Chronic pelvic pain syndrome | The chronic pain syndrome

Chronic pelvic pain syndrome

Chronic pelvic pain syndrome describes a disorder characterized by prolonged pain in the pelvic region and lower back. The disease occurs more frequently in men after the age of 50 and formally belongs to the clinical picture of bacterial prostate inflammation (prostatitis), even if the cause of chronic pelvic pain syndrome is not a bacterial infection. Chronic pelvic pain syndrome is defined as a pain in the pelvic region that has existed for more than three months and is associated with complaints of the prostate.

A further distinction is made between an inflammatory and a non-inflammatory form of chronic pelvic pain syndrome. The exact cause is unknown and often cannot be fully explained to the patient. Symptoms are the eponymous pelvic pain, problems with urination and disturbances in erectile function.

The diagnosis is made on the basis of an anamnesis together with a physical examination of the pelvis and urine examination. In addition, the ejaculate can also be examined and a transrectal ultrasound of the prostate can be performed. During this examination, a probe-shaped ultrasound probe is inserted into the rectum, resulting in a better resolution of the prostate. The therapy is limited to the relief of symptoms. Among other things, medication can be given to relieve the discomfort of urination and painkillers.

Classification according to ICD

The ICD (International Statistical Classification of Diseases and Related Health Problems) is an internationally used classification system for diseases. This standardization is important for making uniform diagnoses. It also plays a decisive role in billing with health insurance companies.

The chronic pain syndrome and its subtypes are also listed in the ICD. A distinction is made here according to the exact background and characteristics of the clinical picture. The problem is that mental illnesses are not listed in the ICD.

However, the chronic pain syndrome often has a psychological component. It has also been proven that mental involvement in the chronification of pain plays a decisive role in the intensity and course of the disease. The ICD has therefore been supplemented accordingly, so that both somatic (physical) and psychological forms of chronic pain syndrome are listed. In fact, the various sub-items even list in more detail whether the mental illness came first and then the physical illness or vice versa. These exact distinctions make a standardization of medical diagnostics and therapy on an international level possible.

Classification according to Gerbershagen

With the Gerbershagen classification, the chronification of pain can be more accurately categorized. The classification contains five different axes, each of which is divided into three stages. Stage 1 shows the best prognosis, while stage 3 is assigned to the most severe pain disorders.

The first axis describes the temporal course of the pain conditions. Attention is paid to whether pain is always present or only temporary and whether the intensity of the pain changes or whether the pain is continuously of equal intensity. If the pain is particularly severe, it is referred to as stage 3.

If the pain is only intermittent and its intensity is weak, it is referred to as stage 1. The second axis deals with the localisation of the pain. If the patient can clearly assign the pain to a body region, then he is in stage 1.

In the case of diffuse, non-localizable pain all over the body, the patient is referred to as stage 3. The third axis deals with the intake of pain medication. In this context, particular attention is paid to whether there is an overdose or misuse of medication.

If this is the case over a longer period of time, the patient is referred to as stage 3. If self-medication is correct and pain-related, the patient is classified as stage 1. The fourth axis describes the extent to which a patient requires medical help.

More precisely, attention is paid to whether the patient regularly visits a doctor (often the family doctor) when necessary, or, usually out of desperation, visits many different medical facilities at short intervals. In the first case this corresponds to stage 1 according to Gerbershagen, in the second to stage 3. The fifth and last axis deals with the patient’s social environment.

If this is stable or only marginally burdened by problems, this is stage 1. If the family structure has broken up and the patient is not integrated into professional life and society, this is stage 3. In summary, the classification of the chronification of pain according to Gebershagen offers a multidimensional classification system from which both the symptoms and the patient’s handling of the disease can be read. It should be noted, however, that the boundaries between the stages are often blurred and therefore a classification is not always accurate.