Background & Aims
Chronic pelvic pain (CPP) is a physically and psychologically debilitating condition 1. European Association of Urology (EAU) Guidelines strongly emphasise multi-speciality and interdisciplinary assessment and intervention in the management of CPP 2. In 2014 the Walton Centre NHS trust developed a specialised rehabilitative female chronic pelvic pain management program (CPP PMP). Post-treatment outcomes suggest this intervention is effective for women with CPP across a range of outcome domains3–5. How well these changes are maintained following treatment is not fully understood6,7.
This poster aims to report the long-term outcomes of efficacy for persons who have completed a seven-day multidisciplinary CPP PMP.
Methods
All patients who attended the CPP PMP between September 2014 – June 2019 and provided outcome data were included. Outcomes were collected at pre-treatment baseline, post-treatment and 6-month post-treatment (FU). Outcomes, comprised of: Pain Intensity (PI), Pain Distress (PD), depression – Beck Depression Inventory (BDI), function- Roland and Morris Questionnaire (RMQ), catastrophising- Pain Catastrophizing Scale (PCS), self-efficacy- Pain Self-Efficacy Questionnaire (PSEQ), pain acceptance- Chronic Pain Acceptance Questionnaire (CPAQ), Physical Functioning- 1 min sit>stand (SS) and 5 min walk (5MW), and occupational performance- Canadian Occupational Performance (COPM) performance (COPM-P), satisfaction (COPM-S).
Change in outcomes, benchmarking with effect Size (comparing effect size Cohen’s d to reported effect sizes) and Clinically Significant Change are reported.
Results
Between September 2014- June 2019 104 patients completed the CPP PMP (96 complete data sets), and 58 patients attended 6 month follow-up (FU). The average age of patients was 37.6 yrs (range 19-66) and the average pain duration was 8.2yrs (range 1-35).
Baseline scores (Standard deviation):
PI: 6.68 (1.77), PD: 6.66 (2.31), BDI: 24.16 (10.03), RMQ:11.93 (5.28), PCS: 27.96 (11.37), PSEQ: 23.20 (10.29), CPAQ: 50.90 (15.36), SS:11.77 (7.38), 5MW: 242.19 (124.45), COPM-P: 3.74 (1.25), COPM-S: 6.84 (1.53).
Percentage of patients obtaining CSC post-treatment/FU:
PI:33/45, PD: 45/52, BDI:42/55, RMQ:23/41, PCS:43/62, PSEQ:54/67, CPAQ:53/64, SS:26/41, 5MW:31/43, COPM-P:72/50, COPM-S: 76/57.
Effect Size (Cohen’s d):
Following treatment large effect size d=>0.8 (range d=0.82-1.66) was reported for all outcomes except PI (d=0.71) and SS (d=0.794) where medium effect sizes were reported. At FU large effect sizes were reported for all outcomes (range d= 0.96-1.69) except PI where a medium eff
Conclusions
This paper is the first to report outcomes for a group of this size completing specialised pelvic pain management. The outcomes show that a chronic pelvic pain-specific pain management programme is associated with clinically significant change and effect sizes that exceeded minimal benchmarks for women with chronic pelvic pain. Six-month follow-up outcomes illustrate that post-treatment change is either maintained or improved for this group. The outcomes suggest a multidisciplinary rehabilitation delivered within a tertiary.
pain service is an effective intervention for women with CPP across a range of outcome domains post-treatment and at longer-term follow-up. Although many patients appear to benefit from this intervention, we note a smaller sample attend a 6-month follow-up. Why this is and what helps maintain change in the longer term later requires further evaluation.
References
1. Corte L della, Filippo C di, Gabrielli O, et al. The Burden of Endometriosis on Women’s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. Int J Environ Res Public Health. 2020;17(13):4683. doi:10.3390/ijerph17134683
2.Engeler D, Baranowski AP, Berghmans B, et al. EAU Guidelines on Chronic Pelvic Pain.; 2022.
3.Johnson S, Bradshaw A, Liptrot M, et al. Clinical effectiveness of a female chronic pelvic pain management programme: A specialist interdisciplinary approach. In: Poster. EFIC, European Congress on Pain.; 2023.
4.Twiddy H, Lane N, Chawla R, et al. The development and delivery of a female chronic pelvic pain management programme: a specialised interdisciplinary approach. Br J Pain. 2015;9(4):233-240. doi:10.1177/2049463715584408
5.Kames LD, Rapkin AJ, Naliboff BD, Afifi S, Ferrer-Brechner T. Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain. Pain. 1990;41(1):41-46. doi:https://dx.doi.org/10.1016/0304-3959%2890%2991107-T
6.British T, Society P. The British Pain Society Guidelines for Pain Management Programmes for Adults.; 2013.
7.Aboussouan AB, Mandell D, Johnson J, Thompson N, Huffman KL. An interdisciplinary chronic pain rehabilitation program effectively treats impairment in sexual function, depression, alexithymia, and pain in women with chronic pelvic pain. Journal of Psychomatic Obstetrics & Gynecology. 2020;42(4):261-271. doi:10.1080/0167482X.2020.1735341
Presenting Author
Katie Herron
Poster Authors
selina johnson
PhD, MSc, BSc (Hons)
The Walton Centre NHS trust
Lead Author
Alison Bradshaw (BSc Hons)
The Walton Centre NHS Trust
Lead Author
Natalie Lane (DClin Psych)
The Walton Centre NHS Trust
Lead Author
Katie Herron DClinPsych
PhD
Walton Centre NHS Foundation Trust, Liverpool
Lead Author
Matt Liptrott (MSc)
The Walton Centre NHS Trust
Lead Author
Kerry Mathews (DClin Psych
PhD)
The Walton Centre NHS Trust
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain