Why Should We Consider a Pain-Focused Approach Despite the Presence of Underlying Pathology?

An increasing body of literature suggests similarities between abdominopelvic pain and other chronic pain conditions including peripheral and central nervous system alterations, psychological distress and dysfunction of the hypothalamicpituitary- adrenal axis and autonomic nervous system. These features are also present in conditions associated with chronic abdominopelvic pain including endometriosis, inflammatory bowel disease and interstitial cystitis with Hunner ulcers. In all of these conditions the pain experience is frequently disproportionate to the identified disease severity and there can be associated symptoms from the three main abdominopelvic organs. Moreover, ongoing pain in all these conditions frequently leads to repeated surgical procedures and/or trials of medications with significant systemic side effects. My presentation will review the evidence for dysfunction outside of the pelvis in these conditions and explore strategies to identify and manage these. The presentation will conclude with a discussion of the challenges of moving the patient from a diseasefocussed to a more pain-focussed approach whilst continuing to manage the pathology as appropriate.