Interdisciplinary Management of Pelvic Pain: Bridging the Gap Between Primary Care and Specialty Referral

Author: Jennifer Hah

The prevalence of chronic pelvic pain in women 18 to 50 years old is around 15%. However, only one-third of these women currently seek medical care. Also, the average time from presentation to a primary care provider and appropriate specialty referral and diagnosis ranges from 3 to 7 years. To narrow the gap between symptom onset and treatment, multifaceted education of the general public, patients, and providers is essential. As healthcare providers, we need to encourage patients to seek treatment, rather than to suffer in silence. Given the unique challenges associated with treating chronic pelvic pain, for example, in the domain of sexual function, pain in this region presents a unique set of considerations for any provider.

Primary care providers serve an indispensable role for patients with chronic pelvic pain. While these patients may often be referred to several specialists, the primary care provider plays a critical role in helping to formulate and integrate an interdisciplinary care plan, involving different disciplines working together to achieve a common goal. In order to narrow the gap between current and optimal practice, it is essential for healthcare providers to appreciate the epidemiology, risks factors, and etiology of a spectrum of pelvic pain conditions in addition to relevant treatment options. Some of these treatment options could be initiated concurrently with specialist referral. Because chronic pelvic pain is an indication for 15% to 40% of laparoscopies and 12% of hysterectomies in the US, and because a third of women have unclear pathology after diagnostic laparoscopy, primary care providers play a critical role in managing pain and encouraging patients to pursue interdisciplinary care.

Chronic pelvic pain is often defined as "nonmalignant pain perceived in the structures related to the pelvis that has been present for greater than 6 months or has a nonacute pain mechanism of a shorter duration." Given the conglomeration of structures within the pelvis, chronic pelvic pain can result from disorders of the urological, gynecological, gastrointestinal, musculoskeletal, and/or nervous system. Oftentimes, the pain is an end result of a multitude of factors at play. For example, it is not uncommon for a woman to present with a history of fibromyalgia, irritable bowel syndrome, and painful bladder syndrome. Gynecologic etiologies contributing to chronic pelvic pain can include endometriosis, adhesions, chronic pelvic inflammatory disease, and pelvic congestion syndrome.

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