Psychological evaluation should be performed early in the evaluation of CPP. Stress reduction, relaxation, and behavioral therapies should also be addressed.143[II] Assessment should evaluate the pain complaint, impact on life circumstances, controlling factors, and coping mechanisms. Issues often involve relationship dysfunction requiring family and marital therapy, presence of past or current physical or sexual abuse, and the negative effects on self-esteem and independence. Prolonged psychotherapy for these issues is generally not part of pain management but can be used in conjunction. No RCTs have assessed the effect of psychological approaches on chronic pelvic pain, however, a randomized trial of multidisciplinary management of CPP (which involves a component of psychological assessment and therapy) has demonstrated significant improvement in pain and well-being with the multi-disciplinary approach compared with standard gynecologic treatment. Standardized psychological testing is helpful to determine whether affective disturbance is present, as well as to establish a baseline against which to measure treatment response and guide treatment approaches.
There have been studies looking at cognitive-behavioral therapy and chronic pain, although not specifically with respect to CPP.179
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