Recommendations for patient education in the management of persistent pelvic pain: a systematic review of clinical practice guidelines

Prevalence and Impact of Period and Pelvic Pain in Australian Adolescents: The PPEP Talk Schools Program

BACKGROUND

In 2018 the Australian Government launched the world's first National Action Plan for Endometriosis (NAPE). Of its three priorities 'Priority 1' was 'Education and Awareness'. In response, the Pelvic Pain Foundation of Australia was funded to deliver their Periods, Pain and Endometriosis Program (PPEP) Talk to a proportion of Australian schools. Since then, PPEP Talk has been delivered to over 110,000 students.

AIMS

This retrospective cross-sectional study investigated students assigned female at birth (AFAB) and the prevalence and impact of period and pelvic pain, interaction with health care services and knowledge of endometriosis.

MATERIALS AND METHODS

Multiple choice, pre and post PPEP Talk, paper survey responses between July 2022 and June 2023 were collected from 13,078 students AFAB.

RESULTS

52.6% of students reported regular severe period pain. 22.9% of students reported regularly missing school or work with their period. 21.5% of students had presented to a health professional for pain, and 5.7% had presented to an Emergency Department. 5.2% of students reported pelvic pain for more than 10 days per month. The prevalence and impact of period and pelvic pain varied across demographic variables. The proportion of students who knew what endometriosis was rose from 47.8% to 95.5% after the program.

CONCLUSIONS

The NAPE's objective to enhance education and awareness of endometriosis and period/pelvic pain was met. 100% of schools who received PPEP Talk want it to return. Wide discrepancies in the prevalence of pain within different demographics were identified, providing previously unknown data to improve and direct services.

Biopsychosocial Approaches for the Management of Female Chronic Pelvic Pain: A Systematic Review

BACKGROUND/OBJECTIVE

Current guidelines recommend biopsychosocial-informed treatment for chronic pelvic pain (CPP). The objective of this systematic review was to describe the available biopsychosocial approaches for the treatment of CPP, and the outcomes reported, to understand how guideline-recommended treatments can be applied.

SEARCH STRATEGY

MEDLINE, CINAHL, PsycINFO, EMBASE, Emcare, AMED and Cochrane trial registries were searched (inception to 17 November 2023).

SELECTION CRITERIA

CPP Studies in women where the principal treatment modality was a biopsychosocial approach were included. Prospero registration: CRD42022374256.

DATA COLLECTION/ANALYSIS

Data extraction included study setting, population, study design, intervention characteristics and outcome measures and is described via a narrative synthesis.

RESULTS

The review included 14 RCTs (871 patients) and identified four broad intervention categories (Acceptance Commitment Therapy n = 2, Cognitive Behavioural Therapy n = 6, Mindfulness-based approaches n = 2, and Physiotherapy-based interventions n = 4). Pain science education (PSE) and, exposure/engagement with valued activity were recognised as important aspects of treatment regardless of intervention type. The most utilised outcomes were pain reduction and emotional functioning, with all studies reporting improvements in these domains. Heterogeneity in outcomes prevented efficacy comparison. High risk of bias was identified in six studies (1/4 physiotherapy-based approaches, 2/6 CBT, 1/2 ACT and 2/2 mindfulness-based interventions).

CONCLUSIONS

CBT and ACT-based biopsychosocial approaches were found effective in reducing pain and improving psychometric outcomes for CPP. Evaluation indicated PSE, and exposure/engagement in valued activity are important components of biopsychosocial management. Outcome heterogeneity needs to be addressed in future trials.

The Utility of CO2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery

This study aimed to examine the impact of fractional CO2 laser treatment of pelvic symptoms in women who have undergone perineal trauma from vaginal delivery. It was a retrospective, monocentric analysis that encompassed all women assessed for pelvic discomfort or signs of vulvovaginal atrophy following vaginal delivery between 2013 and 2018. The severity of symptoms was assessed using the Visual Analogue Scale (VAS). Twenty-seven patients met the inclusion criteria and were sorted into two groups: (1) women who had undergone episiotomies during labor (n = 11); and (2) women who had experienced spontaneous tears during vaginal delivery (n = 16). For women with episiotomies, each treatment and subsequent evaluation consistently showed a significant reduction in dyspareunia intensity. A similar positive trend was observed regarding pain at the introitus (7.5 vs. 6.5 after the first treatment, p = 0.03; 6.5 vs. 3 after the second treatment, p = 0.01; 3 vs. 1 after the third treatment, p = 0.01). Among women experiencing spontaneous perineal tears during delivery, there was a notable decrease in dyspareunia following all treatments (8 vs. 7 after the first treatment, p = 0.01; 8 vs. 4 after the second treatment, p = 0.02; 3 vs. 1 after the third treatment, p = 0.03). The impact of laser treatment did not exhibit significant differences between women who underwent episiotomies and those who experienced spontaneous perineal tears. In conclusion, fractional CO2 laser can be regarded as a non-pharmacological option for managing pelvic floor symptoms in women who encountered perineal trauma during delivery, independently from the nature, spontaneity, or iatrogenesis of the perineal laceration.