Objeción De Conciencia

SOGC CLINICAL PRACTICE GUIDELINES
SOGC CLINICAL PRACTICE GUIDELINES

No 164, Part one of two, August 2005

Consensus Guidelines for the Management of
Chronic Pelvic Pain
This guideline was developed by the Chronic Pelvic Pain Working
Group and approved by the Executive and Council of the Society
of Obstetricians and Gynaecologists of Canada.
PRINCIPAL AUTHORS
John F. Jarrell, MD,FRCSC, MSc, CSPQ, Calgary AB
George A. Vilos, BSc, MD, FRCSC, FACOG, FSOGC, London ON
CO-AUTHORS AND CHRONIC PELVIC PAIN COMMITTEE
Catherine Allaire, MD CM, FRCSC, Vancouver BC
Susan Burgess, MA, MD, CCFP, FCFP, Vancouver BC
Claude Fortin, MD, CSPQ, FRCSC, FACOG, Montreal QC
Robert Gerwin, MD, FAANCS, Baltimore MD
Louise Lapensée, MD, FRCSC, Montreal QC
Robert H. Lea, MD, FRCSC, Halifax NSNicholas A. Leyland, BSc, MD, FRCSC, FSOGC, Toronto ON
Paul Martyn, MB BS (Hons), FRCOG, FRCSC, Calgary AB
Hassan Shenassa, MD, FRCSC, Ottawa ON
Paul Taenzer, PhD, CPsych, Calgary AB
CONTRIBUTING AUTHOR
Basim Abu-Rafea, MD, FRCSC, London ON

Abstract
Objective: To improve the understanding of chronic pelvic pain (CPP)
and to provide evidence-based guidelines of value to primary care
healthprofessionals, general obstetricians and gynaecologists,
and those who specialize in chronic pain.
Burden of Suffering: CPP is a common, debilitating condition
affecting women. It accounts for substantial personal suffering and
health care expenditure for interventions, including multiple
consultations and medical and surgical therapies. Because the
underlying pathophysiology of this complexcondition is poorly

understood, these treatments have met with variable success
rates.
Outcomes: Effectiveness of diagnostic and therapeutic options,
including assessment of myofascial dysfunction, multidisciplinary
care, a rehabilitation model that emphasizes achieving higher
function with some pain rather than a cure, and appropriate use of
opiates for the chronic pain state.Evidence: Medline and the Cochrane Database from 1982 to 2004
were searched for articles in English on subjects related to CPP,
including acute care management, myofascial dysfunction, and
medical and surgical therapeutic options. The committee reviewed
the literature and available data from a needs assessment of
subjects with CPP, using a consensus approach to develop
recommendations.
Values: Thequality of the evidence was rated using the criteria
described in the Report of the Canadian Task Force on the
Periodic Health Examination. Recommendations for practice were
ranked according to the method described in that report (Table 1).
Recommendations: The recommendations are directed to the
following areas: (a) an understanding of the needs of women with
CPP; (b) general clinicalassessment; (c) practical assessment of
pain levels; (d) myofascial pain; (e) medications and surgical
procedures; (d) principles of opiate management; (f) increased use
of magnetic resonance imaging (MRI); (g) documentation of the
surgically observed extent of disease; (h) alternative therapies;
(i) access to multidisciplinary care models that have components of
physical therapy (such asexercise and posture) and psychology
(such as cognitive-behavioural therapy), along with other medical
disciplines, such as gynaecology and anesthesia; (j) increased
attention to CPP in the training of health care professionals; and
(k) increased attention to CPP in formal, high-calibre research. The
committee recommends that provincial ministries of health pursue
the creation of multidisciplinaryteams to manage the condition.
Chapter 2: Scope, Definition, and Causes of Chronic Pelvic Pain
1. Because of the complex nature and multifactorial development of
its common state, CPP should be increasingly incorporated into
the educational curricula of health professionals (medical students,
residents, nurses, physiotherapists, specialists) (III-B).
Chapter 3: History-taking, Physical...