An Interdisciplinary Approach to Endometriosis-associated Persistent Pelvic Pain

Abstract

spinal cord level. CS may explain the frequent coexistence of endometriosis with other conditions in the pelvis, such as painful bladder syndrome, irritable bowel syndrome, vulvar vestibulodynia, and myofascial pain conditions (9). Women with PPP also frequently experience psychological distress, catastrophising thoughts, kinesiophobia, and sleep disturbance. Although there is a growing understanding of the processes at play, there is still a paucity of evidence on how to best manage this challenging condition. It is our premise that improvement in pain, function, and quality of life can be better achieved if the peripheral nociceptive triggers, psychosocial factors, and central sensitivity are addressed concurrently. With this goal in mind, the BC Women's Centre for Pelvic Pain and Endometriosis was founded in 2011 to offer interdisciplinary management of PPP and to provide a platform for research in this area. Evaluation of the PPP/endometriosis patient Women with endometriosis and/or pelvic pain are referred to our centre by their family physician or specialist. We are a tertiary centre of care, with four gynaecologists evaluating approximately 1000 patients per year coming from the entire province of British Columbia (population of 4.7 million, spread out over 947,000 km 2) (10). Prior to their initial visit to the clinic, patients are required to complete extensive online questionnaires, which cover demographics, medical history, childhood sexual and physical abuse history, previous treatments, current severity of dysmenorrhea, non-menstrual pelvic pain, dyspareunia, and dyschezia (11). In addition, we use validated questionnaires to assess sleep (12), as well as to screen for irritable bowel syndrome (IBS) (13) and painful bladder syndrome (PBS) (14). Patients who score high on

Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument

“…CPP remains a challenging disorder to treat because of the complexities of pain sensation and unclear aetiology. Standard medical and surgical treatments seldom prove effective at improving quality of life and pain intensity among affected women [4]. Furthermore, the variation in outcome reporting of trials evaluating interventions has prevented the synthesis of data to identify effective treatments and draw clinically relevant conclusions in the context of guideline formation [5].…”

A systematic review on reported outcomes and outcome measures in female idiopathic chronic pelvic pain for the development of a core outcome set

“…It is a challenging disorder to treat due to its poorly understood aetiology and complexities of pain perception and sensation. Standard medical or surgical treatments lack a holistic approach and often fail to improve the severity of symptoms or the quality of life 4 …”

Interdisciplinary Teams in Endometriosis Care

“…Only a few centers have published on an established interdisciplinary approach to CPP and endometriosis. 12,86,87 Extracting from the very solid literature on chronic pain management and the more limited evidence in endometriosis and CPP, an interdisciplinary team approach for endometriosis care was developed at the BC Women's Centre for Pelvic Pain and Endometriosis in Vancouver, Canada, in 2011. This center is funded by the Provincial Health Services Authority (PHSA) and is a tertiary referral center for complex endometriosis cases from across the province of British-Columbia (BC).…”

“…A detailed description of our clinic's model of interdisciplinary care for endometriosis-associated pelvic pain has been published elsewhere. 12 This approach is summarized in ►Fig. 1.…”

“…This is described in detail in other reviews. [10][11][12] Such an approach will allow identification of the presence of comorbidities as concurrent pain generators. The most common comorbidities that can exacerbate endometriosisassociated pain involve the bladder, bowel, and musculoskeletal systems.…”