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Wissing MC, van der Net L, Engels Y, Vissers KCP, Kluivers KB, Wal SVD, Notten KJB. Lessons learned from the experiences of patients with chronic pelvic pain syndrome (CPP syndrome) with a multidisciplinary consultation: a qualitative study. Reg Anesth Pain Med 2024:rapm-2024-105548. [PMID: 38866558 DOI: 10.1136/rapm-2024-105548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Chronic pelvic pain syndrome is a complex multifactorial condition with an increasing prevalence probably due to a rising awareness. Chronic pelvic pain syndrome is pain in the pelvic area and often accompanied with complaints in other organ systems of the lesser pelvis. Patients with chronic pelvic pain syndrome who present at our center are evaluated in a standardized care pathway with an integrated multidisciplinary consultation. The team works in a single center and consists of gynecologists, pain specialists, urologists, a pelvic floor physiotherapist and a psychologist. The aim of this interview study is to evaluate the value of the multidisciplinary consultation from the patient's perspectives. METHODS In a qualitative study, we evaluated the experiences and perspectives of patients with chronic pelvic pain syndrome concerning the multidisciplinary consultation at the Radboud University Medical Center. Semistructured interviews were conducted with patients with chronic pelvic pain syndrome who attended a multidisciplinary consultation between 2019 and 2022. All interviews were transcribed verbatim, coded and analyzed via ATLAS.ti with the conventional content analysis. RESULTS Data saturation was reached after seven interviews, followed by three confirmative interviews. In total, 10 patients (22-76 years) participated in the study. Three relevant themes were identified in the interviews: the deleterious effects of pain on overall health, the importance of the design of the multidisciplinary consultation, and the performance of healthcare professionals (knowledge, skills and interaction with patients and colleagues). Participants suggested that although the consultation did not improve their pain experience, there was value in having a comprehensive assessment of their disease. Patients preferred the consultation to occur at the beginning of the care. Additionally, they acknowledged the performance of healthcare providers and having their complaints recognized. However, some participants suggested the need for additional attention to mental health issues during the multidisciplinary consultation. DISCUSSION Even though patients did not perceive the multidisciplinary consultation to improve their pain experience, they appreciated the sense of recognition by this team. CONCLUSION A multidisciplinary consultation is of value from the patients' perspective. A suggestion for improvement emerged where the multidisciplinary consultation should occur at the beginning of the patient journey.
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Affiliation(s)
- Myrthe C Wissing
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Lotte van der Net
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
| | - Selina van der Wal
- Department of Anesthesiology, Pain and Palliative medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kim J B Notten
- Department of Gynecology and Obstetrics, Radboudumc, Nijmegen, The Netherlands
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Green R, Mardon AK, Beaumont T, Phillips K, Chalmers KJ. The accessibility of pelvic health physiotherapy for adolescents with persistent pelvic pain: a qualitative framework analysis. Physiother Theory Pract 2024; 40:973-982. [PMID: 36345863 DOI: 10.1080/09593985.2022.2143736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physiotherapy, with a specific focus on pelvic health, is one service used in the multidisciplinary management of adolescent persistent pelvic pain (PPP). However, there has been little investigations into the accessibility of physiotherapy for adolescents with PPP. OBJECTIVE This qualitative study aimed to detail the experiences of adolescents with PPP accessing a tertiary hospital physiotherapy service. METHODS Two focus groups included six adolescent females diagnosed with PPP that had either a) been referred and attended the physiotherapy clinic (n = 5), or b) been referred to physiotherapy but yet to attend their appointment (n = 1 plus one support person). Focus group transcripts were deductively thematically analyzed according to four domains from the patient-centered healthcare accessibility framework. RESULTS The domain of 'Approachability and ability to perceive' was impacted by limited information and poor patient health literacy. 'Acceptability and ability to seek' was hindered by adolescent mental health struggles and failures of previous PPP management. 'Availability and accommodation, and ability to reach' was influenced by lengthy referral processes, and reliance on familial support for transport. 'Acceptability and ability to engage' was facilitated by engaging clinicians and group environments, however, adolescents became dependent on physiotherapy for pain management. CONCLUSION Physical, social, and environmental factors influence the accessibility of physiotherapy for adolescents with PPP. Healthcare services should consider the specific needs of adolescents with PPP for optimizing accessibility.
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Affiliation(s)
- Rose Green
- Women's Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - Tara Beaumont
- Women's Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - Kate Phillips
- Women's Physiotherapy, Women's and Children's Hospital, Adelaide, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
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Briscoe S, Thompson Coon J, Melendez-Torres GJ, Abbott R, Shaw L, Nunns M, Garside R. Primary care clinicians' perspectives on interacting with patients with gynaecological conditions: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0133. [PMID: 37968071 PMCID: PMC11169973 DOI: 10.3399/bjgpo.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/28/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Studies have found that women with gynaecological conditions and symptoms do not feel listened to by primary care clinicians (PCCs). Less understood is whether PCCs perceive that there are challenges around listening to and interacting with this patient group. AIM To understand PCCs' perspectives on the challenges of listening to and interacting with women patients with gynaecological conditions and symptoms. DESIGN & SETTING Systematic review of English-language studies. METHOD We searched ASSIA (Applied Social Sciences Index and Abstracts), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, HMIC (Healthcare Management Information Consortium), and MEDLINE from inception to July 2023. We also conducted forward and backward citation searches of included studies. Identified records were screened independently by two reviewers. Data extraction was undertaken by one reviewer and checked by a second. Quality appraisal used the Wallace checklist. 'Best-fit' framework synthesis was used to synthesise findings around themes that explored the challenges of patient-clinician interaction. RESULTS We identified 25 relevant articles. Perceived challenges associated with listening to and interacting with patients with gynaecological conditions and symptoms were identified at four 'levels': individual clinician level factors; structural and organisational factors; community and external factors; and factors related to gynaecological conditions. Interpretive analysis identified specific challenges relating to sociocultural factors affecting the consultation experience; the need for further education, training, or guidance for clinicians; factors affecting referral decisions; and factors related to service structure and organisation. CONCLUSION PCCs acknowledge that empathy, respect, and attentive listening are important when interacting with women patients with gynaecological conditions and symptoms. However, these ideals are impeded by several factors.
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Affiliation(s)
- Simon Briscoe
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Jo Thompson Coon
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - G J Melendez-Torres
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Rebecca Abbott
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Liz Shaw
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Michael Nunns
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
| | - Ruth Garside
- Exeter PRP Evidence Review Facility, University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, Devon, UK
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Kayacik Günday Ö, Harmanci H, Şenol Y. The Effect of Affective Temperament, Pain Catastrophizing, and Anxiety Sensitivity on Pain Severity in Patients With Chronic Pelvic Pain: A Pilot Study. J Psychiatr Pract 2023; 29:447-455. [PMID: 37801636 DOI: 10.1097/pra.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE The goals of this study were to investigate whether there was a dominant temperament type, and to assess the effect of temperament, pain catastrophizing, and anxiety sensitivity on pain severity, in female patients diagnosed with chronic pelvic pain (CPP) compared with healthy controls. METHODS This cross-sectional study involved 51 patients 18 to 65 years of age who were diagnosed with CPP without a history of psychiatric treatment and 97 healthy volunteer women with sociodemographic characteristics similar to those of the study group. A sociodemographic form prepared by the researchers, the Anxiety Sensitivity Index, the Pain Catastrophizing Scale, a temperament scale (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire), and a visual analog pain scale (VAS) were completed. The results were compared between the patient and control groups. Multiple regression analyses were performed to examine the predictive effects of temperament characteristics, pain catastrophizing, and anxiety sensitivity on pain severity. RESULTS Scores on the Pain Catastrophizing Scale and the VAS were statistically significantly higher in the CPP group ( P <0.001). The frequency of depressive, cyclothymic, and irritable temperaments was found to be significantly higher in the CPP group (CPP: 7.78±3.32 vs. controls: 6.54±3.19; P =0.027; CPP:10.61±4.41 vs. controls: 8.82±4.21; P =0.017; CPP: 5.22±4.29 vs. controls: 3.75±3.41; P =0.025). According to the model established by temperament traits, anxiety sensitivity, and pain catastrophizing level, pain catastrophizing level explained 11.6% of the variance in pain severity. A 1-unit change in the score for pain catastrophizing level caused a 0.278-point change in the VAS total score ( P <0.01). CONCLUSIONS Cyclothymic, depressive, and irritable temperament types that increase the risk of affective disease are more common in patients with CPP. The level of pain catastrophizing in patients with CPP affects their perception of the severity of the pain.
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Proulx L, Brizzolara K, Thompson M, Wang-Price S, Rodriguez P, Koppenhaver S. Women with Chronic Pelvic Pain Demonstrate Increased Lumbopelvic Muscle Stiffness Compared to Asymptomatic Controls. J Womens Health (Larchmt) 2023; 32:239-247. [PMID: 36450120 DOI: 10.1089/jwh.2022.0198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Although lumbopelvic muscle stiffness is commonly clinically assessed in women with chronic pelvic pain (CPP), it has not been objectively quantified in this population, and its association with other pain-related impairments has not yet been established. Objective: To compare superficial lumbopelvic muscle stiffness in women with and without CPP. In addition, pressure pain threshold (PPT) was compared between groups and the associations between muscle stiffness and PPT were assessed in women with CPP. Study Design: Case-control. Methods: Muscle stiffness and PPT of 11 lumbopelvic muscles were assessed in 149 women with CPP and 48 asymptomatic women. Subjective outcome measures, including pelvic floor function, health history, and psychosocial outcomes, were collected before muscle stiffness and PPT measurements. Analysis of covariance was used to compare muscle stiffness differences between groups, and independent t-tests were used to compare PPT between groups. Associations between measurements of PPT and muscle stiffness were calculated using correlation analysis. Results: Five of the 11 muscles measured were significantly stiffer in women with CPP than those without CPP (p < 0.05). PPT was significantly decreased in all muscles measured in women with CPP; however, there was not a significant association between muscle stiffness and PPT in women with CPP. Conclusion: The study identified the abdominal lumbopelvic muscles that have increased stiffness in women with CPP compared to asymptomatic women. In addition, muscle stiffness and PPT are two distinct impairments within this population. The results suggest that women with CPP have peripheral muscle impairments, which may be addressed without intravaginal or intrarectal intervention. Clinical Trial Registration: NCT04851730.
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Affiliation(s)
- Laurel Proulx
- School of Physical Therapy, Rueckert-Hartman College of Health Professions, Regis University, Denver, Colorado, USA
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Bosma R, Burke E, Mustafa N, Di Renna T, Wilson R. Fractured system, fractured care: The experiences of Canadian women with chronic pelvic pain waiting for interprofessional pain care. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2023. [DOI: 10.1177/22840265221148786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Chronic pelvic pain (CPP) is a common disorder in women that includes complex interactions between biological, psychological, and social factors. Accessibility to interprofessional, biopsychosocial CPP care remains a challenge for many patients. There is a lack of knowledge regarding the experiences of women using health services for CPP care and the impact of waiting for interprofessional CPP care. This study explores the perceptions and experiences of Canadian women with CPP interacting with the health system while waiting for interprofessional CPP care. Methods: Our qualitative study included women with CPP waiting for interprofessional care in Ontario, Canada. Data were obtained through semi-structured interviews which were transcribed verbatim and analyzed inductively using established methods for thematic analysis. Results: Ten women (median age of 38.5 years, age range 28–57) participated in in-depth semi-structured interviews. Three main themes were identified: (1) feeling adrift in the health system, (2) feeling “On hold,” uncertain, and in need of guidance, and (3) feeling reliant on a system that does not understand. Within these themes, women with CPP describe tangible strategies and recommendations for improving health system navigation and care. Conclusion: Our study highlights the need for improved access to interprofessional CPP programs, enhanced and targeted training for health professionals in CPP management, and better health system navigation support. Specific recommendations were provided from the perspectives of women with CPP and included providing information on what to expect and prepare for their appointment and engaging patients in education resources while they wait.
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Affiliation(s)
- Rachael Bosma
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Emeralda Burke
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Nida Mustafa
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Tania Di Renna
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Rosemary Wilson
- Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, ON, Canada
- School of Nursing, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
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Brooks T, Sharp R, Evans S, Baranoff J, Esterman A. Psychological Interventions for Women with Persistent Pelvic Pain: A Survey of Mental Health Clinicians. J Multidiscip Healthc 2021; 14:1725-1740. [PMID: 34262286 PMCID: PMC8275108 DOI: 10.2147/jmdh.s313109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To establish which psychological therapies mental health professionals use with reference to the treatment of women with persistent pelvic pain conditions. This research investigates overall therapies and specific techniques that clinicians believe are the most effective with this patient group, and the challenges mental health clinicians face in administering interventions. The study aims to suggest improvements to clinical practice and establish directions for targeted future research. Design Cross-sectional survey design. Methods An online survey was developed to ask mental health clinicians questions regarding the therapies and techniques they use with women experiencing persistent pelvic pain, their perspective on their practice in this area. The survey was advertised on relevant social media and professional websites. Survey results were tabled, and chi-square statistical analyses were undertaken to examine differences in therapy use according to country and profession. Results Mental health clinicians predominantly utilized cognitive behavioral therapy, acceptance and commitment therapy and associated techniques for women with persistent pelvic pain conditions. The results of the chi-square analyses showed that psychologists were more likely to use cognitive behavioral therapy or acceptance and commitment therapy, than counsellors who preferred counselling interventions. Chi-square analyses showed that Australian clinicians used acceptance and commitment therapy with a higher frequency than mental health clinicians in other countries. Clinicians provided multiple insights into their experiences working with women affected by persistent pelvic pain and their opinions as to valuable future research directions. Conclusion Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness therapies were most commonly used by mental health clinicians working with women with persistent pelvic pain conditions, despite severely limited evidence for the use of these psychological interventions in this client group.
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Affiliation(s)
- Tiffany Brooks
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Rebecca Sharp
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Susan Evans
- Welland Health, North Adelaide, South Australia, Australia
| | - John Baranoff
- Centre for Treatment of Anxiety and Depression, Adelaide, South Australia, Australia
| | - Adrian Esterman
- The University of South Australia, Clinical and Health Sciences, Adelaide, South Australia, Australia
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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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Tempest N, Efstathiou E, Petros Z, Hapangama DK. Laparoscopic Outcomes after Normal Clinical and Ultrasound Findings in Young Women with Chronic Pelvic Pain: A Cross-Sectional Study. J Clin Med 2020; 9:E2593. [PMID: 32785173 PMCID: PMC7464721 DOI: 10.3390/jcm9082593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic pelvic pain (CPP) is one of the most common chronic pain problems experienced by women, with prevalence rates comparable to asthma and back pain. However, it is poorly understood and causative pathology is only seldom found. We aimed to establish prevalence of abnormal findings at diagnostic laparoscopy in young women with CPP after normal findings at clinical examination and pelvic ultrasound scan. Information was retrospectively collected on all laparoscopies undertaken on women aged 16-30 years with normal preoperative findings over a 24-month period. One-hundred-and-fifty women (mean age 25 years and BMI 24.5) were included with laparoscopic examination revealing normal anatomy in 110 (73.3%) and pathology in 40 (27.2%). Endometriosis was detected in 30 (20%); 25 (16.7%) stage 1, 2 (1.3%) stage 2, 2 (1.3%) stage 3 and 1 (0.7%) stage 4. Most laparoscopies carried out on young women with CPP and normal clinical examination and pelvic ultrasound scan showed no significant clinical stigmata of pelvic disease. Women should be fully informed of the multifactorial nature of CPP and there should be a comprehensive management pathway for these women, as proceeding with invasive laparoscopy does not provide additional benefit when investigating CPP in the context of risk, cost and effect on long-term wellbeing.
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Affiliation(s)
- Nicola Tempest
- Liverpool Women’s Hospital NHS Foundation Trust, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK;
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
| | - Ekaterina Efstathiou
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
| | - Zena Petros
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
| | - Dharani K. Hapangama
- Liverpool Women’s Hospital NHS Foundation Trust, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK;
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners affiliations, Liverpool L8 7SS, UK; (E.E.); (Z.P.)
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Bishop MD, Bialosky JE, Alappattu MJ. Riding a Tiger: Maximizing Effects of Manual Therapies for Pelvic Pain. JOURNAL OF WOMEN'S HEALTH PHYSICAL THERAPY 2020; 44:32-38. [PMID: 34163308 PMCID: PMC8218714 DOI: 10.1097/jwh.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Manual therapy interventions are frequently used during the management of pelvic pain conditions. Pain relief after any intervention results from effects unrelated to the intervention, effects specific to the intervention, and effects of context in which the intervention is provided. Understanding these multiple mechanisms allows providers of manual therapy to maximize outcomes by deliberately harnessing each of these core elements of pain relief.
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Affiliation(s)
- Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
| | - Joel E. Bialosky
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
- Brooks-PHHP Research Collaboration, Jacksonville, Florida
| | - Meryl J. Alappattu
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
- Brooks-PHHP Research Collaboration, Jacksonville, Florida
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Mellado BH, Pilger TL, Poli-Neto OB, Rosa E Silva JC, Nogueira AA, Candido Dos Reis FJ. Current usage of qualitative research in female pelvic pain: a systematic review. Arch Gynecol Obstet 2019; 300:495-501. [PMID: 31201537 DOI: 10.1007/s00404-019-05212-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/07/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Qualitative research has received growing attention in the multidisciplinary investigation of patients' perceptions about chronic diseases. The purpose of this systematic review was to characterize the usage of qualitative research in women with chronic pelvic pain (CPP). METHODS We performed a structured search in Web of Science, Pubmed, and EMBASE platforms until June 2019. The search combined the keywords: "pelvic pain", "endometriosis", "dyspareunia", "dysmenorrhea", "vaginismus", "focus groups", "qualitative research", "hermeneutics", "grounded theory", and "women". Qualitative studies on female CPP were included and the main findings combined using thematic synthesis. RESULTS We found 1211 citations, of which 52 were included in this review. The majority of included studies were based on phenomenological design. The main method for data collection was semi-structured interviews. Endometriosis was the theme of 23 studies, chronic pelvic pain of eight, dysmenorrhea of eight, dyspareunia of four, interstitial cystitis of two, vaginismus of two, vulvodynia of two, and pelvic inflammatory disease of one study. We found a wide variety of contributions. Among them, the impact of the disease on women's lives was the commonest. CONCLUSION Qualitative research has the potential to reveal and explain several aspects of CPP in women. The medical community may better accept knowledge gained from these studies if the methods are described more transparently in published articles.
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Affiliation(s)
- Bruna Helena Mellado
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Taynara Louisi Pilger
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Omero Benedicto Poli-Neto
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Julio Cesar Rosa E Silva
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Antonio Alberto Nogueira
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil
| | - Francisco José Candido Dos Reis
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 8º andar, Ribeirão Preto, SP, 14048-900, Brazil.
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Abstract
OBJECTIVES The aim of this study was to assess the validity, reliability, and factor structure of the Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ). MATERIALS AND METHODS This was a cross-sectional questionnaire study that was administered online. To be eligible to participate, women had to have experienced chronic pelvic pain for a minimum of 6 months and be at least 18 years of age. A total of 969 women (mean age: 35.4 y, SD=12.0) took part. The main outcome measure was the IF-CPPQ. Additional validated measures that assessed related constructs were also administered. Principal axis factor analysis was used to assess the factor structure of the IF-CPPQ. Internal consistency was assessed using Cronbach α. Convergent and discriminant validity was assessed using Pearson correlations between factor scores on the IF-CPPQ and measures of related constructs. The consistency and model fit of the resulting factor structure was assessed using confirmatory factor analysis. RESULTS The final 26-item questionnaire comprised 5 factors (Psychological Impact, Sexual Impact, Relationship Impact, Occupational Impact, and Emotional Impact). Findings suggested good convergent and discriminant validity and internal consistency. DISCUSSION The findings indicate that the IF-CPPQ is a reliable and valid measure of the impact of chronic pelvic pain on women. While the IF-CPPQ has the potential for multiple uses within research and clinical practice, further research is needed to determine the questionnaire's ability to detect clinically meaningful changes with treatment.
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Mirowska-Allen KL, Sewell M, Mooney S, Maher P, Ianno DJ, Grover SR. The characteristics of women recommended a laparoscopy for chronic pelvic pain at a tertiary institution. Aust N Z J Obstet Gynaecol 2018; 59:123-133. [DOI: 10.1111/ajo.12836] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Megan Sewell
- The Mercy Hospital for Women; Melbourne Victoria Australia
| | | | - Peter Maher
- The Mercy Hospital for Women; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
| | - Damian J. Ianno
- Monash Health; Melbourne Victoria Australia
- University of Sydney; Sydney Australia
| | - Sonia R. Grover
- The Mercy Hospital for Women; Melbourne Victoria Australia
- University of Melbourne; Melbourne Victoria Australia
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Thompson DG, O’Brien S, Kennedy A, Rogers A, Whorwell P, Lovell K, Richardson G, Reeves D, Bower P, Chew-Graham C, Harkness E, Beech P. A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundChronic gastrointestinal disorders are major burdens in primary care. Although there is some evidence that enhancing self-management can improve outcomes, it is not known if such models of care can be implemented at scale in routine NHS settings and whether or not it is possible to develop effective risk assessment procedures to identify patients who are likely to become chronically ill.ObjectivesWhat is the clinical effectiveness and cost-effectiveness of an intervention to enhance self-management support for patients with chronic conditions when translated from research settings into routine care? What are the barriers and facilitators that affect the implementation of an intervention to enhance self-management support among patients, clinicians and organisations? Is it possible to develop methods to identify patients at risk of long-term problems with functional gastrointestinal disorders in primary care? Data sources included professional and patient interviews, patient self-report measures and data on service utilisation.DesignA pragmatic, two-arm, practice-level cluster Phase IV randomised controlled trial evaluating outcomes and costs associated with the intervention, with associated process evaluation using interviews and other methods. Four studies around identification and risk assessment: (1) a general practitioner (GP) database study to describe how clinicians in primary care record consultations with patients who experience functional lower gastrointestinal symptoms; (2) a validation of a risk assessment tool; (3) a qualitative study to explore GPs’ views and experiences; and (4) a second GP database study to investigate patient profiles in irritable bowel syndrome, inflammatory bowel disease and abdominal pain.SettingSalford, UK.ParticipantsPeople with long-term conditions and professionals in primary care.InterventionsA practice-level intervention to train practitioners to assess patient self-management capabilities and involve them in a choice of self-management options.Main outcome measuresPatient self-management, care experience and quality of life, health-care utilisation and costs.ResultsNo statistically significant differences were found between patients attending the trained practices and those attending control practices on any of the primary or secondary outcomes. The intervention had little impact on either costs or effects within the time period of the trial. In the practices, self-management tools failed to be normalised in routine care. Full assessment of the predictive tool was not possible because of variable case definitions used in practices. There was a lack of perceived clinical benefit among GPs.LimitationsThe intervention was not implemented fully in practice. Assessment of the risk assessment tool faced barriers in terms of the quality of codting in GP databases and poor recruitment of patients.ConclusionsThe Whole system Informing Self-management Engagement self-management (WISE) model did not add value to existing care for any of the long-term conditions studied.Future workThe active components required for effective self-management support need further study. The results highlight the challenge of delivering improvements to quality of care for long-term conditions. There is a need to develop interventions that are feasible to deliver at scale, yet demonstrably clinically effective and cost-effective. This may have implications for the piloting of interventions and linking implementation more clearly to local commissioning strategies.Trial registrationCurrent Controlled Trial ISRCTN90940049.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David G Thompson
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Sarah O’Brien
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Anne Kennedy
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Anne Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Peter Whorwell
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - David Reeves
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Elaine Harkness
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Paula Beech
- Stroke Rehabilitation Unit, Salford Royal Foundation Trust, Salford, UK
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Fuentes-Márquez P, Valenza MC, Cabrera-Martos I, Ríos-Sánchez A, Ocón-Hernández O. Trigger Points, Pressure Pain Hyperalgesia, and Mechanosensitivity of Neural Tissue in Women with Chronic Pelvic Pain. PAIN MEDICINE 2017; 20:5-13. [DOI: 10.1093/pm/pnx206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Pedro Fuentes-Márquez
- Faculty of Health Sciences, Physical Therapy Department, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Faculty of Health Sciences, Physical Therapy Department, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Faculty of Health Sciences, Physical Therapy Department, University of Granada, Granada, Spain
| | - Ana Ríos-Sánchez
- Faculty of Health Sciences, Physical Therapy Department, University of Granada, Granada, Spain
| | - Olga Ocón-Hernández
- Obstetrics and Gynecology Clinic, Virgen de las Nieves Hospital, Granada, Spain
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Twiddy H, Bradshaw A, Chawla R, Johnson S, Lane N. Female chronic pelvic pain: the journey to diagnosis and beyond. Pain Manag 2017; 7:155-159. [PMID: 28073312 DOI: 10.2217/pmt-2016-0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hannah Twiddy
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
| | - Alison Bradshaw
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
| | - Rajiv Chawla
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
| | - Selina Johnson
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK.,Institute of Translational Medicine, The University of Liverpool, Liverpool, UK
| | - Natalie Lane
- The Pain Management Department, the Walton Centre NHS Trust, Liverpool, UK
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Ayorinde A, Bhattacharya S, Druce K, Jones G, Macfarlane G. Chronic pelvic pain in women of reproductive and post-reproductive age: a population-based study. Eur J Pain 2016; 21:445-455. [DOI: 10.1002/ejp.938] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- A.A. Ayorinde
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - S. Bhattacharya
- Institute of Applied Health Sciences; School of Medicine and Dentistry; University of Aberdeen; Aberdeen UK
| | - K.L. Druce
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - G.T. Jones
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - G.J. Macfarlane
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
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Ayorinde AA, Macfarlane GJ, Saraswat L, Bhattacharya S. Chronic pelvic pain in women: an epidemiological perspective. ACTA ACUST UNITED AC 2015; 11:851-64. [PMID: 26450216 DOI: 10.2217/whe.15.30] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic pelvic pain (CPP) is common in women of reproductive age and has a significant impact on quality of life, work efficiency and healthcare utilization. CPP can be a manifestation of many different, often multifactorial conditions, and in the absence of an identified cause, the management can be particularly challenging. High quality epidemiological studies would improve the understanding of CPP and identify risk factors which may be targeted for the development of appropriate management strategies. This review focuses on what is known about the prevalence, risk factors, individual and societal burden of CPP and outlines important management strategies.
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Affiliation(s)
- Abimbola A Ayorinde
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Gary J Macfarlane
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Lucky Saraswat
- Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, Scotland, UK
| | - Siladitya Bhattacharya
- Institute of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
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Assessing psychological factors, social aspects and psychiatric co-morbidity associated with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men -- a systematic review. J Psychosom Res 2014; 77:333-50. [PMID: 25300538 DOI: 10.1016/j.jpsychores.2014.09.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain disease with high prevalence rates and substantial health care costs. An interdisciplinary classification system is commonly used (UPOINT) which includes psychosocial factors. Nevertheless, psychosocial influences on CP/CPPS only recently became a research focus. Therefore, we aimed to synthesize the existing data and to identify further research topics. Then, based on our results, diagnosis and treatment can be improved. METHODS In a systematic review conducted according to the PRISMA reporting guidelines we searched different databases (MEDLINE, EMBASE, PsychINFO) using the broad search terms "chronic pelvic pain syndrome AND men". Two raters independently screened the literature and assessed the risk of bias. RESULTS We included 69 original research articles which considered psychosocial variables. We found studies investigating different psychosocial factors (pain catastrophizing, stress, personality factors, social aspects), co-morbid psychiatric disorders (depression, anxiety and trauma-related disorders, somatization disorder, substance abuse) and Quality of Life (QoL). In addition, there is a high risk of bias in most studies e.g. concerning the study design or the measures. CONCLUSIONS There is evidence suggesting that psychological factors are important in understanding CP/CPPS. However, research concentrated on a few aspects while the others were not covered adequately. We found evidence of a higher number of psychosocial factors and psychiatric co-morbidities than is currently included in the UPOINT system. More high quality research is needed to understand the interplay of psychosocial factors in CP/CPPS. Furthermore, these factors should be incorporated into treatment approaches.
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Hartmann D, Sarton J. Chronic pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol 2014; 28:977-90. [DOI: 10.1016/j.bpobgyn.2014.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 12/01/2022]
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Witzeman KA, Kopfman JE. Obstetrics-gynecology resident attitudes and perceptions about chronic pelvic pain: a targeted needs assessment to aid curriculum development. J Grad Med Educ 2014; 6:39-43. [PMID: 24701308 PMCID: PMC3963792 DOI: 10.4300/jgme-d-13-00053.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/04/2013] [Accepted: 07/29/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) accounts for 10% of gynecologic visits and is a common complaint in university-based and community resident clinics. Resident education about CPP has been inconsistent, and review of the limited literature shows predominantly negative perceptions of patients with CPP. Current literature lacks information regarding obstetrics-gynecology residents' attitudes and acquired knowledge regarding CPP. OBJECTIVE This targeted needs assessment aims to identify regional obstetrics-gynecology resident attitudes and self-perceived knowledge regarding chronic pelvic pain in order to better address potential educational barriers and look toward placing a greater emphasis on this area in resident training. METHODS We conducted a focus group of obstetrics-gynecology residents to identify major themes regarding attitudes about CPP. This informed the development of a survey administered to university-based and community-based obstetrics-gynecology residents (N = 57) in the Colorado part of the Western Mountain Region. Cronbach α was calculated to determine reliability for each theme, and descriptive statistics were calculated for each theme. Independent samples t tests assessed differences between training levels and between university and community training sites. RESULTS Survey response rate was 72% (41 of 57). Residents consistently reported feeling overwhelmed by CPP patients, perceived a lack of time to see these patients, and indicated a desire to learn more in this area, but they varied in chosen learning methods. No significant differences were found between levels of training or training sites. CONCLUSIONS Most obstetrics-gynecology residents surveyed believe they are inadequately prepared to address the needs of women presenting with CPP.
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Harkness EF, Harrington V, Hinder S, O'Brien SJ, Thompson DG, Beech P, Chew-Graham CA. GP perspectives of irritable bowel syndrome--an accepted illness, but management deviates from guidelines: a qualitative study. BMC FAMILY PRACTICE 2013; 14:92. [PMID: 23805998 PMCID: PMC3700862 DOI: 10.1186/1471-2296-14-92] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/20/2013] [Indexed: 12/31/2022]
Abstract
Background The estimated prevalence of irritable bowel syndrome (IBS) is 10%. Up to one third of patients develop chronic symptoms, which impact on everyday functioning and psychological wellbeing. Guidelines suggest an increased role for primary care in the management of patients with IBS, and referral for psychological interventions. Literature reports dissatisfaction and frustration experienced by both patients with IBS and healthcare professionals. The aim of this study was to explore the perspectives of general practitioners (GPs) in relation to the diagnosis and management of IBS and their views on the potential use of a risk assessment tool to aid management decisions for patients with IBS in primary care. Methods This was a qualitative study using face-to-face semi-structured interviews with GPs in North West England. Interviews were fully transcribed and data analyzed using constant comparison across interviews. Tensions between GP accounts and the NICE guideline for the management of IBS were highlighted. Results GPs described IBS as a diagnosis of exclusion and the process as tentative and iterative, with delay in adding a Read code to the patient record until they were confident of the diagnosis. Whilst GPs accepted there was a link between IBS and psychological symptoms they suggested that the majority of patients could be managed within primary care without referral for psychological interventions, in conflict with the NICE guideline. They did not feel that a risk assessment tool for patients with IBS would be helpful. Conclusions This study highlights the tensions between evidence recognizing the need to identify patients whose symptoms may become chronic and offer pro-active care, including referral for psychological therapies, and the perspectives of GPs managing patients in every-day clinical practice. The reluctance of GPs to refer patients for evidence-based psychological treatments may have implications for commissioning services and patient care.
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Affiliation(s)
- Elaine F Harkness
- Institute of Inflammation and Repair, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PL, England.
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Gökyıldız Ş, Beji NK. Chronic pelvic pain: gynaecological and non-gynaecological causes and considerations for nursing care. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2012. [DOI: 10.1111/j.1749-771x.2011.01137.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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