Treatment

Undiagnosed Groin, Abdominal, and Pelvic (UGAP) pain is not an uncommon condition and millions of patients, both females and males suffer from it. It is a great masquerader mimicking several different lower abdominal, groin and pelvic conditions.
Let’s all think of UGAP pain in patients presenting with atypical pain over the lower abdomen, groin, and pelvis. This is one of the few enigmatic conditions where a diagnosis can be strongly suspected in the majority of the patients just on clinical examination.

Let’s help these “Silent Sufferers” and prevent them from doctor shopping, minimize expensive diagnostic workup and prevent unnecessary endoscopies and even unnecessary surgeries. In the process, we will be saving billions of dollars which are currently spent in diagnosing and treating these unfortunate patients.

Treatment is multi-modality requiring a team approach. The goal is to take care of pain, to treat some of the associated problems like muscle spasms, emotional problems including insomnia and depression.

Pain management – non-steroidal anti-inflammatory (NSAID) are of limited value with temporary control of pain. Also, physical therapy with use of ultrasound, TENS unit and local heat to control pain offers only temporary relief. We have achieved good success with strategically placed series of three (3) steroids mixed with local anesthetic injections given two (2) weeks apart. We give these shots in the Pain Clinic with IV sedation.

Emotional and stress management – It is an important part of the treatment of chronic pain. It addresses the vicious cycle and patients learn to cope with pain. Ideally it is better to refer these patients to a psychologist or psychiatrist; however, due to the stigma associated in seeing a psychiatrist majority of our patients refuse to see one. We have taken a different approach and start questioning about their sleeping habits and emphasize how important is sleep to the human body. Surprisingly, most of these patients do take anti-anxiety and anti-depressant even though we mention the word anti-depressant. These patients are extremely happy when they come back for the return visit that they elected to take these medications.

Recently during the past year, we have started using a newer drug called Lyrica (pregabalin). This medication is believed to reduce the number of electrical signals in damaged nerves. They can help you feel less pain. This drug has recently been released by the FDA for the use of fibromyalgia which is somewhat like UGAP pain syndrome. Muscle relaxants are also helpful in several patients. We prefer Baclofen.

Steroid injections, anti-anxiety/anti-depressants and pregabalin are started simultaneously and seem to complement each other’s action and have additive effects.

To prevent future flares up we recommend physical therapy and we have found it to be very useful. Very few physical therapists are specialized in pelvic floor muscles and core muscles therapy. They also have knowledge of paradoxical relaxation and transvaginal myofascial trigger point release/ massage treatment.