CHRONIC PELVIC PAIN - EXPRESSION OF A PSY CHIC DISTURBANCE

Objectives: Chronic pelvic pain (CPP) is one of the most difficult and perplexing problems encountered in gynecology, Lately CPP has been at tributed, among many other etiologies to tension myalgia of the pelvic boor, Identification of trigger points, myofascial problems and the C arnett test have been considered helpful, We hypothesized that these a re not the cause of CPP but a sign of psychic disturbance. Methods: Se venty patients, 40 vith CPP, 20 with organic pain and 10 normal contro ls were investigated, A pain index was defined and used, A blinded psy chologic evaluation was conducted in all cases using the Rorschach and a semi structured psychologic interview, A psychometric index was cal culated. Results: The algometric test was low in controls, It was in t he higher range in CPP patients and in both cases correlated well with the psychometric index. CPP patients expressed a variety of psychic d isturbances, The response of patients with organic CPP to etiologic tr eatment could be predicted by the algometric index, low index = good r esponse; high index = difficult follow up. Conclusion: Trigger points, tension myalgia and abdominal cellulalgia are not the cause of CPP, T hey are the sign of somatization of neurotic or psychosomatic problems in the pelvis, They represent a useful diagnostic tool, which will al low an individualized, multidisciplinary approach to diagnosis and man agement of CPP.