Multi-Disciplinary Pelvic Pain Program—
Although chronic pelvic pain is one of the most common conditions affecting women it is often incompletely evaluated and can be mis-treated. This is the reason we developed our Multi-Disciplinary Pelvic Pain Program at Desert Women's Care. Our physicians are experts in their fields and collaborate to provide the highest quality and most personalized care for women suffering from pelvic pain. Together we will determine the underlying causes and triggers for your pain and formulate a unified plan to treat all components of your pain and associated conditions. Examples of common causes of female pelvic pain include the following:
–undiagnosed pain –urethral syndrome
–pain unresponsive to current therapy –trigonitis
–endometriosis –nephrolithiasis
–interstitial cystitis –hernias
–pelvic adhesions –myofascial dysfunction
–pelvic relaxation & uterine retroversion –degenerative disk disease
–irritable bowel syndrome –scoliosis
–Inflammatory bowel disease --nerve entrapment
–diverticular disease –arthritis
–depression –auto-immune disorders
We offer a multi-specialty, collaborative diagnostic evaluation of female pelvic pain in our state-of-the-art facilities. Providing individualized treatment plans and meticulous follow-up for superior results. Relief of pain and patient satisfaction are our highest goals. Don’t suffer any longer, allow our physicians to bring their extensive experience to bear on your situation today.
Our program involves numerous specialists working together in a unified manner to expeditiously diagnose and treat your condition. Physicians in the following specialties are involved:
Gynecology
Pain Management
Gastroenterology
Neurology
Psychology / Psychiatry
Physical Medicine and Rehabilitation
Doctor of Pharmacy
Urology
Addiction Medicine
Our Multi-Disciplinary Pelvic Pain Program is unique in this area. Typically found in some regional teaching centers, our program brings together physicians from various specialties to collaborate in the diagnosis and treatment of pelvic pain in a state-of-the-art facility.
BENEFITS TO MULTI-DISCIPLINARY APPROACH
1. Substantially decreases liklehood patient will be transferred to care of other specialists only after all therapeutic alternatives have been exhausted without improvement in pain level
2. Decreases habituation to narcotic analgesics: The emphasis shifts from palliating pain to discovering its route cause(s) and treating it; this shift in paradigm lessens physicians’ reliance on narcotic analgesics.
3. More expeditious: quicker time from entry to relief. Seeing all specialists from the beginning often decreases the length of time a patient suffers with pain and lessens the chance she will become habituated to pain killers and have unnecessary procedures.
4. Immediate recognition of psychiatric implications: In the vast majority of cases depression is a contributing etiology for a patient’s pelvic pain. Further, long standing pain can lead to depression even in patients not initially affected. It is essential to recognize and treat this important contributing factor.
Streamlining the process and bringing all the relevant medical professionals together from the outset enhances patient care. Oppositely, the way most patients are cared for outside of this type of program is disjoint and haphazard. A patient presenting to a Gynecologist will most often have all Gynecological therapies exhausted before a referral to other specialists is even considered. Similarly, a patient presenting to a Gastroenterologist will have all GI therapies exhausted before referral to other physicians.
All too often exhausting care within a single specialty before referring the patient to a colleague in another field means numerous unnecessary interventions of increasing invasiveness, complexity, cost and associated consequences may be tried pursuing a fix that is never achieved. Horror stories such as the woman failing to respond to laparoscopy, followed by birth control pills, followed by another laparoscopy, followed by Lupron, followed by hysterectomy and ultimately, in a last ditch effort to control pain, followed by bilateral removal of ovaries (oophorectomy or castration) who becomes addicted to narcotic pain killers in the process are all too common. Because a simple diagnosis from another specialty may not be clear to a single treating physician, a multi-disciplinary approach assures multiple eyes with different backgrounds and perspectives have a chance to evaluate a patient’s complaints and presentation before any significant decisions are made and any treatments are carried out.
A variety of studies have demonstrated the value of a Multi-Disciplinary Approach to female pelvic pain:
The key study in this regard was conducted by Peters and his colleagues and published in 1991. A total of 106 participants were randomized to “Traditional” management (49 patients) and “Multi-Disciplinary” management (57 patients). The “Traditional” group saw a Gynecologist and proceeded through examination and laparoscopy. The “Multi-Disciplinary” group saw various specialists with care paid to psychological, dietary, and non-gynecological etiologies of pelvic pain. Significantly more improvement was noted in the “Multi-Disciplinary” group when compared with the “Traditional” group. This was the first large study that demonstrated the value in Multi-Disciplinary care for women suffering from pelvic pain.
The female pelvis contains numerous organ systems cared for by different specialties in medicine.
KEY ETIOLOGIC ELEMENTS:
1. Gynecologic Disorders: Dysmenorrhea, infection, cysts,
myomas, prior surgeries, endometriosis, endosalpingiosis,
adenomyosis, pelvic congestion syndrome, gynecologic
malignancies, pelvic relaxation, ovarian retention syndrome,
tuberculosis salpingitis, adhesions or ovarian cysts.
2. Urologic Disorders: Urethral syndrome, trigonitis,
interstitial cystitis, peritoneal endometriosis overlying
the urinary tract, bladder endometriosis, chronic cystitis,
bladder carcinoma, radiation cystitis, urethral diverticulum,
or calculi.
3. Gastrointestinal Disorders: Irritable bowel disorder,
inflammatory bowel disease, diverticular disease, chronic
appendicitis, adhesions, bowel endometriosis, celiac disease, colon
carcinoma, or colitis.
4. Myofascial Disorders: Hernias (incisional, inguinal,
femoral, and ventral), fasciitis, scar formation, fascial
tears, myofascial dysfunction, fibromyalgia, pelvic or floor
myalgia.
5. Skeletal/Neurologic Disorders: Scoliosis, degenerative
disc disease, pelvic trauma, nerve entrapment, chronic
coccygeal or back pain, neoplasia of spinal cord or sacral
nerve compression or spondylosis.
6. Rheumatologic Disorders: Arthritides and autoimmune
disorders.
7. Psychological Causes: Depression
8. Other Causes: Undiagnosed pain or somatization disorder
In a study of women with pelvic pain of a single cause, the following distribution was found:
Gynecologic Conditions- 68% of cases
Gastroenterologic Conditions- 9% of cases
Urologic Conditions- 5% of cases
Neurologic Conditions- 15% of cases
Other conditions- 3% of cases
Within this study population when Psychiatric Conditions were added, 80% of patients with somatic conditions had a Psychiatric component.
Because of the extensive differential diagnoses for pelvic
pain, it is important to implement a multidisciplinary
approach to this symptom complex to assure that patients
have the most complete evaluation available. It is also
important to coordinate and administer the widest range of
therapies possible for reduction or alleviation of pain.
The goal is to assure simultaneous evaluation of the various
organ systems by our contributing specialists to minimize
the length of time from initial presentation to diagnosis
and institution of a treatment plan, and in so doing, to
minimize the potential for habituation to narcotic
analgesics. With the simultaneous evaluation of the various
organ systems, we assure that no stone is left unturned and
all potential etiologies for pain are explored early on in a
patient’s evaluation. In other words, just because the
patient presented initially to a gynecologist for evaluation
does not mean that possible gastrointestinal or
musculoskeletal complaints would be overlooked at the outset
of the evaluation.
It is also clear that because of the problematic nature of
the chronic pain, at least 70% to 80% of chronic pain
sufferers have some psychologic component related to their
suffering. It is also possible that patients with depression
somatasize their depression manifesting in various
complaints related to pelvic pain. Hence, it is important to
involve a psychologist at the initial evaluation and involve
the psychologist throughout the patient’s progress through
the treatment process. Despite the cost of involving
multiple specialists initially in a patient’s evaluation, an
integrated approach to pelvic pain often saves money by more
expeditiously isolating all of the etiologic factors
responsible for the patient’s pelvic pain, and treating all
those factors immediately, and eliminating costly treatments
or unnecessary surgeries which may not improve the patient’s
outcome and by foreshortening the entire process. Our pain
program is guided by advice of normative bodies including
American College of Obstetricians & Gynecologists (Practice
Bulletin 51), International Pelvic Pain Society and others.
Our intention is not to continue
casual use of narcotic analgesics which can often lead to
patient habituation and dependence. Narcotics will be
continued during the initial evaluation process but the goal
is to make the diagnoses and effect treatment rather that to
mask pain with long-term use of narcotics. The more narcotics the
patient is exposed to, the lower the patient’s threshold for
pain and more narcotics are required to assist the patient
in achieving relief subsequently. The physiologic
implications of addiction are addressed in our program and the negative
aspects of long-term narcotic use are stressed. Our program is unique in that we work closely with an addiction medicine specialist from the outset to assure our patients both get relief from their symptoms and limit dependence on narcotic analgesics to contribute to overall health and quality of life.
Entering Our Multi-Disciplinary Pelvic Pain Program—
Entering our Multi-Disciplinary Pelvic Pain Program means your entire pelvis with all of its component parts will be evaluated for causes of your pain simultaneously. Often, particularly in the most complicated cases, multiple factors cause pain. These different factors can be from different organ systems. Only by providing a Multi-Disciplinary approach can we assure all potential causes for a patient's pain get immediate consideration. Because all of our specialists collaborate we are able to offer a standardized patient intake and work up that will be used by each physician. The intake history and physical along with the unified laboratory and imaging work-up constitute the basis of a patient's evaluation.
Once a patient registers she is scheduled for an initial consultative visit. A comprehensive History & Physical examination and pelvic ultrasound are conducted. Patients are asked to fill out the Pelvic Pain Questionnaire, PUF Questionnaire and IBS Questionnaire.
Laboratory evaluation includes CBC with differential, CRP, ESR, Urinalysis and Urine C&S. Pelvic Initial imaging studies include MRI of the lumbo / spine, MRI Pelvis with attention to uterus & pelvic nerve plexus with Gadalinium infusion, CT Urogram. Lower GI and CT with Infusion of the abdomen may be ordered depending on the results of the GI Consultation. After a patient completes the unified evaluation she consults with the remaining team members and any additional studies are scheduled at this point.
Our physicians are committed to the most innovative diagnosis and treatment for women suffering from pelvic pain. We look forward to the chance to treat patients with the most complicated and long standing cases of pelvic pain because we feel we can make a positive difference in those patients' lives. We also welcome the opportunity to treat cases of pelvic pain soon after onset before sequellae of chronicity complicate the picture.
In summary, our work-up involves the following:
Unified laboratory and imaging evaluation available to each team member
Patient seen by each specialist with specific additional work-up as deemed necessary
Regular meetings of team to discuss cases and develop integrated treatment plans
We offer treatments for all etiologies of a patient's pain simultaneously with the goal of treating the root cause(s) and not masking pain with narcotics. Because Pain Management physicians are part of the group we offer immediate solutions for pain to augment treatments directed at the cause(s) of the pain itself. Although narcotics may be continued during the initial evaluation process but the goal is to make the diagnoses and effect treatment rather that to mask pain with long-term use of narcotics. The cyclic nature of habituation is key. The more narcotics the patient is exposed to, the lower the patient's threshold for pain and more narcotics are required to assist the patient in achieving relief subsequently. The physiologic implications of addiction are stressed with every patient. The goal is to relieve pain, not to mask pain with narcotic analgesics.
FINANCIAL DISCLOSURE It is stressed that a multi-disciplinary approach to pelvic pain may not be approved by all insurance carriers, often seeking to cut corners to save on cost. DWC or its associated physicians make no representation that all insurance carriers will cover all aspects of this evaluation and therapy. It is expressly the patient's duty to ascertain what coverage she may have and determine whether she will seek care in this program. In all cases the patient is responsible for all costs of participation in our Multi-Disciplinary Pelvic Pain Program. Although DWC will be glad to assist patient's in appealing coverage decisions to their insurance carrier's by providing medical literature substantiating the value of the Multi-Disciplinary approach, conducting any appeal remain's the patient's sole responsibility.
Desert Women's Care
9377 East Bell Road, Suite 131, Scottsdale, Arizona 85260
80 North McClintock Drive, Suite 104, Chandler, Arizona 85226
Copyright 2015 - Desert Women's Care - All Rights Reserved
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