Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort

Allaire, Catherine; Williams, Christina; Bodmer‐Roy, Sonja; Zhu, Sean; Arion, Kristina; Ambacher, Kristin; Wu, Jessica; Yosef, Ali; Wong, Fabian; Noga, Heather; Britnell, Susannah; Yager, Holly; Bedaiwy, Mohamed A.; Albert, Arianne; Lisonkova, Sarka; Yong, Paul J.

doi:10.1016/j.ajog.2017.10.002

Cited by 106 publications

(80 citation statements)

References 27 publications

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“…Despite the well-recognised fact that an interdisciplinary sociopsychobiomedical approach is the gold standard intervention for chronic pain conditions, 1,7,8,13 there is currently no such provision available for CPP within the majority of gynaecological services.…”

Section: Discussionmentioning

confidence: 99%

“…The total mean of the current sample was 11-12 points higher than the comparative samples (see Table 1). Compared with available samples of women with CPP taken from the literature 13…”

Section: Methodsmentioning

confidence: 99%

“…27 While there are no international normative values for pain catastrophising for women with CPP, existing studies that have measured pain catastrophising on a number of measures show sample means that are significantly higher than non-pelvic pain control groups. 13,28,29 This suggests that this group may be uniquely at risk of developing CPP and for poorer outcomes after biomedical intervention.…”

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confidence: 99%

“…To inform future service development, an audit was undertaken of women with pelvic pain referred to the general gynaecology clinic in a tertiary women's hospital, with the aim of establishing the level of psychosocial need within in this group. It was hypothesised that, in line with international literature, 13,28,29 there would be a significant minority with significant pain catastrophising that could benefit from targeted intervention.…”

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confidence: 99%

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Unmet treatment needs in patients with chronic pelvic pain in a New Zealand gynaecology service

Joseph

Mills

2019

Aust NZ J Obst Gynaeco

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BACKGROUNDChronic pelvic pain (CPP) is defined as continuous or intermittent pain in the abdomen and/or pelvis lasting for at least six months. 1 Current prevalence estimates suggest one in every four to six women experience CPP, making it relatively common. 2,3 For many of these women, CPP is accompanied by high levels of distress, disability, and reduced quality of life. 2,3 The high levels of distress experienced by these women have resulted in strong lobbying for increased treatments to alleviate CPP. 2 The mainstay of such treatments has been based on traditional biomedical perspectives of pain directed toward the end Background: Chronic pelvic pain, which carries a high burden of disability and distress, is a common presentation to gynaecology clinics. While there is increasing acknowledgment of the complexity of chronic pelvic pain, and the benefits of providing management from a multidisciplinary team within a sociopsychobiomedical framework, the mainstay of management in gynaecology outpatient clinics remains within a single clinician biomedical-focused model. This model of care is only sufficient for women who present with minimal psychosocial complexity to their pain. Aims: To estimate the proportion of women attending the gynaecology outpatient clinic at a public women's hospital in New Zealand referred with chronic pelvic pain who have needs unmet by the current biomedical model of care. Informed by international research, pain catastrophising was used as a psychosocial correlate of this complexity. Methods: An audit was undertaken of 100 consecutive pre-appointment questionnaires of women, referred to a gynaecology outpatient clinic for review of pelvic pain of duration over six months, with no red flags in their referral history. Results:An unexpectedly high level of catastrophic thoughts about pain was reported. Seventy-seven percent of the women scored in the high or severe range, with 55% endorsing clinically significant scores for helpless catastrophising.Conclusions: The Pain Catastrophising Scores in this cohort were found to be higher than those in similar groups in the published international literature and also than in patients referred to the local tertiary level pain management centre, further reinforcing the need for investment into appropriate services for women with chronic pelvic pain. K E Y W O R D Scatastrophising, chronic pain, endometriosis, pain management, pelvic pain

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Section: Discussionmentioning

confidence: 99%

“…The total mean of the current sample was 11-12 points higher than the comparative samples (see Table 1). Compared with available samples of women with CPP taken from the literature 13…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Unmet treatment needs in patients with chronic pelvic pain in a New Zealand gynaecology service

Joseph

Mills

2019

Aust NZ J Obst Gynaeco

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“…Chronic pelvic pain affects 15% of women, results in considerable psychological, physical and economic burden and is difficult to treat . Tenderness or hypertonicity of the pelvic floor muscles can be a hyperalgesic muscular response to a noxious stimulus and has been reported in 22‐94% of women with chronic pelvic pain .…”

Section: Introductionmentioning

confidence: 99%

Pelvic floor hypertonicity in women with pelvic floor disorders: A case control and risk prediction study

Cameron

Sabourin

Sanaee

et al. 2018

Neurourology and Urodynamics

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Aim Myofascial pelvic pain is a chronic and debilitating condition, sometimes associated with pelvic floor disorders (PFD) such as urinary incontinence, defecatory dysfunction or pelvic organ prolapse. Our aim was to identify risk factors in women with PFD and hypertonic pelvic floor, compared to controls without hypertonicity. Methods Case control study (2009‐2017) of patients with PFD and a diagnosis of hypertonic pelvic floor. Cases were matched with patients who presented with the same PFD but without pelvic floor hypertonicity. Postoperative patients with hypertonic pelvic floor were matched with patients who underwent surgery for the same PFD but did not develop pain. Risk factors were compared between groups. Results Ninety‐five cases were matched; 71% had urogynecologic surgery as a possible trigger for myofascial pain. Most were post‐menopausal. Overall, case patients were younger than controls (mean 54 vs 59, P = 0.002). Multivariate logistic regression identified risk factors of younger age (OR 1.45, 95%CI 1.04‐2.07), history of depression (OR 3, 95%CI 1.03‐9.09), musculoskeletal spine injury (OR 4.32, 95%CI 1.01‐21.26) and transobturator midurethral sling (OR 8.36, 95%CI 2.68‐31.32). Retropubic midurethral sling was protective against pelvic floor hypertonicity (OR 0.37, 95%CI 0.15‐0.86). A clinical prediction model including depression, endometriosis, irritable bowel, spine injury and type of midurethral sling was developed to estimate the probability for myofascial pain after urogynecologic surgery. Conclusions Specific risk factors predispose women with PFD to chronic pelvic floor hypertonicity. Knowledge of these can help with patient counselling and choice of midurethral sling prior to PFD surgery.

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Chronic Pelvic Pain in Women

Lamvu

Carrillo

Ouyang

et al. 2021

JAMA

172

139

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ImportanceChronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world’s female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions.ObservationsChronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process.Conclusions and RelevanceChronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.

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Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort

Cited by 106 publications

References 27 publications

Unmet treatment needs in patients with chronic pelvic pain in a New Zealand gynaecology service

Unmet treatment needs in patients with chronic pelvic pain in a New Zealand gynaecology service

Pelvic floor hypertonicity in women with pelvic floor disorders: A case control and risk prediction study

Chronic Pelvic Pain in Women

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