Update on Chronic Pelvic Pain Discovering New Therapeutic Tools

Abstract

Introduction: Chronic pelvic pain in women is frequent, heterogeneous, and carries a high functional burden; the definition of chronicity beyond three months and the distinction between primary and secondary pain reorient diagnosis and treatment. Objective: To synthesize evidence on clinical evaluation, conventional management, and neuromodulation in chronic pelvic pain. Methods: Narrative integrative review across major biomedical databases, with no time restriction, including studies in English and Spanish, using controlled descriptors and inclusion criteria for pharmacological, hormonal, physiotherapy, psychological, and neuromodulation interventions. Results: A comprehensive evaluation is recommended, avoiding duplication of tests. Initial treatment prioritizes prudent use of nonsteroidal anti-inflammatory drugs, hormone therapies aimed at amenorrhea, pelvic floor physiotherapy, and psychotherapy based on cognitive-behavioral therapy and mindfulness; opioids should be limited. In refractory cases, neuromodulation shows benefits: sacral stimulation with sustained improvement; conus medullaris stimulation with pain reduction and greater tolerance for sitting; dorsal root ganglion stimulation with superiority over dorsal column stimulation in therapeutic success; dorsal column stimulation, including high-frequency modalities, useful in selected subgroups; and pudendal nerve stimulation as a focal alternative. Conclusions: A multidisciplinary and personalized approach optimizes pain control, function, and quality of life. Neuromodulation targets expand the therapeutic arsenal and require comparative trials to define patient selection profiles and long-term safety.