An INTERDISCIPLINARY approach to chronic pelvic pain management IS BETTER.
What is interdisciplinary?
By: Jorge F. Carrillo MD, FACOG, IPPS Board Member
Chronic pelvic pain is usually a multifactorial problem that can be caused by the complex interaction of gynecological, gastrointestinal, urological, musculoskeletal, neurological and psychosocial conditions among others.1,2 Furthermore, pain in general has been described as a biopsychosocial phenomenon in which an interaction occurs between biological factors (such as physiological or anatomical alterations), psychological factors (such as beliefs, attitudes, affectivity and illness behavior) and social factors (such as culture, social interactions or work for example).3
With this model in mind the US Department of Health and Human Services (DHHS) released in 2019 a document titled “Pain management best practices inter-agency task force report. Updates, gaps, inconsistencies, and recommendations.”4 This document was released to guide federal agencies, private stakeholders, and the public at large through common gaps identified in the treatment of pain patients. The recommendations encourage providers, policymakers, legislators, regulators, and patients to adopt a biopsychosocial approach to pain management. A very important point brought up in this document was that using a multidisciplinary management approach, in a coordinated and integrated fashion, has been documented to reduce pain severity, improve mood and overall quality of life, and increase function. 4
As part of identifying treatment approaches, it is important to discuss basic concepts and definitions. Per the International Association for the Study of Pain (IASP):
1. A
multimodal treatment generally refers to multiple therapies combined, these not necessarily offered by different healthcare professionals.
2. A
multidisciplinary approach refers to the addition of the competencies of multiple professionals who stay within the boundaries of their fields, without necessarily communicating amongst them, and
3. An
interdisciplinary treatment denotes that various disciplines are coordinated toward a common and coherent approach.5
The benefits of using a multidisciplinary approach with a shared decision-making model have been studied in patients with conditions such as chronic low back pain, TMJ, fibromyalgia, chronic headache, neck pain in the USA and other countries (England, Denmark, Canada).6–9 Furthermore, there is research suggesting that an interdisciplinary approach is clinically superior and more cost-effective than a multidisciplinary alone.10 This could be due to lack of integration of the services involved with limited communication among providers found in a multidisciplinary approach. However, is clear that for chronic pain patients a multidisciplinary approach is better than unimodal and multimodal approaches alone, so it should be encouraged. There are few studies investigating the effect of interdisciplinary and multidisciplinary approaches to chronic pelvic pain conditions, the results are promising, but we still need more research to make conclusive statements.2,11
For chronic pelvic pain patients, a comprehensive team should potentially include some or ideally all of the following healthcare providers: gynecologist, urologist, GI/colorectal specialist, physical therapist, behavioral therapist, physical medicine and rehab specialist, pharmacist, social worker, pain medicine/anesthesiologist, sex therapist, integrative medicine specialist and/or a dietician. If you are interested in expanding your network of chronic pelvic pain providers and potentially build a multidisciplinary or interdisciplinary team, a list of pelvic pain specialists members of IPPS, organized by region, can be found at our website.12 This is a free resource for both IPPS members/non-members, and healthcare providers/patients.
References
1. Steege JF, Siedhoff MT. Clinical Expert Series Chronic Pelvic Pain. Obs Gynecol. 2014;124(3):616-629. doi:10.1097/AOG.0000000000000417
2. Allaire C, Williams C, Bodmer-Roy S, et al. Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort. Am J Obstet Gynecol. 2018. doi:10.1016/j.ajog.2017.10.002
3. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions. Psychol Bull. 2007;133(4):581-624. doi:10.1037/0033-2909.133.4.581
4. U.S. Department of Health and Human Services ITF. Executive Summary Pain Management Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations.; 2019. https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html.
5. IASP. Task Force on Multimodal Pain Treatment Defines Terms for Chronic Pain Care. https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=6981. Published 2017. Accessed April 5, 2020.
6. Choi, B, Pak A. Multidisciplinarity, inter-disciplinarity and trans-disciplinarity in health research. Clin Investig Med. 2006. doi:10.1002/eji.201090065
7. Gatchel RJ, Okifuji A. Evidence-Based Scientific Data Documenting the Treatment and Cost-Effectiveness of Comprehensive Pain Programs for Chronic Nonmalignant Pain. J Pain. 2006. doi:10.1016/j.jpain.2006.08.005
8. Giusti EM, Castelnuovo G, Molinari E. Differences in Multidisciplinary and Interdisciplinary Treatment Programs for Fibromyalgia: A Mapping Review. Pain Res Manag. 2017. doi:10.1155/2017/7261468
9. Simmons JW, Avant WS, Demski J, Parisher D. Determining successful pain clinic treatment through validation of cost effectiveness. Spine (Phila Pa 1976). 1988. doi:10.1097/00007632-198803000-00020
10. Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management. Am Psychol. 2014;69(2):119-130. doi:10.1037/a0035514
11. Brotto LA, Yong P, Smith KB, Sadownik LA. Impact of a Multidisciplinary Vulvodynia Program on Sexual Functioning and Dyspareunia. J Sex Med. 2015. doi:10.1111/jsm.12718
12. IPPS. Find the provider. https://www.pelvicpain.org/IPPS/Professional/Find_A_Provider/IPPS/Content/Professional/Find_A_Provider.aspx?hkey=d783de9c-cc3a-4655-95c6-fd9da7a3fdf8. Accessed May 8, 2020.