TY - JOUR
T1 - No. 164-Consensus Guidelines for the Management of Chronic Pelvic Pain
AU - Jarrell, John F.
AU - Vilos, George A.
AU - Allaire, Catherine
AU - Burgess, Susan
AU - Fortin, Claude
AU - Gerwin, Robert
AU - Lapensee, Louise
AU - Lea, Robert H.
AU - Leyland, Nicholas A.
AU - Martyn, Paul
AU - Shenassa, Hassan
AU - Taenzer, Paul
N1 - Publisher Copyright:
© 2018
PY - 2018/11
Y1 - 2018/11
N2 - Objective: To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. Disclaimer: This guideline has been reaffirmed for use and approved by Board of The Society of Obstetricians and Gynaecologists of Canada. A revision is underway. Burden of Suffering: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. Outcomes: Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. Evidence: Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subjects related to CPP, including acute care management, myofascial dysfunction, and medical and surgical therapeutic options. The committee reviewed the literature and available data from a needs assessment of subjects with CPP, using a consensus approach to develop recommendations. Values: The quality of the evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice were ranked according to the method described in that report (Table 1). Recommendations: The recommendations are directed to the following areas: (a) an understanding of the needs of women with CPP; (b) general clinical assessment; (c) practical assessment of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d) principles of opiate management; (f) increased use of magnetic resonance imaging (MRI); (g) documentation of the surgically observed extent of disease; (h) alternative therapies; (i) access to multidisciplinary care models that have components of physical therapy (such as exercise and posture) and psychology (such as cognitive-behavioural therapy), along with other medical disciplines, such as gynaecology and anesthesia; G) increased attention to CPP in the training of health care professionals; and (k) increased attention to CPP in formal, high-calibre research. The committee recommends that provincial ministries of health pursue the creation of multidisciplinary teams to manage the condition.
AB - Objective: To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. Disclaimer: This guideline has been reaffirmed for use and approved by Board of The Society of Obstetricians and Gynaecologists of Canada. A revision is underway. Burden of Suffering: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. Outcomes: Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. Evidence: Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subjects related to CPP, including acute care management, myofascial dysfunction, and medical and surgical therapeutic options. The committee reviewed the literature and available data from a needs assessment of subjects with CPP, using a consensus approach to develop recommendations. Values: The quality of the evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice were ranked according to the method described in that report (Table 1). Recommendations: The recommendations are directed to the following areas: (a) an understanding of the needs of women with CPP; (b) general clinical assessment; (c) practical assessment of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d) principles of opiate management; (f) increased use of magnetic resonance imaging (MRI); (g) documentation of the surgically observed extent of disease; (h) alternative therapies; (i) access to multidisciplinary care models that have components of physical therapy (such as exercise and posture) and psychology (such as cognitive-behavioural therapy), along with other medical disciplines, such as gynaecology and anesthesia; G) increased attention to CPP in the training of health care professionals; and (k) increased attention to CPP in formal, high-calibre research. The committee recommends that provincial ministries of health pursue the creation of multidisciplinary teams to manage the condition.
KW - Pelvic pain
KW - adenomyosis
KW - adhesions
KW - adnexal torsion
KW - complementary therapies
KW - diagnostic imaging
KW - endometriosis
KW - endosalpingiosis
KW - hormonal treatment
KW - hysterectomy
KW - laparoscopy
KW - myofascial pain syndromes
KW - ovarian cysts
KW - ovarian remnant syndrome
KW - pelvic congestion syndrome
KW - pelvic inflammatory disease
KW - pelvic peritoneal defects
KW - residual ovary syndrome
KW - uterine fibroids
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U2 - 10.1016/j.jogc.2018.08.015
DO - 10.1016/j.jogc.2018.08.015
M3 - Article
C2 - 30473127
AN - SCOPUS:85056896911
SN - 1701-2163
VL - 40
SP - e747-e787
JO - Journal of Obstetrics and Gynaecology Canada
JF - Journal of Obstetrics and Gynaecology Canada
IS - 11
ER -