A randomized clinical trial to compare two different approaches in women with chronic pelvic pain

Peters, A. C. B.; Dorst, E.B.L. van; Jellis, B.; Zuuren, E. Van; Hermans, Jos; Trimbos, J. B.

doi:10.1016/0020-7292(92)90764-a

Cited by 103 publications

(73 citation statements)

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“…The cognitive-behavioural model of pain has great potential in the management of CPP, as it can be adapted to provide an explanation for pain without identifiable pathology. There is already some randomised evidence that an integrated, rather than pathology centred, approach to care improves outcomes in women with CPP, 18 and this pain management approach has been endorsed elsewhere. 3,15 New interventions need to be developed, which address the needs of women with CPP, to determine whether they are feasible, acceptable, and improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study

Price¹,

Farmer

Harris³

et al. 2006

BJOG

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Objective To describe the attitudes that women with chronic pelvic pain (CPP) attending gynaecology clinics have to their consultations and to determine the ways in which their health care can be improved.Design Qualitative study using semistructured individual interviews.Setting UK gynaecology outpatient clinics in district general and teaching hospitals.Sample Twenty-six women with CPP.Methods Semistructured individual interviews were conducted. Data gathering and analysis followed a grounded theory approach.Main outcome measures Women's wishes regarding their care and their actual experiences of care.Results Four main themes emerged. The women wanted (a) personal care, which they often did not receive; (b) to feel understood and to be taken seriously, although they often felt dismissed, which applied both to women with and without an explanation for their pain; (c) explanation as much as cure, but an adequate explanation was often not provided; and (d) to be reassured, which often they were not. Effective reassurance was complex as it included general reassurance and specific reassurance about cause and treatment.Conclusions Improvements are needed in the outpatient care of women presenting with CPP. Changes should focus on providing more personal care, so that presenting problems are seen to be taken seriously, findings and management are appropriately explained, and women are more effectively reassured. Interventions need to be developed that meet these needs and tested to determine if they are feasible, acceptable, and improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study

Price¹,

Farmer

Harris³

et al. 2006

BJOG

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“…The most common gynecologic etiologies for CPP are adhesions, endometriosis or infections [16,17]. The prevalence of adhesions in patients with CPP varies between 28 and 58.8% [18][19][20][21]. It should be noted that somatic pathology does not necessarily account for the extent of subjective complaints [22].…”

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confidence: 99%

Chronic Pelvic Pain as a Somatoform Disorder

Ehlert

Heim

Hellhammer³

1999

Psychother Psychosom

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BACKGROUND: The purpose of this study was to determine whether psychiatric disturbances, particularly somatization, and an increased number of traumatic and critical life events, which have been found in women with idiopathic chronic pelvic pain (ICPP), can also be observed in women with chronic pelvic pain and abdominal adhesions (ACPP). METHODS: Forty women who underwent diagnostic laparoscopy were subdivided into three groups according to blind rated somatic pathologies: ICPP patients (n = 16), ACPP patients (n = 10), infertile controls without pain (n = 14). Besides the standardized assessment of DSM-III-R diagnosis, questionnaires and semistandardized interviews were used to estimate depression, somatization, pain, the prevalence of sexual and physical abuse, and the number of critical life events. RESULTS: Diagnostic criteria for somatoform pain disorder were fullfilled in 73.3% of the ICPP patients, 60% of the ACPP patients and none of the controls. With respect to the somatization symptom checklist the two pain groups scored significantly higher than the controls (p < 0.05). Referring to perceived pain, ACPP patients differed from the ICPP patients by one out of seven subscales (higher persistence of pain; p < 0.05). No correlation was found between the intensity of pain and the severity of classified adhesions. The two groups of pain patients significantly differed from controls by a higher prevalence of sexual abuse (p < 0.05). Depression was found neither in the pain groups nor in the controls. CONCLUSIONS: Because high somatization and high prevalence rates of abuse were not only found in patients suffering from ICPP but also in ACPP patients, it seems to be doubtful that the somatic pathology may fully explain the psychopathology in patients with ACPP. Abstract Background:The purpose of this study was to determine whether psychiatric disturbances, particularly somatization, and an increased number of traumatic and critical life events, which have been found in women with idiopathic chronic pelvic pain (ICPP), can also be observed in women with chronic pelvic pain and abdominal adhesions (ACPP). Methods: Forty women who underwent diagnostic laparoscopy were subdivided into three groups according to blind rated somatic pathologies: ICPP patients (n = 16), ACPP patients (n = 10), infertile controls without pain (n = 14). Besides the standardized assessment of DSM-III-R diagnosis, questionnaires and semistandardized interviews were used to estimate depression, somatization, pain, the prevalence of sexual and physical abuse, and the number of critical life events. Results: Diagnostic criteria for somatoform pain disorder were fullfilled in 73.3% of the ICPP patients, 60% of the ACPP patients and none of the controls. With respect to the somatization symptom checklist the two pain groups scored significantly higher than the controls (p ! 0.05). Referring to perceived pain, ACPP patients differed from the ICPP patients by one out of seven subscales (higher persistence of pain; p ! 0.05). No corr...

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“…Compared to characteristics of patients in studies of medical care for women with CPP, our patients were in the same age range and were similar in terms of low-back pain and dysmenorrhea, but there appeared to be fewer with a history of sexual/physical abuse (Peters et al, 1991;Reiter, 1990;Reiter and Gambone, 1990;Reiter & Milburn, 1992). Patients in our study did not report much use of supplements or herbs.…”

Section: Pilot For a Manual Placebo-controlled Trial 29mentioning

confidence: 83%

Issues in Planning a Placebo-Controlled Trial of Manual Methods: Results of a Pilot Study

Hawk

Long

Reiter³

et al. 2002

The Journal of Alternative and Complementary Medicine

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Objective: There are fundamental differences between the administration of medications and the application of manual procedures, such as those used by chiropractors. The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite, randomized placebo-controlled trial of chiropractic care for women with chronic pelvic pain (CPP).Design: Pilot study for a multisite, randomized, placebo-controlled clinical trial. Setting: Three chiropractic research clinics in the midwest United States. Subjects: Thirty-nine (39) women with CPP of at least 6 months' duration, diagnosed by boardcertified gynecologists.Interventions: The active intervention consisted of the chiropractic technique, lumbar spine flexion-distraction, combined with manual Trigger Point Therapy. The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage (light massage).Outcome measures: The primary outcome measure was the change in the Pain Disability Index (PDI) from baseline to the end of treatment (6 weeks), assessed by group and site. If the change score was in the same direction at all sites, the results were to be combined to estimate treatment effect size.Results: Patient characteristics were similar to those of patients with CPP in other studies. Recruitment methods, particularly in respect to the eligibility criteria and screening protocols, would require modification in order to recruit an adequate sample for the planned randomized controlled trial. Clinicians followed standardized procedures with apparently minimal deviation, patients in both groups were satisfied with their care and blinding appeared to be successful. PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated.Conclusions: The technical and personnel resources required to achieve adequate standardization of procedures at multiple sites may make a placebo-controlled trial unfeasible, given our current lack of knowledge about the active agent in manual chiropractic procedures.

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A randomized clinical trial to compare two different approaches in women with chronic pelvic pain

Cited by 103 publications

References 0 publications

Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study

Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study

Chronic Pelvic Pain as a Somatoform Disorder

Issues in Planning a Placebo-Controlled Trial of Manual Methods: Results of a Pilot Study

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