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Perspectives | Health Care Reform

Chronic Pelvic Pain Finding the Cure

David J. Tauben, MD
Arch Intern Med. 2011;171(22):1989. doi:10.1001/archinternmed.2011.571.
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Dismayed by the recent Institute of Medicine report of $650 billion annually spent on pain care1 and a 2011 meta-analysis reporting that pain treatments reduce pain by less than 30% in only half of those treated,2 I report a current case of a young woman with chronic pelvic pain attributed initially to endometriosis and later interstitial cystitis.

This 28-year-old woman was referred for consultation after 8 years of uncontrolled pelvic pain. The pain worsened despite laparoscopic and adhesiolyses, an ovariectomy, and later abdominal hysterectomy, and ongoing cystoscopies and bladder distentions. Each procedure failed to clarify the cause for her pain but exacerbated her pain and prompted an escalation of her opioid dose. Intravesicular medications had no measurable benefit and further increased opioid intake. Physicians were frustrated. She was hopeless and so severely disabled that her mother assumed care of her 4 young children. Her marriage was failing and she was desperate to “find a cure.”

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