Neurological Conditions Linked to Chronic Pelvic Pain

Neurological conditions frequently co-occur with chronic pelvic pain (CPP), but most patients are not diagnosed for many years, according to a new study presented at Pain Week 2024 in Las Vegas. 

Nearly three quarters of patients with CPP who had symptoms like falls or large fiber neuropathy had a neurological disorder. The most common neurological symptoms also included small fiber neuropathy, lumbosacral radiculopathy, and severe spinal stenosis. Nearly 85% of patients with symptoms were previously undiagnosed. 

The research indicates a need for a more holistic approach to identifying and treating CPP and opens up a “positive Pandora’s box,” said Charles Argoff, MD, an author of the study, neurologist, and director of the Comprehensive Pain Program at Albany Medical Center in New York. 

Argoff said never receive a comprehensive evaluation and needlessly suffer from neurological disorders that are easily treatable. Clinicians treating patients with CPP should consider referring to a neurologist, especially if they have symptoms of a disorder, he said. 

The retrospective observational study took place between 2022 and 2024 and included 126 adult patients who were seen by the clinic’s neurologists, urologists, and gynecologists. All patients screened positive for neurological symptoms such as falls; pain radiating from the back down the leg; multiple overlapping pain syndromes; bladder, bowel, or sexual dysfunction; or abnormal neurological responses such as poor reflexes. 

Patients with CPP who exhibit these symptoms should be screened for neurological conditions, said Elise De, urologist at Albany Medical Center and an author of the study.

“People live in pain without a diagnosis and optimal treatment unnecessarily, sometimes for years, and part of the reason is that pelvic pain crosses many disciplines — neurology, pain management, urology, gynecology, gastroenterology, physical therapy — and most clinical interactions are set up as a single specialty.” 

Often patients with CPP are referred or go to urologists for treatment. 

But “the fact that we work in silos makes it likely that a patient may not get a complete assessment,” said Sheila Dugan, MD, physiatrist and co-founder of Rush Program for Abdominal and Pelvic Health in Chicago. “Pain in the genitals should not just be seen by urologists. We need to broaden our teams.” 

CPP is defined as persistent pelvic pain lasting for more than 6 months and makes functioning difficult. The disorder is poorly understood and affects up to 25% of people worldwide and can lower the quality of life significantly. 

The complex condition is nongynecologic in approximately 80% of patients. Additionally, the average patient with CPP has 2.4 comorbidities including irritable bowel syndrome, interstitial cystitis, fibromyalgia, migraines, or myofascial pain. 

According to Dugan, the new research is just scratching the surface in understanding chronic pelvic pain, but “what’s most important is how this is impacting [a patient’s] function, how we prioritize treating whatever the pain is limiting them with and how we move forward to meet the goals of the patient.” 

The study authors reported no disclosures. Dugan had no disclosures.

Brittany Vargas is a medicine, mental health, and wellness journalist.