The psychological profile of women presenting to a multidisciplinary clinic for chronic pelvic pain: high levels of psychological dysfunction and implications for practice

Bryant, Christina; Cockburn, Rebecca; Planté, Anne-Florence; Chia, Angela

doi:10.2147/jpr.s115065

Cited by 56 publications

(56 citation statements)

References 41 publications

(59 reference statements)

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“…It is essential for clinicians to take this into account in the assessment and treatment of CPP. 3,6,44 Specific issues related to the pelvic area, as sexual function/dysfunction, incontinence and constipation should also be paid attention. In addition, the high prevalence of abuse exposure is of great importance.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study

Nygaard

Stedenfeldt

Øian

et al. 2019

Scandinavian Journal of Pain

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Abstract Background and aims Chronic pelvic pain (CPP) in women is a complex condition that can seriously impact health and quality of life. Clinical guidelines for CPP place great demands on healthcare professionals, as they require both specialized knowledge about the pelvic area and knowledge of the mechanisms of chronic pain. To ensure best possible assessment and treatment of these women it is important to bring about more knowledge of the special CPP features. The purpose of this paper is to describe the characteristics of women with CPP evaluated at the University Hospital of North Norway, and further referred to physiotherapy. The frequency of having a history of abuse or previous pelvic surgery will also be reported, and analyses performed to investigate if subjective health status differs between women with and without these experiences. Methods We collected cross-sectional data from 62 women with CPP aged 20–65 (mean age 38.0), referred to physiotherapy after assessment by medical specialists. Data were collected by semi-structured interviews for demographic variables and medical history, and self-administered questionnaires on pain intensity, sexual function, urinary incontinence (UI), anal incontinence (AI), obstructed defecation syndrome (ODS), subjective health complaints (SHC) and symptoms of anxiety and depression. Results Pain duration of more than 10 years was reported by 42%, mean pain score was 4.7/10, and analgesics were used weekly by 48%. Previous pelvic or abdominal surgery was reported by 71%, and sick leave >12 weeks the last year by 34%. Reduced sexual desire was reported by 78%, dyspareunia by 73%, UI by 54%, AI by 23%, and obstructed defecation syndrome (ODS) by 34%. More than 90% reported musculoskeletal or pseudoneurologic complaints. Anxiety and depression scores defined as requiring treatment were reported by 40%. Abuse was reported by 50%, and associated with significantly more reports of ODS (p=0.02), more SHC (p=0.02) and higher anxiety scores (p=0.009). Analgesic use and sick leave were significantly higher both among women with a history of abuse (p=0.04 and p=0.005) and among those with previous surgery (p=0.04 and p=0.02). Women with previous surgery reported significantly lower pain intensity during intercourse than those without previous surgery (p=0.008). Conclusions Women with CPP have complex symptoms and high scores for both physical and psychological complaints. Women exposed to abuse have especially high scores related to analgesic use, sick leave, ODS, anxiety and SHC. Women with previous surgery report more analgesic use and sick leave, and lower pain intensity during intercourse, than those without previous surgery. Implications This study illustrates the complexity of CPP and highlights the need for health professionals to have specialized knowledge of the possible features of the condition. Previous abuse seems to be more associated with poor scores on several health outcomes than surgery, but this needs to be investigated further.

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Section: Discussionmentioning

confidence: 99%

Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study

Nygaard

Stedenfeldt

Øian

et al. 2019

Scandinavian Journal of Pain

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“…Fifty-two percent of the 100 questionnaires reviewed had scores of 30 or greater, therefore falling within the severe range for this measure. Twenty-three percent of scores fell within the moderate range (20)(21)(22)(23)(24)(25)(26)(27)(28)(29), with the remainder falling within the mild range (<20). Subscale mean totals for the Magnification and Helplessness scales fell within the clinically significant range (≥5 and ≥13, respectively).…”

Section: Methodsmentioning

confidence: 98%

“…10,11 The findings regarding the role of catastrophising and pain may be particularly relevant for patients with CPP, as it has been noted that this group appears to score higher on measures of catastrophic thoughts and behaviours than cohorts with other persistent pain conditions. 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.…”

mentioning

confidence: 99%

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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“…The simplest level of assessment is screening using a few simple self‐report instruments at the primary level and which would indicate a need for a path through secondary and tertiary care. The comprehensive level of assessment, recommended for specialists who manage patients with persistent chronic pain and pain‐related disabilities, is the full set of Axis‐II assessment which should be considered a component of best practices . In addition, an in‐depth interview should augment the full set of Axis‐II instruments in highly specialised (tertiary) pain care facilities, such as hospitals or academic centres.…”

Section: Settingsmentioning

confidence: 99%

Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain

Sharma

Breckons

Lambelet³

et al. 2019

J of Oral Rehabilitation

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Distress, suffering and care‐seeking behaviour are characteristics of pain‐related disease and illness. Pain that transitions from an acute to a chronic phase carries with it the potential of further effects: these include a worsening of the disease or illness; high‐impact chronic pain; and substantial personal, societal and economic burden. The biopsychosocial model directly addresses these multiple processes, yet clinical frameworks supporting this model are not universally implemented. This paper explores barriers to clinical implementation of a full biopsychosocial framework for temporomandibular disorders (TMD) and other oro‐facial pain (OFP) conditions. In June 2016, INfORM invited OFP researchers to a workshop designed to optimise the DC/TMD Axis‐II. Workshop groups identified five sources of implementation barriers: (1) cultures and societies, (2) levels‐of‐care settings, (3) health services, (4) cross‐cultural validity of self‐report instruments and (5) provider and patient health literacy. Three core problems emerged: (A) mental health aspects are seldom fully considered, thus impairing the recognition of illness, (B) training in use of validated multi‐axial assessment protocols is under‐rated and insufficiently used, and (C) clinical assessment often fails to recognise that sensory and emotional dimensions are fundamental aspects of pain. To improve patient care, these barriers and problems require action. Most importantly, TMD/OFP educators and researchers need to coordinate globally and (i) be educated in the biopsychosocial model, (ii) implement evidence‐based biopsychosocial guidelines for assessment and management of OFP conditions at their institutions, (iii) incorporate this model in undergraduate and postgraduate dental curricula and (iv) be responsive to stakeholders, including regulatory authorities and practitioners.

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The psychological profile of women presenting to a multidisciplinary clinic for chronic pelvic pain: high levels of psychological dysfunction and implications for practice

Cited by 56 publications

References 41 publications

Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study

Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study

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

Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain

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