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©2013 UpToDate ® Print Email ACOG chronic pelvic pain level B and C recommendations Recommendations based on limited or inconsistent scientific evidence (level B) Intervention Indication GnRH agonists CPP other than endometriosis Adhesiolysis CPP attributed to dense bowel adhesions Hysterectomy Reproductive tract symptoms Sacral nerve stimulation CPP Physical therapy CPP Nutritional supplementation with vitamin B1 or magnesium Dysmenorrhea Injection of trigger points CPP Application of magnets to trigger points Acupuncture, acupressor, transcutaneous nerve stimulation Primary dysmenorrhea Recommendations based on consensus and expert opinion (level C) Intervention Indication Antidepressants CPP Opioids CPP Adapted and modified from Clinical Management Guidelines for Obstetrician-Gynecologists. Number 51, March 2004: Chronic Pelvic Pain. Obstet Gynecol 2004; 103:589.