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Abstract：
To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain.
CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates.
Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state.
Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subjects related to CPP, including acute care management, myofascial dysfunction, and medical and surgical therapeutic options. The committee reviewed the literature and available data from a needs assessment of subjects with CPP, using a consensus approach to develop recommendations.
The quality of the evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice were ranked according to the method described in that report (Table 1).
The recommendations are directed to the following areas: (a) an understanding of the needs of women with CPP; (b) general clinical assessment; (c) practical assessment of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d) principles of opiate management; (f) increased use of magnetic resonance imaging (MRI); (g) documentation of the surgically observed extent of disease; (h) alternative therapies; (i) access to multidisciplinary care models that have components of physical therapy (such as exercise and posture) and psychology (such as cognitive-behavioural therapy), along with other medical disciplines, such as gynaecology and anesthesia; G) increased attention to CPP in the training of health care professionals; and (k) increased attention to CPP in formal, high-calibre research. The committee recommends that provincial ministries of health pursue the creation of multidisciplinary teams to manage the condition.
CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates.
Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state.
Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subjects related to CPP, including acute care management, myofascial dysfunction, and medical and surgical therapeutic options. The committee reviewed the literature and available data from a needs assessment of subjects with CPP, using a consensus approach to develop recommendations.
The quality of the evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice were ranked according to the method described in that report (Table 1).
The recommendations are directed to the following areas: (a) an understanding of the needs of women with CPP; (b) general clinical assessment; (c) practical assessment of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d) principles of opiate management; (f) increased use of magnetic resonance imaging (MRI); (g) documentation of the surgically observed extent of disease; (h) alternative therapies; (i) access to multidisciplinary care models that have components of physical therapy (such as exercise and posture) and psychology (such as cognitive-behavioural therapy), along with other medical disciplines, such as gynaecology and anesthesia; G) increased attention to CPP in the training of health care professionals; and (k) increased attention to CPP in formal, high-calibre research. The committee recommends that provincial ministries of health pursue the creation of multidisciplinary teams to manage the condition.
摘要：
为了提高对慢性盆腔疼痛（CPP）的认识，并为初级保健专业人员提供有价值的循证指南，一般产科医生和妇科医生，以及专门研究慢性疼痛的人。
CPP是常见的，影响女性的衰弱状况。它为干预措施带来了大量的个人痛苦和医疗保健支出，包括多次咨询以及医疗和手术治疗。因为人们对这种复杂疾病的潜在病理生理学知之甚少，这些治疗方法的成功率各不相同。
诊断和治疗选择的有效性，包括肌筋膜功能障碍的评估，多学科护理，一种康复模式，强调在疼痛而不是治愈的情况下实现更高的功能，以及适当使用阿片类药物治疗慢性疼痛状态。
搜索了Medline和Cochrane数据库从1982年到2004年的有关CPP主题的英文文章，包括急性护理管理，肌筋膜功能障碍,以及医疗和外科治疗选择。委员会审查了来自CPP受试者需求评估的文献和可用数据，使用协商一致的方法来制定建议。
使用加拿大定期健康检查工作组报告中描述的标准对证据的质量进行评级。实践建议根据该报告中描述的方法进行排序（表1）。
这些建议针对以下领域：（a）了解患有CPP的妇女的需求；（b）一般临床评估；（c）疼痛程度的实际评估；（d）肌筋膜疼痛；（e）药物和外科手术；（d）阿片类药物管理原则；（f）增加使用磁共振成像（MRI）；（g）记录手术观察到的疾病程度（认知姿势和替代治疗），例如多学科治疗；以及其他医学学科，例如妇科和麻醉；G）在培训医疗保健专业人员时增加了对CPP的关注；（k）在正式，高水平的研究。委员会建议省卫生部继续建立多学科小组来管理这种疾病。
CPP是常见的，影响女性的衰弱状况。它为干预措施带来了大量的个人痛苦和医疗保健支出，包括多次咨询以及医疗和手术治疗。因为人们对这种复杂疾病的潜在病理生理学知之甚少，这些治疗方法的成功率各不相同。
诊断和治疗选择的有效性，包括肌筋膜功能障碍的评估，多学科护理，一种康复模式，强调在疼痛而不是治愈的情况下实现更高的功能，以及适当使用阿片类药物治疗慢性疼痛状态。
搜索了Medline和Cochrane数据库从1982年到2004年的有关CPP主题的英文文章，包括急性护理管理，肌筋膜功能障碍,以及医疗和外科治疗选择。委员会审查了来自CPP受试者需求评估的文献和可用数据，使用协商一致的方法来制定建议。
使用加拿大定期健康检查工作组报告中描述的标准对证据的质量进行评级。实践建议根据该报告中描述的方法进行排序（表1）。
这些建议针对以下领域：（a）了解患有CPP的妇女的需求；（b）一般临床评估；（c）疼痛程度的实际评估；（d）肌筋膜疼痛；（e）药物和外科手术；（d）阿片类药物管理原则；（f）增加使用磁共振成像（MRI）；（g）记录手术观察到的疾病程度（认知姿势和替代治疗），例如多学科治疗；以及其他医学学科，例如妇科和麻醉；G）在培训医疗保健专业人员时增加了对CPP的关注；（k）在正式，高水平的研究。委员会建议省卫生部继续建立多学科小组来管理这种疾病。
