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266: CHRONIC PELVIC PAIN SYNDROME

Cynthia E. Neville, DPT, PT, WCS

CONDITION/DISORDER SYNONYMS

  • Chronic pelvic pain syndrome

  • Levator ani syndrome

  • Urogenital pain disorders

FIGURE 266-1

Diagnostic approach: Pelvic pain. (From Henderson MC, Tierney LM, Smetana GW. The Patient History: An Evidence-Based Approach to Differential Diagnosis. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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ICD-9-CM CODES

  • 338.4 Chronic pain syndrome

  • Associated medical diagnoses

    • 564.6 Anal spasm

    • 569.42 Anal or rectal pain

    • 595.1 Chronic interstitial cystitis

    • 601.1 Chronic prostatitis

    • 617 Endometriosis

    • 625.0 Dyspareunia

    • 625.5 Pelvic congestion syndrome

    • 625.7 Vulvodynia

    • 625.71 Vulvar vestibulitis

  • Associated physical therapy diagnoses

    • 719.45 Pain in the hip joint, pelvic region, and thigh

    • 724.7 Disorders of coccyx

    • 728.2 Muscular wasting and disuse atrophy

    • 728.85 Spasm of muscle

    • 728.89 Disorders of muscle, ligament, and fascia

    • 729.1 Myalgia

    • 729.2 Neuralgia/neuritis

    • 729.9 Other disorders of soft tissue

    • 780.7 Malaise and fatigue

    • 782.3 Edema

ICD-10-CM CODES

  • G89.4 Chronic pain syndrome

  • N30.10 Interstitial cystitis (chronic) without hematuria

  • N30.11 Interstitial cystitis (chronic) with hematuria

  • N41.1 Chronic prostatitis

  • N80 Endometriosis

  • R10.2 Pelvic and perineal pain

  • Symptom specific diagnoses

    • K59.5 Anal spasm

    • N53.12 Painful ejaculation

    • N94.1 Dyspareunia

    • N94.81 Vulvodynia

    • N94.810 Vulvar vestibulitis

    • N94.818 Other vulvodynia

    • N94.819 Vulvodynia unspecified

    • N94.89 Other condition associated with female genital organs and menstrual cycle

PREFERRED PRACTICE PATTERN

  • As of July 2014, the APTA Guide to Physical Therapist Practice does not include practice patterns for organ system pathology

  • Associated or secondary musculoskeletal patterns include:

    • 4C: Impaired Muscle Performance1

    • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1

PATIENT PRESENTATION

A 45-year-old woman reports that 3 years ago she had a urinary tract infection (UTI) that was treated with antibiotics. She had recurrent symptoms of UTIs every 2 to 3 months for the next 2 years until during the last episode, she was told by the physician that the urinalysis was negative. The burning with urination was painful. In the past year she has developed more symptoms. She has noticed that she has to urinate more frequently, at least 10 times per day. She wakes up at least three times at night to urinate. Pain is temporarily relived by urination. She reports that in the last year, she has started having problems with bowel movements. Sometimes she is constipated, and sometimes stools are loose. She never had these problems before. She now is having pain during intercourse, and sometimes feels a throbbing pain in the vaginal regions while she is working at her desk. She has stopped exercising because she is concerned that running is making her symptoms worse. She is afraid to have intercourse because it was very painful the last time.

KEY FEATURES

Description2

  • Nonspecific, poorly localized ...

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