The development and delivery of a female chronic pelvic pain management programme: a specialised interdisciplinary approach

Abstract

Context/Background: Chronic pelvic pain (CPP) is a physically and psychologically debilitating condition. European Association of Urology (EAU) Guidelines (2013) and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines (2012) place strong emphasis upon multi-speciality assessment and liaison, as well as interdisciplinary assessment and intervention in reference to the management of CPP. Objectives: The aim was to introduce and describe the development and delivery of an interdisciplinary pain management programme (PMP), at a Specialised Pain Management Centre in Liverpool, United Kingdom, for women diagnosed with CPP. Method: The format and content of the CPP PMP at The Walton Centre, Liverpool, is described and the preliminary results from the CPP PMP are presented. Results: Preliminary data suggest that outcomes on the specialised CPP PMP indicate that patients are able to make clinically important change across a range of outcome measures. Moreover, these results compare favourably to the established PMP for generalised chronic pain when comparing clinically significant outcomes with the Walton Centre's (a tertiary-level pain management centre) 2013 PMP Audit document. Patients attending the CPP PMP positively appraised the PMP and felt it was useful and supportive to be in a group dedicated to CPP. Conclusions: This article presents some preliminary results that suggest there is value in delivering a specialised multidisciplinary PMP for this group. There is a clear need for further clinical research into the effectiveness of similar interventions for CPP, including the early identification of those CPP patients who may benefit from both multi-specialty and interdisciplinary management.

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…”

“…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.…”

“…We cannot therefore establish the causal pathways between pain, anxiety, depression, and dysfunctional beliefs. On the basis of previous research, however, we have good reason to believe that they are reciprocal, and need to be taken into account in treatment planning 11,20. Future work should seek to follow women up after they have completed treatment in order to ascertain the changes that may or may not result from treatment.…”

“…Moreover, it is often debilitating, affecting a woman’s personal relationships, ability to work, sexual functioning, and self-esteem 8,9. In recent years a number of guides to the management of this condition have been published10 and increasing clinical attention is being paid to the condition,11 with an emphasis on moving away from an organ-specific model of CPP to a broad biospychosocial understanding of this condition. Nevertheless, women often find the experience of clinical assessment and treatment unsatisfactory 12.…”

Clinical and emotional/behavioral characteristics of acute and chronic low-back pain

“…Неадекватное управление болью является источником значительных экономических затрат для пациентов, их семей и общества [7]. Эмоциональные переживания, связанные с болью и инвалидностью, могут быть изнурительными и оказывать выраженное воздействие на качество жизни [10,11].…”