Drug treatments in the therapeutic management of chronic pelvic and perineal pain

Introduction. - Chronic pelvic and perineal pain is a common compliant due to a wide range of causes. The treatment strategy obviously depends on the identified aetiologies, which constitute the main target of treatment. However; pain often becomes self-perpetuating with time, generating and feeding on the social and functional consequences, resulting in a specific disease: chronic pain or pathological pain. Objectives. - To define the place of drug treatment in the management of chronic pelvic and perineal pain. Methods. - Review of the literature devoted to drug treatments. Results. - Drugs have an inevitable place in the treatment strategy, but their role is poorly known and they are rarely completely effective. Drugs can only be part of the treatment of these syndromes and can only be prescribed in the context of a predefined strategy. Other treatment modalities are also available and often essential: physiotherapy, global management, TENS (transcutaneous electrical nerve stimulation), surgery, neuromodulation (peripheral, spinal cord, cortex stimulation, intrathecal infusion). As in chronic neuropathic pain, the analgesic drugs proposed in chronic pelvic and perineal pain mainly consist of tramadol, antidepressants and antiepileptics. Conclusion. - The limited number of specific randomized clinical trials, the sometimes insufficient efficacy of drug treatments, associated with significant adverse effects, the very disabling nature of this disease, and the frequent need for off-label prescription indicate the need for effective multidisciplinary management. (C) 2010 Elsevier Masson SAS. All rights reserved.