Managing Persistent Pelvic Pain in a distinct "pain" clinic

Persistent pelvic pain produces physiological stress and productivity loss in the reproductive period.

Key Points

Highlights:

• Women with persisting pelvic pain should be evaluated in a special multidisciplinary clinic with a gynecologist, a psychologist, and a pelvic floor physiotherapist
• This would help patients both psychologically and medically, also avoid emergency department attendance.

Importance:

• A special pain clinic to follow-up the patients with persistent pelvic pain could reduce emergency department visits and also control the morphine usage of daily users.

What's done here:

• This retrospective cohort study collected the data from a multidisciplinary pain clinic established in the emergency department of Mater Hospital, South Brisbane, Australia in 2017.
• This clinic is named "persistent pelvic pain clinic"  and aimed to provide multidisciplinary care to women with persistent pelvic pain.
• The frequency and the nature of emergency department presentation, regular opioid usage, and surgeries performed on this population were evaluated on one hundred cases who attended this clinic.

Key Results:

• After 12 months of attendance of this special clinic, more than a half reduction in the emergency presentations, and more than two-thirds reduction in short-stay admissions were noticed.
• 19% fewer patients showed up with an exacerbation of pelvic pain due to this clinical attendance.
• A similar reduction in the number of presentations, short-stay admissions, and daily opioid use in regular users was determined in the same period.
• There was no significant change in the number of inpatient admissions. 
• This special clinic helped to reduce the resource burden on a busy emergency department.
• A decrease in the number of explorative laparoscopies was determined as the result of reviewing an advanced laparoscopic gynecologist when suspected endometriosis was reported.

Lay Summary

Persistent pelvic pain is an important problem producing physiological stress and productivity loss during the reproductive period of women.

A specific pelvic pain clinic named "Mater Health Persistent Pelvic Pain Clinic" was established in 2017 in a part of the emergency department in Mater Hospital, Queensland, Australia. The clinic aimed to reduce the burden of a busy emergency department and to eliminate the need to submit to an emergency department by a multidisciplinary follow-up of patients with persistent pelvic pain.

Wilkinson et al. from the Department of Obstetrics and Gynecology of Mater Health Services, Brisbane, Australia, recently published the results of their retrospective study on 100 patients in the journal "The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG)".

Patients with persistent pelvic pain were referred to their publicly funded clinic after their general gynecological management, including laparoscopy and endometriosis excision. In this specific pelvic pain clinic, another gynecologist, a specially trained pain physician, a psychologist, and a pelvic floor physiotherapist examined them. This multidisciplinary approach helps to gain better results while managing persistent pelvic pain.

These patients were known to be emergency department presenters for their pelvic pain. The absolute number of their emergency department visits decreased more than 50% after 12 months of clinical attendance to the persistent pelvic pain clinic. Furthermore, the number of needs for short-stay emergency department admissions, and the daily morphine intake for opioid users were also decreased. There was no change in the number of inpatient admissions.

The authors admitted that they did not make a detailed cost analysis. This should be taken into account while discussing the benefits of this special pain clinic and its financial impact at a different institution. 

Research Source: https://pubmed.ncbi.nlm.nih.gov/33984153/