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Pelvic Pain – all the fun stuff

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GLOBAL YEAR

This year’s theme focuses on increasing the awareness of clinicians, scientists, and the public of our growing pain knowledge and how it can benefit those living with pain.

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Many of us here at BiM went to the Festival de NOI a couple of weeks ago. It was fab. However, we know that most of you couldn’t make it and we thought we would briefly recap some of the talks so you can feel the passion for yourselves. Here is the first one…..

This morning in the practice where I work, I overheard a male patient telling one of the male physiotherapists about his problem: “I get pain… when I’m taking a leak… if I move him around too much… when I’m having sex, ya know, finishing up… all the fun stuff!”

This got me thinking… why is it that we are all too afraid to talk about penile, vaginal, and pelvic pain? Why do we avoid using anatomically correct terms (which, let’s face it, we all do) when talking about pain in the pelvic region? Why do so many health professionals feel uncomfortable listening to and dealing with patients with pelvic pain? Many patients aren’t even brave enough to discuss their pelvic pain with health professionals. But it is such a huge problem.

Primary care stats show pelvic pain prevalence is comparable to that of asthma and back pain[1]. In Australia alone, we spend over $6 BILLION on medical and surgical treatments for pelvic pain[2]! Endometriosis affects more people in the 15-49 age range than breast cancer, prostate cancer, diabetes (type I and II), and AIDS combined.[2] And that’s not including the other women and men with other types of pelvic pain. So, with such a high incidence and so much money put into pelvic pain, why do we not hear more about it? Everyone knows how horrible, disabling, and financially difficult back pain is; why do we not recognise that pelvic pain is just as much of a problem?

Dr Patricia Neumann tackled these very issues at the recent NOI 2012 Neurodynamics & the Neuromatrix Conference. She opened our eyes, albeit in a different way to the male streaker who graced the conference the following day, to what’s going on in the pelvic region.

One issue she explored was language. We are lacking international definitions of chronic pelvic pain/persistent pelvic pain. We can’t even decide whether we want to call interstitial cystitis just that, or painful bladder syndrome, or bladder pain syndrome. It doesn’t help that we have a social ‘shying’ away from talking about the pelvis; we have an international ‘thought virus’ that the pelvic region is too private to talk about. How many of us feel comfortable asking patients about urinating? Incontinence? Ejaculation? Masturbation? Sex? With knee pain, we ask functional questions about stair climbing, running, jumping, etc. With pelvic pain then, shouldn’t we be asking questions about the pelvic functions?

Trish highlighted the need for consistency between pelvic pain and other chronic pain conditions. We can approach pelvic pain patients with the same biopsychosocial model that we use with our other chronic pain patients. So many pelvic pain patients fear disability, infertility, and how their pelvic pain will affect their sexual repertoire. We need to be aware of the taboos, myths, and stigma of pelvic pain, and tackle our patients concerns, fears, and anxieties head on.

So what can we do as clinicians? GET RID OF THOSE THOUGHT VIRUSES. Overcome your own fear of talking about pelvic pain. Get comfortable with asking patients questions about their pelvic pain, and let them know they are not alone! Face pelvic pain with the same determination, patience, and understanding as you do with other chronic pain conditions.

Jane Bowering

Jane has an addiction to Vegemite, doesn’t eat cereal, and has recently finished her Honours in Physiotherapy degree. What is Jane doing at BiM? Jane is a part time research assistant doing lots of zapping with lasers as well as working part time as a physio in private practice.

Here is Jane talking more about her honours research project

References

[1] Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, & Kennedy SH (1999). Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. British journal of obstetrics and gynaecology, 106 (11), 1149-55 PMID: 10549959

[2] Pain Australia & Australian and New Zealand College of Anaesthetists 2011, The $6 Billion Woman and the $600 Million Girl, PDF .

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