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Pain management, May 1, 2017

Female chronic pelvic pain Chronic pelvic pain (CPP) is defined as persistent pain in the lower a... more Female chronic pelvic pain Chronic pelvic pain (CPP) is defined as persistent pain in the lower abdomen or pelvis of minimum 6-month duration that does not occur exclusively with menstruation, pregnancy or intercourse [1]. Estimates from the UK and the USA suggest that 4-24% of women, aged 18-50 years, report experiencing CPP within the last 3 months [2]. CPP accounts for 20-40% of all gynecology outpatient appointments [3,4] and approximately 3.8% of visits to primary care [5]. The prevalence of CPP within primary care is higher than for migraine 2.1% and comparable to asthma 3.7% and back pain 4.1% [6]. The annual UK treatment costs have been estimated at GB£158 million with further indirect costs of GB£24 million [7]. It is believed that these figures do not truly reflect the size of the problem as it is estimated that only about a third of women with CPP seek medical care [6,8-11]. In addition to the physical symptoms of CPP there is well-documented evidence that patients also experience associated negative psychological, behavioral, cognitive and sexual consequences [7]. The European Association of Urology Guidelines for management of CPP have highlighted the need for treatment of CPP to recognize these consequences as an important c omponent of CPP management [1]. Psychosocial factors have long been considered significant in understanding an integrated and full picture of complex chronic pain conditions [12]. Pain-related distress and the emotional consequences of living with persistent pain can have debilitating and marked effects on an individual's quality of life. Hence, it is little surprise that women with CPP often report depression, anxiety and reduced sexual function [13]. These latter difficulties are commonly linked with desires to start a family, pregnancy and childbirth. Tripp et al. (2013) [14] and Romão et al. (2011) [15] found that CPP affected women's relationships, day-today living, emotions and their perspectives for the future. It has been reported that women often feel unable to plan their daily life, owing to the constant imminence of pain and they report significantly more pain, depression and anxiety symptoms, and were physically more impaired than women in a control group [10,16]. Many aspects of women's quality of life are Commentary

British journal of pain, May 7, 2015

Context/Background: Chronic pelvic pain (CPP) is a physically and psychologically debilitating co... more Context/Background: Chronic pelvic pain (CPP) is a physically and psychologically debilitating condition. European Association of Urology (EAU) Guidelines (2013) and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines (2012) place strong emphasis upon multi-speciality assessment and liaison, as well as interdisciplinary assessment and intervention in reference to the management of CPP. Objectives: The aim was to introduce and describe the development and delivery of an interdisciplinary pain management programme (PMP), at a Specialised Pain Management Centre in Liverpool, United Kingdom, for women diagnosed with CPP. Method: The format and content of the CPP PMP at The Walton Centre, Liverpool, is described and the preliminary results from the CPP PMP are presented. Results: Preliminary data suggest that outcomes on the specialised CPP PMP indicate that patients are able to make clinically important change across a range of outcome measures. Moreover, these results compare favourably to the established PMP for generalised chronic pain when comparing clinically significant outcomes with the Walton Centre's (a tertiary-level pain management centre) 2013 PMP Audit document. Patients attending the CPP PMP positively appraised the PMP and felt it was useful and supportive to be in a group dedicated to CPP. Conclusions: This article presents some preliminary results that suggest there is value in delivering a specialised multidisciplinary PMP for this group. There is a clear need for further clinical research into the effectiveness of similar interventions for CPP, including the early identification of those CPP patients who may benefit from both multi-specialty and interdisciplinary management.

Journal of oral and facial pain and headache, Jun 1, 2021

Aims: To understand the experiences of patients diagnosed with chronic facial pain (CFP) who atte... more Aims: To understand the experiences of patients diagnosed with chronic facial pain (CFP) who attended a specialist facial pain management program (PMP); specifically, to explore how they experienced attending the facial PMP itself and how they felt it impacted their management of CFP. Methods: Qualitative methodology and focus groups were used to gather patients' views and experiences of attending a facial PMP. Two focus groups were conducted for patients who had all completed the facial PMP. Discussions were recorded and transcribed. Data were then analyzed using thematic analysis to establish key themes relating to participants' experiences of the facial PMP. Results: Thematic analysis identified three main themes, with numerous subthemes within them. The theme "psychologic change" had subthemes of self-compassion, acceptance, and reflection. The theme "behavioral change" contained subthemes of re-engagement with valued activity, medication, and communication. The theme "structure and process" contained subthemes of concentration, need for one-on-one time with the clinician, meeting others, and not enough time (clinical and nonclinical). Conclusion: Facial PMPs may provide a valuable treatment to support long-term coping and adaptation for patients with CFP. Positive changes to coping include both psychologic and behavioral elements. Further research is necessary to clarify how group-based facial PMPs should be structured and delivered.

Pain Management, 2017

British Journal of Pain, 2015