CPP a form of reflex sympathetic dystrophy? (Small Study).

SAN DIEGO -- Chronic pelvic pain that does not respond to standard treatments such as surgery or drug therapy may be a form of reflex sympathetic dystrophy, according to Dr. Thomas Janicki.

This distinction could have important therapeutic implications, Dr. Janicki said at a meeting sponsored by the International Pelvic Pain Society.

Reflex sympathetic dystrophy represents a maladaptation of the autonomic nervous system, so management of these patients should incorporate strategies that can restore the balance between internal and external environments, such as psychotherapy and stress-reduction techniques.

In a comparison of 16 patients with chronic pelvic pain (CPP) that's lasted at least 1 year and 15 age-matched healthy controls, the CPP patients scored significantly higher on a questionnaire designed to assess the degree of autonomic dysfunction, said Dr. Janicki of Case Western Reserve University in Cleveland.

The mean weighted score among women with CPP was 43, compared with 14 in the control group, indicating higher autonomic dysfunction in the CPP group. To his knowledge, this is the first study to suggest that some cases of CPP may be neurologic in origin.

Clues that a patient may have autonomically related CPP include congestion of pelvic vessels without a clear source of pain and inability to reproduce the pain during an examination.

Several similarities exist between this form of CPP and other pain syndromes that result from autonomic dysfunction. For example, patients with CPP often are extremely sensitive to relatively minor pain stimuli: What's more, the CPP itself may be triggered by conditions such as occult hernias or minimal endometriosis or adhesions. In some patients, transection of the superior hypogastric plexus--part of the autonomic nervous system--reduces pain by more than 50%.