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

Abstract

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

An Aotearoa New Zealand survey of the impact and diagnostic delay for endometriosis and chronic pelvic pain

“…These include practitioner bias, logistical, and financial barriers 36 , as well as significant inequities, with ethnic minorities experiencing poorer health outcomes 38 – 40 . For CPP sufferers, the current healthcare model is inadequate, highlighting a specific area of unmet patient need 41 . Furthermore, an extensive body of international literature shows that the culture of normalising CPP may contribute to diagnostic delay, and this normalisation effect may occur both informally and formally when patients are seen by a doctor 42 , 43 .…”

Evidence for the role of multidisciplinary team care in people with pelvic pain and endometriosis: A systematic review

“…The psychological profiles of people with endometriosis and pelvic pain presenting to a multidisciplinary clinic have been highlighted in seven studies 20–26 . Bryant et al reported higher levels of anxiety symptoms compared to depressive symptoms in patients with chronic pelvic pain, which was strongly correlated with pain catastrophising and weaker self‐efficacy 20 .…”

“…Several critical methodological issues should be considered in interpreting the results of this study. First, we recognise that some studies focused on pelvic pain as the primary health concern, and while endometriosis was mentioned in these papers, it was not the main focus of the work 11–14, 19–21,23 . As chronic pelvic pain can occur in the absence of endometriosis (or continue following successful treatment of endometriosis), our study set may be diluted by non‐endometriosis‐specific findings.…”

Emergency department attendances for persistent pelvic pain are not reduced following laparoscopic surgery for women with or without endometriosis

“…21 An audit of attendees to the CWH gynaecology clinic with pelvic pain found a strikingly high level of catastrophic worry about pain and other psychosocial yellow flags. 22 Surgical intervention is unlikely to improve these factors. There is, however, evidence that multidisciplinary (MDT) pain clinics where interventions address such psychosocial domains improve quality of life and reduce healthcare costs by over 90% for those living with musculoskeletal pain.…”