Regenerative Therapy for Chronic Pelvic Pain Syndromes

Chronic pelvic pain (CPP) is one of the common painful conditions that is difficult to diagnose and treat. Consequently, patients are seen in interventional pain management settings. CPP is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous system. The symptoms of CPP appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. CPP is seen in both genders even though it is common in females. Overall, CPP is a nonspecific, all-inclusive term that includes a variety of diagnosis ranging from pudendal neuralgia and coccygodynia, prostatodynia, vulvodynia and painful bladder syndrome (PBS). In broad terms, the usual symptoms of CPP include neuropathic symptoms such as paresthesia, numbness, burning, or lancinating pain in the pelvis, anus, and/or genital. While the exact cause is unclear, there are a variety of gender and organ-specific conditions which carry a high risk for the development of CPP. In many cases, CPP is a diagnosis of exclusion likely encompassing other pathologic states and often comprises and evolution of states into a clearly chronic neuropathic pain condition. CPP is also closely linked with sexual dysfunction in both males and females impacting emotional status and overall quality of life. Consequently, CPP and substance use disorders share considerable psychosocial factors, such as post-traumatic stress disorder (PTSD) history, trauma, sleep disorders, anxiety and depression. Interventional pain management typically occurs later in their continuum of care. Consequently, conservative modalities have already been tried and interventional pain physicians are left with injections and nerve blocks with limited effectiveness in such cases. Regenerative medicine management may be an option. This chapter provides literature review of CPP and therapeutic interventions.