New hope for pelvic pain sufferers

A Murdoch medical centre is one of 20 GP clinics across Australia selected to support patients with endometriosis and chronic pelvic pain. Dr Andrew Leech explains the concept.

Our current experience is that patients with chronic pelvic pain and endometriosis generally struggle for significant periods of time without a clear diagnosis.

Symptoms can be misdiagnosed because testing modalities such as ultrasound or pathology are not always helpful. Other issues such as infertility, mental health, pain and suffering are significant.

Patients are often lost to follow-up and may lose hope that anything can be done. We recognise that endometriosis and pelvic pain can be complex. There can be difficult conversations around trauma, sexual health and fertility that doctors may not always have time to approach.

Services are also disjointed across the public and private sectors and may not collaborate on how they are managing patients.

Our vision for this new service is to provide care with a focus on physical, mental, and spiritual wellbeing. The staff involved in the Pelvic Pain Clinic will support and work with patients to tailor an individualised treatment plan, recognising the complex interplay of factors that can lead to pelvic pain, and the significant impact it can have on all areas of a woman’s life.

Through advertising and social media, we will increase community awareness of pelvic pain and encourage patients to seek treatment.

And there will be regular training and education in the management of pelvic pain, including medical management, physiotherapy, psychological factors, dietary and lifestyle factors.

We plan to use the multidisciplinary team to bring knowledge and wisdom together, with the patient and their needs always at the centre. The aim is to include the patient in setting realistic and achievable goals and regularly review her progress towards those goals, adjusting the plan when necessary, in collaboration with the patient and other providers. continued on Page 29

We will have a focus on gathering feedback from patients to improve the service to women and contribute to ongoing research. The Commonwealth Government recently announced funding for 20 GP clinics across Australia to offer improved services for patients experiencing endometriosis and chronic pain. The goal of these clinics is to improve accessibility to care and streamline the process. The average time for a diagnosis of endometriosis in Australia is 10 years. We aim to not only improve this wait time, but also improve the quality of care patients receive during the process. This is an area that has many facets, and it is important we consider not only the physical nature of the problem, but also the psychological impacts on patients.

We will use the funding to build our existing service through increased training and upskilling of doctors and nurses, recruitment of additional nursing team members who will help triage, screen and support patients, workshops and education for patients and purchasing of essential equipment such as gynaecology examination beds.

We have also considered more broader opportunities that we would not normally have had. Ideas from our team have included trialling a Tens machine, training in acupuncture, purchasing VR goggles for pain management during procedures and for mindfulness, running regular zoom education sessions and improving our online resources.

Most of the clinics involved are mixed billing practices and will continue this model for consultations with patients. However, we are looking at ideas around how to offer some of the grant funding towards allied health, diagnostic imaging and specialists so that these services are not unaffordable for patients.

We also hope to value-add to the service we already provide through funding the education workshops and resources so that patients are not out of pocket for these.

An additional benefit is the link between the 20 clinics. We have already met together and discussed how we will share our resources and run our service, and we are setting up a community of practice so that the experiences we each have can lead to better outcomes.

We have already connected with local specialists including several gynaecologists who have additional training and skills in dealing with endometriosis. We have also linked with local women’s health allied health and women’s imaging services. We have had initial meetings with Endometriosis WA and connected with Endometriosis Australia. WAPHA has helped us to navigate how to use the funding appropriately and will also be seeking our feedback on improving the Health Pathways for endometriosis.