Background & Aims
Chronic pelvic pain (CPP) is common, affecting perhaps one in six of the adult female population. CPP can be defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months duration. CPP patients present in primary care as frequently as migraine or low back pain patients, which can result in a significant impact functional ability. Early effective management of chronic pain may help to reduce the disruption to the patient’s life and may avoid an endless proccession of referrals, investigations and operations.
By creating a dedicated seminar for CPP, we taught patients how to better manage their symptoms using a multi-disciplinary approach towards holistic care. The information morning provides practical skills on how to better manage stress, pace activities, and exercise. It also explores background knowledge about the complexity of chronic pain. We then evaluated patient satisfaction, their progress, and recommendations for improvement.
Methods
Inclusion criteria: Female patients presenting to the outpatient pain service with chronic pelvic pain.
Exclusion criteria: Patients with pain in other body areas.
Duration: April 2021 to September 2022.
Sample underwent a single morning seminar, delivered by a multi-disciplinary team. This included elements of the general chronic pain education seminar, and addressed pelvic pain specific issues.
Outcomes were measured by questionnaires:
1. Pain Catastrophizing Scale (PCS) – Done twice by each participant, once before the seminar and three months after.
2. Pain Self-Efficacy Questionnaire (PSEQ) – Done twice by each participant, once before the seminar and three months after.
3. Seminar evaluation Questionnaire – Taken upon completion of the pain seminar, and included 8 closed and 4 open questions.
The average change in total score of the PCS and PSEQ was compared to the minimal important change (MIC) – based on studies into chronic lower back pain.
Results
Overall average change in PCS score was 9.62 (indicating reduced catastrophising). This is greater than the MIC observed in chronic lower back pain (CLBP) studies. The overall average change in PSEQ score was 10.36 (indicating increased self efficacy). This is significantly greater than the MIC observed in CLBP studies.
Responses in the seminar evaluation questionnaire were largely positive. Negative feedback was received on the wait for the programme, a lack of group discussion, duration of the seminar (too long as per n=2) and requests for pictures of how to stretch.
Conclusions
Our pilot demonstrates that CPP-specific education seminars seem to be well received, and result in PCS and PSEQ improvements exceeding the MICs stated in the literature (albeit for CLBP). The seminar had a positive impact on increasing self-efficacy amongst patients with CPP, and their pain catastrophising.
In the closed questions of the seminar evaluation questionnaire, largely ‘agreed’ or ‘strongly agreed’ with statements of positive impact, with only 3 ‘disagrees’. The ensuing feedback indicated that the seminar would be received better if there was a shorter wait for it.
The pilot had a low sample size (28) of a single gender initially by design. There was no control group to allow comparison of baseline PCS and PSEQ score change, and the PCS and PSEQ MICs were based on data from studies on CLBP. Despite this, the profound positive feedback and positive change reported indicated a beneficial outcome through this low cost, and economically viable programme.
References
1. Ahangari, A. (2014) ‘Prevalence of Chronic Pelvic Pain Among Women : An Updated Review’, Pain physician, 17(2), pp. E141–E147.
2. Latthe, P. et al. (2006) ‘WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity’, BMC public health, 6, p. 177.
3. Chiarotto, A. et al. (2016) ‘Responsiveness and Minimal Important Change of the Pain Self-Efficacy Questionnaire and Short Forms in Patients With Chronic Low Back Pain’, The journal of pain: official journal of the American Pain Society, 17(6), pp. 707–718.
4. Monticone, M. et al. (2022) ‘Responsiveness and minimal important change of the Pain Catastrophizing Scale in people with chronic low back pain undergoing multidisciplinary rehabilitation’, European journal of physical and rehabilitation medicine, 58(1), pp. 68–75.
5. Suzuki, H. et al. (2020) ‘Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain’, PloS one, 15(3), p. e0229228.
Presenting Author
Mehul Raithatha
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Abdominal and Pelvic Pain