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

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="j_sjpain-2018-0308_s_999"> <jats:title id="d2672598e43555">Background and aims</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0308_s_998"> <jats:title id="d2672598e43563">Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0308_s_997"> <jats:title id="d2672598e43571">Results</jats:title> <jats:p>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 &gt;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 (<jats:italic>p</jats:italic>=0.02), more SHC (<jats:italic>p</jats:italic>=0.02) and higher anxiety scores (<jats:italic>p</jats:italic>=0.009). Analgesic use and sick leave were significantly higher both among women with a history of abuse (<jats:italic>p</jats:italic>=0.04 and <jats:italic>p</jats:italic>=0.005) and among those with previous surgery (<jats:italic>p</jats:italic>=0.04 and <jats:italic>p</jats:italic>=0.02). Women with previous surgery reported significantly lower pain intensity during intercourse than those without previous surgery (<jats:italic>p</jats:italic>=0.008).</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0308_s_996"> <jats:title id="d2672598e43604">Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0308_s_995"> <jats:title id="d2672598e43613">Implications</jats:title> <jats:p>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.</jats:p></jats:sec>

Psychological Profile in Women with Chronic Pelvic Pain

“…We also found high levels of anxiety (59.5% had level of SA and 49.2% of TA in the percentile range 75–99). In studies in which self-applied scales are used to assess anxiety and depression in women with CPP, high percentage of anxiety and depressive symptoms were found [ 9 , 55 , 56 , 57 , 58 ]. In one study that measured the intensity of anxiety and depression, they found moderate or severe anxiety in 40% and 13.1% respectively, and moderate-to-severe depression in 22.3% and 4.6% [ 9 ], similar to our findings; although we found a higher percentage of severe symptoms.…”

“It's all my fault”: a qualitative study of how heterosexual couples experience living with vulvodynia

“…When male partners conclude they have little influence over their partner's condition, this can exacerbate a sense of powerlessness and frustration, possibly leading to the depressive symptoms that have been reported by male partners in previous studies. 15,16 For some of the couples in our study, family and friends were a source of support in a difficult situation. For others, there was little support available in their social network, either because they did not dare disclose their problems to anyone or because those around them showed little understanding.…”

“…In the meantime, their psychological well-being is undermined 10 as they struggle with sexuality, relationships, self-esteem and identity, [10][11][12][13] as well as depression, anxiety and suicidality. 6,14 Male partners to women with vulvodynia also tend to suffer from anxiety and depression symptoms 15,16 as well as sexual dysfunction. 17 These partners are often the only people in the women's lives who see how much the pain is affecting them.…”

Intensity of pain, disability and psychosocial factors in women with chronic pelvic pain: crosssectional study

“…In a study conducted in Brazil with 91 women, pain intensity varied according to body mass from 2.66 to 3.15 28 . In another study conducted in Norway, 108 women with CPP participated and the average pain intensity assessed was 4,2 30 . The moderate pain intensity observed may justify the use of different analgesic methods reported by the participants.…”