Published online by Cambridge University Press: 08 March 2021
Nerve pain is more often than not a cause of pelvic pain. This is particularly true in patients in whom pain started after pelvic trauma, surgery, or vaginal delivery. Unfortunately, most of gynecologists who are often physicians of primary contact for mesh patients are not trained in recognizing and treating patients with nerve injury pain. Patients with nerve injury pain can almost always pinpoint the moment when the pain started. It is often unilateral and neuropathic in nature. Patients have a burning, tingling sensation often associated with increased sensitivity to stimuli analogous to skin pain after sunburn. Pain is often exacerbated by body movements and certain body positions. It is very important for the first provider who sees patients with pelvic pain that pain may be related to nerve injury because expeditious treatment increases the chances of recovery. It is also important to instruct patients to avoid activity that started the pain in the first place and minimize activity that exacerbates the pain. Trial of muscle relaxants, gabapentin, or pregabalin may be appropriate first treatment; however, prompt referral to physical therapy, neurology, or a specialized pelvic pain center is often necessary.
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