Women with chronic pelvic pain (CPP) often present without obvious cause on imaging
studies, laboratory values or physical exam. Dysfunctional sensory processing in the central nervous
system (CNS) may explain pain of unclear origin. Central sensitization (CS), a mechanism of centrally
mediated pain, describes this abnormal processing of sensory information. Women with CPP often
present with several seemingly unrelated symptoms. This can be explained by co-existing chronic pain
syndromes occurring in the same patient. Central sensitization occurs in all of these pain syndromes,
also described as dysfunctional pain syndromes, and thus may explain why several often occur in the
same patient. Six of the most common pain disorders that co-exist in CPP include endometriosis, painful
bladder syndrome/interstitial cysitis, vulvodynia, myofascial pain/ pelvic floor hypertonus, irritable bowel syndrome,
and primary dysmenorrhea. Central pain generators, (pain originating from CS) and peripheral pain generators, (pain from
local tissue damage), can both occur in each of these six conditions. These pain generators will be described.
Chronic pain, specifically dysfunctional sensory processing, is recognized as a systemic disease process like diabetes to be
managed as opposed to a local problem to be “fixed” or cured. A multi-disciplinary approach to assessment and treatment
with a focus on improving emotional, physical and social functioning instead of focusing strictly on pain reduction is
more effective in decreasing disability. This is best achieved by determining the patient’s needs and perspective through a
patient-centered approach. Algorithms for such an approach to assessment and treatment are outlined.