Pelvic and Urogenital Pain

Neuropathic pain (NP) arises as a direct consequence of a lesion or a disease affecting the somatosensory system. Assessment of a patient with suspected NP aims at recognition of NP, localizing the lesion, and diagnosing the causative disease. Information of the character of the condition is the basis of the treatment. Disease-modifying treatment should be provided when possible. Symptomatic pharmacotherapy is the major choice in NP. For most types of NP, tricyclic antidepressants, serotonin-noradrenalin reuptake inhibitors (SNRI)-antidepressants duloxetine and venlafaxine, gabapentinoids, tramadol, strong opioids and topical lidocaine have proven efficacy. If the pain relief is insufficient by a single drug, combination therapies are considered. Treatment for NP needs to be individualized according to the etiology of the pain, concomitant diseases, medications and other individual factors. Spinal cord stimulation should be considered for patients with peripheral NP refractory to pharmacotherapy. As in other chronic pain conditions, cognitive behavioral therapy may also be beneficial. © 2011 Blackwell Publishing Ltd