Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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M.J. Solnik and M.T. Siedhoff
outcomes [ 25 ]. To date, multiple procedures have been described in
observational trials and include internal iliac/ovarian vein embolization,
sclerotherapy, and ovarian vein ligation.
Ovarian Remnant Syndrome
Women at risk for ovarian remnant syndrome (ORS) , whereby a functional
portion of the ovary is inadvertently left in place after oophorectomy,
include those in whom the fibrovascular attachments are obscured
from dense pelvic adhesions, endometriosis, or reproductive malignancy
[ 26 ]. Resulting pain symptoms are typically cyclic and are accompanied
by a solid pelvic mass with ovarian follicular development. Follicle
stimulating hormone (FSH) and serum estradiol levels are in the premenopausal
range if bilateral salpingo- oophorectomy was undertaken;
however, hormone levels are not conclusively diagnostic. Nonsurgical
attempts to manage pain with steroid hormone suppression should first be
considered, given the predisposing surgical risks. Properly identifying
and resecting the remaining disease can also prove to be extremely difficult,
and has not been evaluated sufficiently in clinical trials.
Pain of Neurosensory Origin
Chronic pain can arise from virtually any organ system, implicating
a framework for a common origin within the neurosensory system. This
concept is corroborated by surgical research, whereby the presumed
underlying pathology was adequately treated, but symptoms persisted or
recurred soon after the targeted operation [ 27 ].
Two major areas of interest, as mentioned previously, include IBS
and IC/PBS. Notwithstanding similarities such as pelvic pain, some
form of visceral dysfunction, and the label of diagnosis of exclusion,
there is no consensus upon which a diagnosis for either of these can be
confirmed. Treatment has thus focused on lifestyle modifications or
reducing inflammatory exposure and sensory input. Pharmacological
agents such as tricyclic antidepressants (TCAs) represent the most
widely studied neuroleptic agents. Although they are routinely used in
CPP management paradigms, there is no high- level evidence to support
their use [ 28 ]. One small trial evaluating nortriptyline in women with
CPP resulted in a 50 % dropout rate because of intolerable side effects.