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If possible, your doctor will want to identify the cause of your chronic pelvic pain, as the preferable form of treatment is to identify and resolve the underlying cause directly. If no definitive cause can be identified, your doctor will focus on managing your symptoms to get your pain under control. Over-the-counter (OTC) painkillers can reduce levels of pain by interrupting the production of a certain chemical called prostaglandin which controls pain sensations.  Simple painkillers target the affected area to reduce levels of prostaglandins, thus lessening the severity of pain as well. Simple painkillers are commonly purchased over the counter. Dosage for adults is usually 500 mg tablets every four to six hours. An example of simple painkiller is ibuprofen (Advil). Your doctor might prescribe stronger, narcotic painkillers if the simple painkillers are not working to relieve your symptoms.  Your doctor may prescribe hydrocodone (vicodin or norco), or oxycodone (Roxicodone). Dosage may vary depending upon the severity of the pain but normal dosage of oral Tramadol for adults is about 50–100 mg every four to six hours, for instance. So long as you are not trying to get pregnant or have any other conditions that would interfere with birth control, you may find that taking birth control pills can have a significant effect on decreasing chronic pelvic pain. This is particularly true if your pelvic pain is cyclical and linked to a part of your menstrual cycle. Many women have worse pain during ovulation (two weeks into their cycle), and during the menstrual period itself. If you find yourself with these cyclical symptoms, speak to your doctor about birth control or other hormonal treatment options. Chronic pelvic pain that is caused by an infection is commonly treated with antibiotics. Be sure to finish the full course of antibiotics that your doctor prescribes, even if your symptoms begin to feel better, as finishing the full course helps to prevent any recurrent infections or complications down the road. These drugs can be helpful in treating several chronic pain syndromes, so they are sometimes prescribed for women with chronic pelvic pain who do not suffer from depression.  Examples include tricyclic antidepressants like amitriptyline or nortriptyline (Pamelor) which contain both pain relief and antidepressant properties. Amitriptyline works on the brain and spinal cord by suppressing the pain signals that are sent to these areas. The recommended initial dose is 75 mg per day. The maintenance dose is 150 to 300 mg per day, which can be given in single or divided doses. Chronic pain may be caused by psychological factors such as depression, stress or personality disorder. Finding time to seek help from expert counselors could help ease the stress, thereby relieving pain sensations as well. Cognitive behavior therapy (CBT) and biofeedback are two techniques that have both been shown to be helpful in treating chronic pain. You can speak to your counsellor about these options if they interest you to learn more about them. With this therapy, electrodes are used to transmit electrical impulses into the nerve pathways, thereby helping doctors to determine and relax areas of tight muscles. This increases blood flow to the area and helps to prevent the accumulation of irritants such as lactic acid that can cause pain.  TENS is done using a small, battery-powered machine that is about the size of a pocket radio. Two wires that conduct electrical impulses (electrodes) from the machine are attached to the painful area. When the current is delivered, you experience less pain.  Aside from relaxing tight muscles, the electricity stimulates the nerves in the painful area and sends signals to the brain that block the normal pain signals. The doctor or physical therapist usually determines the correct settings of the TENS machine before treatment. TPI is a procedure used to treat painful areas of pelvic muscle that contain trigger points. These trigger points are knots of muscle that are formed when the muscles do not relax. They can often be felt beneath the skin and can cause pain when palpated or pressed upon.  During this procedure, the doctor will first locate the trigger point by palpating the knots of muscles. If pain occurs, then this is the target area. It will now be cleaned with an alcohol based solution. Your doctor will give you an injection of a numbing medicine, usually a long-acting local anaesthetic such as bupivacaine and a small amount of steroid. The injection is given at the specific spot where you are feeling pain (the trigger point) to block the sensation and to provide relief. Surgery is commonly the last resort if all other pain relief measures fail. Surgical interventions are intended to correct underlying problems which may be causing the chronic pelvic pain. Doctors may recommend:  Laparoscopic surgery: If the cause of chronic pelvic pain is endometriosis, adhesions or endometrial tissues can be removed through this procedure. Your doctor will administer general anesthesia. A small incision will be made near the umbilicus to allow entry of an instrument called a laparoscope. This instrument will guide the doctors during the removal of endometrial tissues.  Hysterectomy and bilateral oophorectomy: This procedure may be recommended for women past childbearing age who experience chronic pelvic pain. Your doctor will administer  general anesthesia. An incision will be made in the abdomen, then the uterus and the ovaries will be removed. This leads to a deficiency of estrogen, a hormone which is needed by endometriosis (cysts that may aggravate chronic pelvic pain) for growth.
Start by identifying the cause. Take over-the-counter painkillers. Get a prescription for stronger painkillers. Try birth control pills. Treat bacterial infections with antibiotics. Consider taking antidepressants. Look into counseling. Ask your doctor about transcutaneous electrical nerve stimulation (TENS). Opt for trigger point injections. Undergo surgery as a last resort.