What are the recommended management strategies for chronic pelvic pain in primary care, including pharmacological and non-pharmacological options?

Management strategies for chronic pelvic pain in primary care include both pharmacological and non-pharmacological options.

Pharmacological options: Consider prescribing antidepressants such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline for adults aged 18 years and over after discussing benefits and harms, as these may improve quality of life, pain, sleep, and psychological distress even without depression diagnosis. Avoid initiating antiepileptic drugs (including gabapentinoids), antipsychotics, benzodiazepines, corticosteroid trigger point injections, ketamine, local anaesthetics, NSAIDs, opioids, and paracetamol specifically for chronic primary pain management. If patients are already on these medicines, review their use carefully and consider shared decision making about continuation or withdrawal based on benefit and harm balance ¹.

Non-pharmacological options: Offer person-centred assessment to identify factors contributing to pain and its impact on life, and develop a collaborative care and support plan. Encourage exercise programmes and physical activity tailored to the individual. Use pain management programmes that include at least two components, such as physical and psychological therapies, delivered by trained professionals with coordination between components. Support self-management strategies and shared decision making throughout care ¹.

Reassess patients presenting with flare-ups of chronic pelvic pain to review care plans and consider new symptoms or contributing factors ¹.