergone prior to coming to MAPS and we may order addtional testing as necessary. Tests commonly used for the diagnostic workup of pelvic pain include imaging studies such as CT, MRI and/or ultrasound, urodynamic studies, laboratory testing and electrodiagnostic examinations.