Management of adolescent chronic pelvic pain from endometriosis: a pain center perspective.

ABSTRACT

OBJECTIVES: To review the options for the treatment of chronic pelvic pain in adolescents with endometriosis. METHODS: Review of publications and description of author's experience relating to adolescent endometriosis and pain treatment. RESULTS: Pain treatment services offer a multidisciplinary approach for the treatment of chronic pelvic pain consisting of analgesic trials, cognitive-behavioral therapy, physical therapy, and complementary and alternative therapies. Patients are also evaluated for other conditions that might contribute to their chronic pain. Medication trials of antidepressants, anticonvulsants, tramadol, and nonsteroidal anti-inflammatory drugs are frequently used; however, there are limited data on efficacy. Biobehavioral techniques such as relaxation and biofeedback can help patients modify their experience of pain. Cognitive behavioral therapy can improve coping skills and promote improved functioning, particularly in patients who are debilitated from chronic pain. Transcutaneous electrical stimulation (TENS) and physical therapy approaches may be helpful in patients with musculoskeletal conditions that contribute to their pelvic pain. Complementary and alternative therapies are frequently used in the treatment of chronic pain; controlled trials are needed to assess efficacy. CONCLUSIONS: An individualized, multidisciplinary approach may be effective in improving overall outcome in patients with chronic pelvic pain in reducing pain and normalizing function.