CNS Spectrums

Review Article

Psychiatric Comorbidity in Women with Chronic Pelvic Pain

Samantha Meltzer-Brody c1 and Jane Leserman

Abstract

Chronic pain syndromes are often treatment refractory and pose an enormous burden of suffering for the individual. Chronic pelvic pain (CPP) is generally defined as noncyclic pain of at least 6 months duration and severe enough to require medical care or cause disability. CPP has been estimated to have a prevalence of 15% among women of reproductive age. Women are at increased risk for both major depression and chronic pain syndromes such as CPP, and are more likely to report antecedent stressful events, have higher rates of physical and sexual abuse, and subsequently develop posttraumatic stress disorder. High rates of sexual and physical abuse and other trauma have been shown among women with CPP, including symptoms of dyspareunia (pain during intercourse), dysmenorrhea (pain during menstruation), and vulvar pain. A detailed and comprehensive evaluation of the patient with CPP should include a thorough gynecologic exam and a full mental health assessment. Treatment of CPP must include an integrated approach targeted at both the psychiatric comorbidity and pain symptoms. A multidisciplinary treatment team offers the best chance for success with CPP, and it is critical to suggest psychiatric treatment (psychopharmacology and/or psychotherapy) in addition to traditional medical and surgical approaches.

(Received November 03 2010)

(Accepted December 20 2010)

(Online publication February 01 2011)

Correspondence:

c1 Corresponding Author: Samantha Meltzer-Brody, MD, MPH, Associate Professor, Director, UNC Perinatal Psychiatry Program, Campus Box, #7160, UNC Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514; Tel: 919-962-9766; E-mail meltzerb@med.unc.edu

Dr. Meltzer-Brody and Dr. Leserman are faculty in the Department of Psychiatry at the University of North Carolina at Chapel Hill.

Footnotes

Faculty Disclosures: Dr. Meltzer-Brody receives research support from AstraZeneca, the Foundation of Hope, and the NIH (Grant number K23MH085165). Dr. Leserman reports no affiliations with or financial interests in any organization that may pose a conflict of interest.

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