Definitions of Chronic Pelvic Pain(CPP)
Terminology Description
Chronic pelvic pain- Non-malignant pain perceived in structures related to the pelvis of either men or women. In the case of documented nociceptive pain that becomes chronic, pain must have been continuous or recurrent for at least 6 months. If non-acute and central sensitization pain mechanisms are well documented, then the pain may be regarded as chronic, irrespective of the time period. In all cases, there often are associated negative cognitive, behavioral, sexual and emotional
consequences (5,6)
Pelvic pain syndrome - Persistent or recurrent episodic pelvic pain associated with symptoms suggesting lower urinary tract, sexual, bowel or gynecological dysfunction. No proven infection or other obvious pathology (adopted from ICS 2002 report) (1)
Bladder pain syndrome - Suprapubic pain is related to bladder filling, accompanied by other symptoms such as increased daytime and night-time frequency. There is an absence of proven urinary infection or other obvious pathology. This term has been adopted from the ICS 2002 report (1),
where the term painful bladder syndrome was used; the name has been changed to bladder pain syndrome to be consistent with other pain
syndrome terminology (5,6). The European Society for the Study of IC/PBS (ESSIC) publication places greater emphasis on the pain being perceived
in the bladder (4)
Urethral pain syndrome- Recurrent episodic urethral pain, usually on voiding, with daytime frequency and nocturia. Absence of proven infection
or other obvious pathology (1)
Penile pain syndrome- Pain within the penis that is not primarily
in the urethra. Absence of proven infection or other obvious pathology (5,6)
Prostate pain syndrome - Persistent or recurrent episodic prostate pain, associated with symptoms suggestive of urinary tract and/or sexual dysfunction. No proven infection or other obvious pathology (5,6)
Scrotal pain syndrome - Persistent or recurrent episodic scrotal pain associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven epididymo-orchitis or other obvious
pathology (1)
Testicular pain syndrome - Persistent or recurrent episodic pain localized to the testis on examination, which is associated with symptoms suggestive
of urinary tract or sexual dysfunction. No proven epididymo-orchitis or other obvious pathology. This is a more specific definition than scrotal pain syndrome (1)
Epididymal pain syndrome - Persistent or recurrent episodic pain localized to the epididymis on examination. Associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven epididymo-orchitis or other obvious pathology (a more specific definition than scrotal pain syndrome (5,6)
Endometriosis - associated chronic or recurrent pelvic pain where endometriosis is present but does not fully explain all the symptoms (5,6)
Vaginal pain syndrome - Persistent or recurrent episodic vaginal pain associated with symptoms suggestive of urinary tract or sexual dysfunction. No proven vaginal infection or other obvious pathology (1)
Vulvar pain syndrome - Persistent or recurrent episodic vulvar
pain either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction. There is no proven infection or other obvious pathology (1)
Generalized vulvar pain - Vulval burning or pain that cannot be consistently and tightly localized by point syndrome (formally pressure ‘mapping’ by probing with a cotton-tipped applicator or similar dysaesthetic vulvodynia) instrument. The vulvar vestibule may be involved but the discomfort is not limited to the vestibule. Clinically, the pain may occur with or without provocation (touch, pressure or friction) (8)
Localized vulvar pain - Pain consistently and tightly localized by point-pressure mapping to one or more syndrome portions of the vulva. Clinically, pain usually occurs as a result of provocation
(touch, pressure or friction) (8)
Vestibular pain syndrome - Pain localized by point-pressure mapping to one or more portions of the vulva (formerly vulval vestibulitis) vestibule (8)
Clitoral pain syndrome - Pain localized by point-pressure mapping to the clitoris (8)
Anorectal pain syndrome - Persistent or recurrent, episodic rectal pain with associated rectal trigger points/tenderness related to symptoms of bowel dysfunction. No proven infection or other
obvious pathology (5,6)
Pudendal pain syndrome Neuropathic - type pain arising in the distribution of the pudendal nerve with symptoms and signs of rectal, urinary tract or sexual dysfunction. No proven obvious pathology (5,6). (This is not the same as the well-defined pudendal
neuralgia)
Perineal pain syndrome - Persistent or recurrent, episodic,
perineal pain either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction.
No proven infection or other obvious pathology (1)
Pelvic floor muscle pain - Persistent or recurrent, episodic, pelvic floor pain with associated trigger points, syndrome which is either related to the micturition cycle or associated with symptoms suggestive of urinary tract, bowel or sexual dysfunction. No proven infection or other obvious pathology (5,6)
A multidisciplinary approach that includes a plant based diet, the right type of rehab exercise, fresh air, sunlight, water, of diet, rest, healthy relationships, support group and psychotherapy.
Understanding that the above syndromes are overlapping is very important, because they emphasize the importance of interdisciplinary, multidisciplinary assessment and management.
REFERENCES
1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A.
The standardization of terminology of lower urinary tract function: report from the Standardization
Subcommittee of the International Continence Society. Urology 2003 Jan;61(1):37-49.
http://www.ncbi.nlm.nih.gov/pubmed/12559262
2. Merskey H, Bogduk N. Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and
Definitions of Pain Terms. IASP Press, 2002.
3. Baranowski AP, Abrams P, Berger RE, Buffington CA, de C Williams AC, Hanno P, Loeser JD,
Nickel JC, Wesselmann U. Urogenital pain–time to accept a new approach to phenotyping and, as a
consequence, management. Eur Urol 2008;53(1):33-6.
http://www.ncbi.nlm.nih.gov/pubmed/17961909
4. van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, Elneil S, Fall
M, Hohlbrugger G, Irwin P, Mortensen S, van Ophoven A, Osborne JL, Peeker R, Richter B, Riedl
C, Sairanen J, Tinzl M, Wyndaele JJ. Diagnostic criteria, classification, and nomenclature for painful
bladder syndrome/interstitial cystitis: an ESSIC poposal. Eur Urol 2008;53(1):60-7.
http://www.ncbi.nlm.nih.gov/pubmed/17900797
5. Fall M, Baranowski AP, Fowler CJ, Lepinard V, Malone-Lee JG, Messelink EJ, Oberpenning F,
Osborne JL, Schumacher S. EAU Guidelines on Chronic Pelvic Pain. In: EAU Guidelines, edition
published at the 18th Annual EAU Congress, Madrid, 2003. ISBN 90-70244-06-3.
http://www.ncbi.nlm.nih.gov/pubmed/15548433
6. Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, Oberpenning F, Williams A C
de C. EAU Guidelines on Chronic Pelvic Pain. In: EAU Guidelines. 23rd Annual EAU Congress, Milan,
ISBN 978-90-70244-91-0.
http://www.uroweb.org/nc/professional-resources/guidelines/online/
7. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA
1999;282(3):236-7.
http://www.ncbi.nlm.nih.gov/pubmed/10422990
8. Proceedings of the XVth World Congress. International Society for the Study of Vulvovaginal Disease,
Santa Fe, NM, September 26-30, 1999. International Society for the Study of Vulvovaginal Disease
Newsletter, Summer 2000.
Guideline on Chronic Pelvic Pain, European Association of Urology 2009M. Fall (chairman), A.P. Baranowski, S. Elneil, D. Engeler,J. Hughes, E.J. Messelink, F. Oberpenning, A.C. de C. Williams
