Navigating the Diagnostic Labyrinth: A Narrative Review of Atypical Pelvic Pain Syndromes at the Intersection of Gynecologic Oncology, Chronic Infection, and Odontogenic Referred Pain
Abstract
Background: Atypical pelvic pain presents a profound diagnostic challenge, often masking serious underlying pathology across disparate anatomical systems. The convergence of gynecologic malignancies, chronic pelvic inflammatory disease (PID), and referred pain from advanced odontogenic infections creates a clinical triad requiring sophisticated multidisciplinary differentiation.
Aim: This narrative review synthesizes current evidence to construct an integrated diagnostic pathway for atypical pelvic pain, emphasizing the collaborative roles of gynecologic oncology, infectious diseases, internal medicine, dentistry, radiology, laboratory medicine, nursing, and administrative support.
Methods: A comprehensive search of PubMed, Scopus, CINAHL, and Cochrane databases was conducted for English-language articles published between 2010 and 2024. Search terms included "pelvic pain differential diagnosis," "gynecologic cancer masquerade," "chronic pelvic inflammatory disease," "odontogenic referred pain," "multidisciplinary pain assessment," combined with specific disciplines.
Results: The review delineates distinct yet overlapping clinical presentations, biomarker profiles, and imaging findings for ovarian/endometrial malignancies, chronic PID, and maxillofacial pain referral. Key discriminators include nuanced symptom patterns (cyclic vs. constant, positional relationships), inflammatory markers (CA-125, CRP, PVL), and cross-sectional imaging characteristics.
Conclusion: Atypical pelvic pain demands a paradigm shift from sequential specialty consultation to synchronous, coordinated multidisciplinary evaluation. Implementing structured diagnostic algorithms with clear referral triggers can reduce time-to-diagnosis, optimize resource use, and improve patient outcomes. Future directions include developing integrated clinics and shared decision-support tools.
Full text article
References
Ahangari, A. (2014). Prevalence of chronic pelvic pain among women: an updated review. Pain physician, 17(2), E141-E147. https://doi.org/10.36076/PPJ.2014/17/E141
Agrawal, M., & Kolli, S. N. (2019). Role of laparoscopy in the diagnosis of chronic pelvic pain. Journal of Datta Meghe Institute of Medical Sciences University, 14(4), 310-314. DOI: 10.4103/jdmimsu.jdmimsu_172_19
Almutairi, S. S. R., Bahattab, S. A., Anbri, A. A. M., Anbri, M. A., Alobaid, S. Q., Alenazi, M. A., ... & Alharth, F. F. (2024). The role of medical records and medical secretary in supporting Nurses and Psychologists in Treating Chronic Mental Health Disorders. Journal of International Crisis and Risk Communication Research, 7(S9), 2513. DOI:10.63278/jicrcr.vi.1914
Baron, R., Hans, G., & Dickenson, A. H. (2013). Peripheral input and its importance for central sensitization. Annals of neurology, 74(5), 630-636. https://doi.org/10.1002/ana.24017
Bittelbrunn, C. C., de Fraga, R., Martins, C., Romano, R., Massaneiro, T., Mello, G. V. P., & Canciglieri, M. (2023). Pelvic floor physical therapy and mindfulness: approaches for chronic pelvic pain in women—a systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 307(3), 663-672. https://doi.org/10.1007/s00404-022-06514-3
Brunham, R. C., Gottlieb, S. L., & Paavonen, J. (2015). Pelvic inflammatory disease. New England Journal of Medicine, 372(21), 2039-2048. DOI: 10.1056/NEJMra1411426
Caetano, A. J., Human Cell Atlas Oral and Craniofacial Bionetwork, Sequeira, I., & Byrd, K. M. (2022). A roadmap for the human oral and craniofacial cell atlas. Journal of dental research, 101(11), 1274-1288. https://doi.org/10.1177/00220345221110768
Comelli, A., Genovese, C., Gobbi, F., Brindicci, G., Capone, S., Corpolongo, A., ... & Zammarchi, L. (2023). Schistosomiasis in non-endemic areas: Italian consensus recommendations for screening, diagnosis and management by the Italian society of tropical medicine and global health (SIMET), endorsed by the committee for the study of parasitology of the Italian association of clinical microbiologists (CoSP-amcli), the Italian society of parasitology (SoIPa), the Italian society of gastroenterology and digestive endoscopy (SIGE), the Italian society of gynaecology and obstetrics (SIGO), the Italian society of .... Infection, 51(5), 1249-1271. https://doi.org/10.1007/s15010-023-02050-7
Erdogan, O., Ramsey, A., Uyanik, J. M., Gibbs, J. L., & Burns, L. E. (2022). Outcomes of referrals from endodontic to orofacial pain specialists: a retrospective cohort study. Clinical and Experimental Dental Research, 8(1), 457-463. https://doi.org/10.1002/cre2.497
Farman, A. G., & Scarfe, W. C. (2018). Historical perspectives on CBCT. In Maxillofacial Cone Beam Computed Tomography: Principles, Techniques and Clinical Applications (pp. 3-11). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-62061-9_1
Funston, G., Hardy, V., Abel, G., Crosbie, E. J., Emery, J., Hamilton, W., & Walter, F. M. (2020). Identifying ovarian cancer in symptomatic women: a systematic review of clinical tools. Cancers, 12(12), 3686. https://doi.org/10.3390/cancers12123686
Goldthorpe, J., Walsh, T., Tickle, M., Birch, S., Hill, H., Sanders, C., ... & Pretty, I. (2018). An evaluation of a referral management and triage system for oral surgery referrals from primary care dentists: a mixed-methods study. Health and Social Care Delivery Research, 6(8), 1-126. https://doi.org/10.3310/hsdr06080
Grossman, D. C., Curry, S. J., Owens, D. K., Barry, M. J., Davidson, K. W., Doubeni, C. A., ... & US Preventive Services Task Force. (2018). Screening for ovarian cancer: US preventive services task force recommendation statement. Jama, 319(6), 588-594. doi:10.1001/jama.2017.21926
Lavigne, G. J., & Sessle, B. J. (2016). The neurobiology of orofacial pain and sleep and their interactions. Journal of Dental Research, 95(10), 1109-1116. https://doi.org/10.1177/0022034516648264
Luther, B., Barra, J., & Martial, M. A. (2019). Essential nursing care management and coordination roles and responsibilities: A content analysis. Professional Case Management, 24(5), 249-258. DOI: 10.1097/NCM.0000000000000355
Mahoney, D. E., & Pierce, J. D. (2022). Ovarian cancer symptom clusters: use of the NIH symptom science model for precision in symptom recognition and management. Clinical journal of oncology nursing, 26(5), 533. https://doi.org/10.1188/22.CJON.533-542
Mitchell, C., & Prabhu, M. (2013). Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infectious disease clinics of North America, 27(4), 10-1016. https://doi.org/10.1016/j.idc.2013.08.004
Moore, R. G., Blackman, A., Miller, M. C., Robison, K., DiSilvestro, P. A., Eklund, E. E., ... & Messerlian, G. (2019). Multiple biomarker algorithms to predict epithelial ovarian cancer in women with a pelvic mass: Can additional makers improve performance?. Gynecologic oncology, 154(1), 150-155. https://doi.org/10.1016/j.ygyno.2019.04.006
Paavonen, J., Turzanski Fortner, R., Lehtinen, M., & Idahl, A. (2021). Chlamydia trachomatis, pelvic inflammatory disease, and epithelial ovarian cancer. The Journal of Infectious Diseases, 224(Supplement_2), S121-S127. https://doi.org/10.1093/infdis/jiab017
Parker, C., Castro, E., Fizazi, K., Heidenreich, A., Ost, P., Procopio, G., ... & Gillessen, S. (2020). Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 31(9), 1119-1134. https://doi.org/10.1016/j.annonc.2020.06.011
Pradeep, S., Reddy, M. L., Harika, M., Kiranmai, N., & Aarthi, V. (2023, October). Development and Testing of an IoT-Based Medical Assistant Robot: A Design for Enhanced Healthcare Support. In 2023 IEEE 5th International Conference on Cybernetics, Cognition and Machine Learning Applications (ICCCMLA) (pp. 292-297). IEEE. https://doi.org/10.1109/ICCCMLA58983.2023.10346647
Sayasneh, A., Ferrara, L., De Cock, B., Saso, S., Al-Memar, M., Johnson, S., ... & Bourne, T. (2016). Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study. British journal of cancer, 115(5), 542-548. https://doi.org/10.1038/bjc.2016.227
Šedý, J., Rocabado, M., Olate, L. E., Vlna, M., & Žižka, R. (2022). Neural basis of etiopathogenesis and treatment of cervicogenic orofacial pain. Medicina, 58(10), 1324. https://doi.org/10.3390/medicina58101324
Sessle, B. J. (2021). Chronic orofacial pain: models, mechanisms, and genetic and related environmental influences. International journal of molecular sciences, 22(13), 7112. https://doi.org/10.3390/ijms22137112
Shinoda, M., Imamura, Y., Hayashi, Y., Noma, N., Okada-Ogawa, A., Hitomi, S., & Iwata, K. (2021). Orofacial neuropathic pain-basic research and their clinical relevancies. Frontiers in Molecular Neuroscience, 14, 691396. https://doi.org/10.3389/fnmol.2021.691396
Shroff, S. (2023). Infectious vaginitis, cervicitis, and pelvic inflammatory disease. Medical Clinics, 107(2), 299-315. https://doi.org/10.1016/j.mcna.2022.10.009
Silow-Carroll, S., Edwards, J. N., & Rodin, D. (2012). Using electronic health records to improve quality and efficiency: the experiences of leading hospitals. Issue Brief (Commonw Fund), 17(1), 40.
Stewart, C. J., Leung, Y. C., Chaudry, Z., Koay, M. E., Naran, A., Plunkett, M., ... & Soma, A. (2019). Evaluation of pathology review at gynaecological oncology multidisciplinary team meetings: a 5-year prospective analysis of cases with major diagnostic discordance. Pathology, 51(4), 353-361. https://doi.org/10.1016/j.pathol.2019.03.002
Thomassin-Naggara, I., Poncelet, E., Jalaguier-Coudray, A., Guerra, A., Fournier, L. S., Stojanovic, S., ... & Rockall, A. G. (2020). Ovarian-adnexal reporting data system magnetic resonance imaging (O-RADS MRI) score for risk stratification of sonographically indeterminate adnexal masses. JAMA network open, 3(1), e1919896-e1919896. doi:10.1001/jamanetworkopen.2019.19896
Troncon, J. K., Anelli, G. B., Poli-Neto, O. B., & e Silva, J. C. R. (2023). Importance of an Interdisciplinary Approach in the Treatment of Women with Endometriosis and Chronic Pelvic Pain. Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics, 45(11), e635-e637. DOI: 10.1055/s-0043-1777001
Watanabe, T., Soeda, S., Endo, Y., Okabe, C., Sato, T., Kamo, N., ... & Fujimori, K. (2022). Rare hereditary gynecological cancer syndromes. International Journal of Molecular Sciences, 23(3), 1563. https://doi.org/10.3390/ijms23031563
Workowski, K. A., & Bachmann, L. H. (2022). Centers for disease control and prevention’s sexually transmitted diseases infection guidelines. Clinical Infectious Diseases, 74(Supplement_2), S89-S94. https://doi.org/10.1093/cid/ciab1055
Authors
Copyright (c) 2024 Olayan Shaqer Alrashedi, Noura Mohammed Alotaibi, Afnan Yahya M Atiah, Ayed Sfooq Alanzi, Waleed Eid Almutairi, Ziyad M. Alyami, Ibtihal A. Alyami, Turkey Saeed Saeed Alqahtani, Sumaya Awn Awn Alsulobi, Saud Naif Abdulhadi Alanazi, Musab Muhammad Musa Al-Ajam, Mahran Atif Halawani, Ashwaq Ali Asiri, Miad salamah Alolasi
This work is licensed under a Creative Commons Attribution 4.0 International License.