Medication for Pelvic Pain Relief

Women who suffer from chronic pelvic pain take 3 times the medication than women who do not suffer. Medication is often central to coping and recovering from pain. The aim being to improve the sufferers quality of life by improving their behaviour and mobility, as well as the pain itself.

Chronic pelvic pain medication

A recent analysis of pelvic pain treatments promoted the use of the following medications to treat chronic pelvic pain. The lowest effective dose of any medication will be provided by your GP, and its prescription will stop if there is no improvement in the condition or another drug with fewer negative side effects is available. This will be accessed regularly with your doctor, to prevent ineffective drug use.

Always check that each drug you are taking is compatible with others, and thoroughly read the instructions provided to be aware of possible side effects.


Painkillers (Analgesics)

In most treatment plans for chronic pelvic pain, painkillers will be offered short-term. They do not resolve the cause of the pain but do allow you to return to your normal activities whilst the cause is diagnosed (if possible) and treated. This can help your mentality around the pain, which has an effect on the way you experience it.

Caution should be taken when using pain medication, as their ability to reduce your pain will lessen as your body gets used to it. Keep your doctor up to date on the effectiveness of any medication you are on, and keep to the schedule that is prescribed.

  • Paracetamol (acetaminophen) - If you are suffering from mild pelvic pain, over the counter painkillers, such as paracetamol, can be enough to relieve your symptoms.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) - This group of drugs is used to treat mild and moderate chronic pelvic pain. Often available over the counter at a pharmacy, they are most beneficial where the pain is caused by inflammation. However, they generally have significant side effects that you need to be aware of.
  • Neuropathic analgesics - These drugs are taken regularly to reduce consistent pain, rather than in response to when pain is experienced. They relieve neuropathic pain that is related to nerve damage, rather than inflammation or disease.
  • Anticonvulsants - Normally used by epileptics to prevent seizures, some anticonvulsants can be used to manage neuropathic pain that is the result of nerve damage.
  • Combined oral contraceptive pill - There is some evidence suggesting that the combined contraceptive pill can reduce cyclic acute pelvic pain that is associated with your menstrual cycle. It does this by suppressing ovulation, which reduces cramps and thins the endometrial lining.
  • Depot medroxyprogesterone (Depo-Provera) - This medication can provide relief from pelvic pain that is associated with endometriosis. Often administered every 3 months by a health care professional.

Antidepressants

As chronic pelvic pain has a huge impact on your emotions, you may suffer from depression as a result. Therefore antidepressants are often included in a holistic treatment plan for chronic pelvic pain. Some antidepressants may not work for you, as they often come with a large number of possible side effects and can take time to improve your outlook. Some antidepressants can also help with neuropathic pain that is caused by nerve damage.

Antidepressants are often continued for a least 6 months after you begin to feel better, so as to reduce the potential for a relapse.

There are several groups of common antidepressants:

  • Selective serotonin reuptake inhibitors (SSRIs) - SSRIs are the most commonly prescribed group of antidepressants as they have the shortest list of side effects.
  • Serotonin and noradrenaline reuptake inhibitors (SNRIs) - By inhibiting the reuptake of serotonin and noradrenaline (also called norepinephrine), these drugs are usually used to treat anxiety and depression disorders. SNRIs should not be taken by patients suffering with heart disease. The SNRI Duloxetine can also be used as treatment for urinary stress incontinence.
  • Noradrenaline and specific serotonergic antidepressants (NASSAs) - NASSAs are often prescribed to those that have not got on well with SSRIs, as they have fewer sexual side effects.
  • Tricyclic antidepressants (TCAs) - TCAs are now the least commonly prescribed form of antidepressant. They can take a month of daily use to work fully and come with unpleasant side effects and high danger if overdosed. TCAs can be used to treat some forms of pain by altering the balance of chemicals in the brain.

Counselling and cognitive behavioural therapy (CBT) can be an effective alternative to those not wanting to take antidepressant medication. Exercise and an improvement in sleep and diet can also result in lasting improvements in mood.


Medications to Treat Specific Conditions

If the cause of your pain has been diagnosed, medication can become part of the treatment to remove the cause. Whether it be an infection, inflammation or disease.

  • Goserelin (Zoladex) - Goserelin is used for a variety of conditions, most notably perhaps is locally advanced prostate cancer. It can be injected into the anterior (front) abdominal wall to treat endometriosis and anaemia related to uterine fibroids. It should not be used when the cause of vaginal bleeding is unknown, or if endometriosis is not resolved within 6 months. A 3.6 mg dose, implanted under the skin monthly for six months can be used for pain relief in those suffering from chronic pelvic pain from pelvic congestion. Goserelin should not be used by pregnant women or those that are breast feeding. Side effects include depression, diabetes, changes in body hair, hot flushes, and vaginal dryness.
  • Injectable gonadotropin-releasing hormone (GnRH) agonist - An expensive treatment, it can be used to thin the endometrial lining to reduce menstrual bleeding. It has success in treating the symptoms of premenstrual syndrome, however it is connected with loss of bone density.
  • Oral medroxyprogesterone acetate (Provera) - This medication is primarily used for contraception when injected. It can also be used to treat dysfunctional uterine bleeding and mild to moderate endometriosis.

This is not a comprehensive list of medications available to treat pelvic pain, and should be considered as advice taken from multiple clinical studies. Always seek medical advice before proceeding with a new medication.


Sources

Engeler, D. Baranowski, A. P. Borovicka, J. Cottrell, A. Dinis-Oliveira, P. Elneil, S. Hughes, J. Messelink, E. J. van Ophoven, A. Reisman, Y. Williams, A. C. D. C. (2014). Guidelines on Chronic Pelvic Pain. [online] European Association of Urology, 2014. [viewed 15/05/18]. Avaialable from: https://uroweb.org/wp-content/uploads/26-Chronic-Pelvic-Pain_LR.pdf

Fall, M. Baranowski, A. P. Fowler, C. J. Lepinard, V. Malone-Lee, J. G. Messelink, E. J. Oberpenning, F. Osborne, J. L. Schumacher, S. (2004). European Urology. EAU Guidelines on Chronic Pelvic Pain. [online] 46(6), p681-689. [viewed 11/05/18]. Available from: https://www.europeanurology.com/article/S0302-2838(04)00397-5/fulltext

Ignacio, E. A. Dua, R. Sarin, S. Harper, A. S. Yim, D. Mathur, V. Venbrux, A. C.(2008). Seminars in Interventional Radiology. Pelvic Congestion Syndrome: Diagnosis and Treatment. [online] 25(4), p361-368. [viewed 28/06/18]. Available from: https://www.researchgate.net/publication/49841201_Pelvic_Congestion_Syndrome_Diagnosis_and_Treatment

Kaercher, C. W. Genro, V. K. Souza, C. A. Alfonsin, M. Berton, G. Filho, J. S. C. (2011). BMC Women's Health. Baropodometry on women suffering from chronic pelvic pain - a cross-sectional study. [online] 11, p 51. [viewed 01/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228674/

Knott, L. (2017). Antidepressants. [online] Patient, 2017. [viewed 28/06/18]. Available from: https://patient.info/health/depression-leaflet/antidepressants

Kumar, P. Sharma, A. (2014). Journal of Human Reproductive Sciences. Gonadotropin-releasing hormone analogs: Understanding advantages and limitations. [online] 7(3), p170-174. [viewed 28/06/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229791/

NHS Choices. (2015). Antidepressants: Overview. [online] NHS Trust, 2015. [viewed 28/06/18]. Available from: https://www.nhs.uk/conditions/antidepressants/

NICE. (2018a). Goserelin. [online] NICE, 2018. [viewed 28/06/18]. Available from: https://bnf.nice.org.uk/drug/goserelin.html

NICE. (2018b). Medroxyprogesterone Acetate. [online] NICE, 2018. [viewed 28/06/18]. Available from: https://bnf.nice.org.uk/drug/medroxyprogesterone-acetate.html

Sansone, R. A. Sansone, L. A. (2014). Innovations in Clinical Neuroscience. Serotonin Norepinephrine Reuptake Inhibitors: A Pharmacological Comparison. [online] 11(3-4), p37-42. [viewed 28/06/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008300/

The International Pelvic Pain Society. (2014). Chronic Pelvic Pain. [online] The International Pelvic Pain Society, 2014. [viewed 02/05/18]. Available from: https://pelvicpain.org/docs/patients/Basic-Chronic-Pelvic-Pain.pdf

Vercellini, P. De Giorgi, O. Oldani, S. Cortesi, I. Panazza, S. Crosignani, P. G. (1996). American Journal of Obstetrics & Gynecology. Depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low-dose danazol for long-term treatment of pelvic pain associated with endometriosis. [online] 175(2), p396-401. [viewed 28/06/18]. Available from: https://www.ncbi.nlm.nih.gov/m/pubmed/8765259/

Won, H. R. Abbott, J. (2010). International Journal of Women's Health. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach. [online] 2, p263-277. [viewed 28/06/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990894/