Limited randomized controlled trial (RCT) evidence is available to guide treatment decisions in CPP. It is important to be clear as to whether treatment is directed towards an underlying condition such as adhesions or whether pain itself is the main focus. While hormonal therapy aims to achieve benefit in a non-specific manner by inhibiting ovarian activity, based on the observation that many patients with CPP experience resolution at the time of the menopause, psychological approaches aim to enhance coping skills and reduce pain-associated distress. Many proven treatments for chronic neuropathic pain such as low-dose tricyclic antidepressants and gabapentin are equally relevant in CPP where there are neuropathic features. With regard to specific approaches, systematic review identified 14 randomized controlled trials relevant to the management of CPP, the interventions in 12 of which are of practical applicability .
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