When treating the pain is not enough: a multidisciplinary approach for chronic pelvic pain

Abstract

Chronic pelvic pain (CPP) is related to psychological distress and interference in daily activities; however, CPP is not as extensively researched as other forms of chronic pain. Therefore, the purpose of this study was to investigate the relationships among pain, psychological distress, and functional impairment in patients with CPP. There were chart reviews conducted of 107 female patients who completed a psychiatric evaluation at a specialty, CPP clinic as a part of a multidisciplinary evaluation. Results suggest that psychological distress and impairment in daily activities are common in CPP patients. Most areas of functional impairment were not associated with pain variables. Rather, several forms of functional impairment were related to higher levels of depression and anxiety. Results from this study suggest the possibility that psychiatric symptoms are contributing to functional impairment in this population. These findings highlight the importance of a multidisciplinary approach in the evaluation and treatment of CPP patients to help decrease functional impairment in these patients.

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

“…Our findings confirm previous evidence for high levels of psychological distress and functional impairment associated with this condition,21 and extend these findings by including measures that are highly relevant to treatment planning, such as thinking styles and pain self-efficacy. Our findings confirm the need to move away from organ-focused approaches to pain, and use integrated models of pain to understand this condition 10,11…”

“…We cannot, of course, extrapolate from these women to community-based, nonclinical samples, nor were we able to compare our sample with individuals with other types of pain. Nevertheless, these findings share some similarities with other studies based on clinical populations, for example, those of Miller-Matero et al21…”

“…Depressive symptoms were less common overall, but more than a quarter of the sample (26.9%) experienced depressive symptoms in the moderate or severe range. This is lower than the prevalence of 86% reported by Lorencatto et al30 in a study utilizing the Beck Depression Inventory, but similar to the prevalence of 21% reported by Poleshuck et al31 and almost identical to the prevalence of 25.7% reported by Miller-Matero et al, who also used the HADS 21. As the HADS was designed for use in hospital outpatient populations it is possible that this provides a more accurate picture than the Beck Depression Inventory, which includes a number of potentially confounding somatic items.…”

“…The importance of taking a multi-disciplinary approach to CPP was also highlighted in other recent studies 11,21. These authors found that functional impairment and pain interference were more strongly related to psychiatric symptoms, such as anxiety and depression, than to pain severity.…”

“…This study highlighted the importance of negative beliefs about the pain (“pain catastrophizing”). A recent study by Miller-Matero et al21 reported on relationships between functioning pain and psychological variables, but this focused only on symptoms of anxiety and depression. A study of illness perceptions in a clinic population highlighted the weak self-efficacy beliefs held by women with CPP, and their perception that their condition was confusing and perplexing 22…”