Acute management of persistent pelvic pain By Dr Cliff Neppe, Obstetrician and Gynaecologist, Joondalup When first approached to write on the above topic, Coronavirus and the strain it is placing on our health systems was not even a consideration. Given that the last place a patient currently wants to present is to a hospital emergency department, hopefully this will help to provide you with some tools to assist you and your patients through their acute flare of their persistent/ chronic pelvic pain (PPP). I have prepared this with the benefit of various meetings I have attended with pain specialists as well as using the excellent article published in the O&G magazine, Winter 2019 Vol 21 No 2. PPP is caused by a complex combination of visceral and musculoskeletal pain, central sensitisation and pelvic floor
32 | MAY 2020
Key messages PPP affects 15-20% of women Flare-ups can be managed in the community Identify and manage triggers
hypertonicity, often accompanied by evolving psychological dysfunction. It affects 15-20% of women. Acute exacerbations (flares), which can last days to months, are often occupied with significant fear and anxiety relating to escalation of pain. They are often triggered by menstruation, constipation, UTI/ bladder pain and pelvic muscle spasms. We should aim to prevent unnecessary investigations,
admission and surgery and focus on identification and treatment of specific triggers while providing validation, reassurance and education to patients. Management principles need to include excluding acute intraabdominal pathology, recognition and management of likely triggers of the flare, appropriate analgesia with the avoidance of opioids, assessment of psychological stressors and self-harm risk, acknowledgement of the patient’s pain, education and emphasis on self-management and appropriate follow-up. Long-term management involves a multidisciplinary team approach including laparoscopic gynaecologist, pain specialist, psychologist, physiotherapist and referral pathways to psychiatry,
MEDICAL FORUM | WOMEN 'S HEALTH ISSUE
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