A review of physiotherapy pain management strategies in the management of patients with chronic pelvic pain

Author(s): K. Petersen - Pages: 15–22

Abstract

This article describes physiotherapy approaches to the management of patients with chronic pelvic pain (CPP) as a part of the multidisciplinary team. Once treatable medical causes have been excluded, the focus is on utilizing the evidence base for chronic pain, and using the biopsychosocial framework to establish the individual needs of the patient, including support from the pain management team to address medical needs, medication issues and psychological impact. Specific musculoskeletal diagnosis and treatments have been extensively explored in the literature, but physiotherapy treatments of the sensitized nervous system in CPP have been less well documented. There is a recognized need for clinicians managing patients with this diagnosis to be skilled and knowledgeable about the principles of pain management, and the author has drawn on experience, expert opinion and the limited literature available. Explanations about pain mechanisms may be more challenging because these include visceral pain, inflammatory conditions and functional issues unique to the pelvic area. Descriptions of physiotherapy pain management techniques such as desensitization, stretches and exercises focus on commonly observed problems for people with CPP, including poor sitting tolerance, bladder issues and allodynia. The emphasis of the paper is on supporting the patient to develop self-management techniques, and it includes a brief overview of the data collected from Link, the first pelvic pain management programme developed in the UK.

Keywords: chronic pain, chronic pelvic pain, pain management, physiotherapy.