Pain Management for Adenomyosis

First-Line Treatment: NSAIDs

The American College of Physicians recommends Ibuprofen (400-600 mg every 6 hours, maximum 3200 mg daily) as a first-line treatment for adenomyosis-related pain 1
Naproxen (250-500 mg twice daily, maximum 1000 mg daily) and Diclofenac (25-50 mg 2-3 times daily, maximum 150 mg daily) are also effective NSAIDs for pain management 2
NSAIDs should be used with caution in patients at high risk for renal toxicities, GI toxicities, and cardiac toxicities, particularly in patients over 60 years old 1

Depot medroxyprogesterone acetate is effective compared to placebo for pain relief in patients with adenomyosis, as recommended by the American Family Physician 3, 4
The Levonorgestrel-Releasing Intrauterine System (LNG-IUS) reduces systemic side effects compared to oral hormonal treatments and is effective for controlling abnormal uterine bleeding and reducing uterine volume, according to the American College of Radiology 5

The American Society of Clinical Oncology recommends prescribing pain medication on a regular basis rather than "as needed" for chronic pain, with the oral route of administration as the first choice when possible 6, 7
Regular assessment of pain intensity using visual analog scales (VAS) or numerical rating scales (NRS) is recommended, along with monitoring for medication side effects, particularly with long-term NSAID use 6, 7
Baseline blood pressure, renal function, liver function tests, and CBC should be monitored, with repeat monitoring every 3 months with continued NSAID use, as suggested by the National Comprehensive Cancer Network 1