Complementary and Alternative Medicine in the Treatment of Chronic Pelvic Pain in Women: What Is the Evidence?

Chronic pelvic pain (CPP) is defined as pain of at least 6 months’ duration that occurs in the lower abdomen or below the umbilicus and has resulted in functional or psychological disability or required intervention and treatment. Therapeutic interventions center around the treatment of CPP as a diagnosis in and of itself, and treatment of specific disorders that may be related to CPP. A multidisciplinary approach for diagnosis and treatment seems to be most effective for symptomatic relief. This paper reviews the evidence for such interventions as psychological treatments including the use of complementary and alternative medicine techniques for CPP in women. Unfortunately, finding the best evidence in this setting is difficult as only very few randomized controlled trials are available. A combination of treatments is usually required over time for the treatment of refractory CPP. The multifactorial nature of CPP needs to be discussed with the patient and a good rapport as well as a partnership needs to be developed to plan a management program with regular followup. Promotion of a multidisciplinary approach which includes complementary and alternative medicine techniques in managing CPP in women seems to yield the best results. 1. Introduction 1.1. Definition and Epidemiology An estimated one in three people suffer from chronic pain, a condition frequently associated with decreased health-related quality of life (HRQoL) and high levels of psychological distress [1]. Despite conventional healthcare utilization, nearly half of patients with chronic pain report their pain as not under control [2]. Limitations of drug therapy for chronic pain reflect the complex pathophysiology of the condition as well as the profound contribution of psychosocial factors to the perpetuation of pain and suffering [3, 4]. Chronic pelvic pain (CPP) is defined as pain of at least 6 months’ duration that occurs in the lower abdomen or below the umbilicus and has resulted in functional or psychological disability or required intervention and treatment. The pain may be recurring or constant [5]. Estimating the prevalence of CPP in women is challenging in part due to lack of consensus in the definition of CPP among investigators, and to the fact that only one third of women with CPP seek medical care [6–8]. Studies have quoted the range to be anywhere from 4% to 40% [6–9]. Even with a likely underestimation of prevalence, CPP accounts for 10% of indications for hysterectomy [10]. This yields 881.5 billion dollars in health care costs in the United States per year [9]. Although