Chronic Pelvic Pain and Recurrent Abdominal Pain Etiology

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There are many etiologies of CPP and of RAP. There are clear organic causes for CPP/RAP and causes that seem to mix organic processes with psychosocial phenomena. Even with endometriosis, a clearly organic cause of pain, it is known that the severity of the symptoms is not correlated with the amount of abnormal tissue seen in the pelvis. The best way to conceptualize chronic pelvic and abdominal pain syndromes is via a biopsychosocial model (BPSM). This model brings together organic factors, psychological factors, and environmental factors into a comprehensive picture that is often needed to explain these symptoms.

In the past, many people with chronic pain syndromes were said to have psychosomatic causes of their pain, but in recent years, it has become clear that such syndromes are not solely caused by psychological processes, or are psychosomatic in origin. While that term might not be accurate if it is understood to mean caused solely by psychological factors, the authors feel that the term still has relevance. The real definition of ‘psychosomatic’ does fit the BPSM.

According to a current medical dictionary, ‘psychosomatic’ means ‘pertaining to the mind-body relationship’. A psychosomatic disorder is one in which physical symptoms are caused by or exacerbated by psychological factors.

To that we would add that recognition needs to be made of the interplay among all these factors, i.e. the BPSM.

We will first discuss gynecologic etiologies of CPP/RAP, then abdominal etiologies, and finally, management issues.

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