Surgery Day Keynote Lecture - Surgical Management of Pelvic Pain

Presenters

Needs Assessment and Description
Chronic pelvic pain has a prevalence of at least 4% in women of reproductive age and is a major issue in women’s health. Gynecologists often are the primary treating physicians for women with chronic pelvic pain and they generally use surgery as their major modality of treatment. This live course will give gynecologists more information regarding the nature of chronic pelvic pain and the importance of non-surgical treatment options for their patients.

Learning Objectives 
At the conclusion of this session, participants should be able to:

1. Discuss the potential importance and role of neuropathic pain in chronic pelvic pain syndromes. 
2. Evaluate the strong evidence for efficacy of surgical treatments, especially for endometriosis-associated chronic pelvic pain.
3. Describe the general concepts of pain pathophysiology.

ACGME Competency 
Patient Care

TEST QUESTION:
A 25-year-old woman presents to you with pelvic pain that has been constant for 2 years and worsens at menses and with intercourse. She has had 2 laparoscopies with a diagnosis of endometriosis both times. However, in spite of excision of the endometriotic lesions, her pelvic pain has not improved. Also, treatment with combined oral contraceptives has not been effective. After participating in this session, in my practice I will recommend the following as the most appropriate approach to her evaluation and treatment:

1. Proceed with hysterectomy and bilateral salpingooophorectomy for definitive treatment of endometriosis. 
2. Perform surgery again with a presacral neurectomy as a component of the surgery. 
3. Initiate treatment with a gonadotropin-releasing hormone agonist. 
4. Evaluate thoroughly for another diagnosis, especially interstitial cystitis/painful bladder syndrome or irritable bowel syndrome. 
5. Not applicable to my area of practice.