Journal Puts Focus on Chronic Pelvic Pain
In its special report from the Association Française
d’Urologie (AFU) 2010 meeting, the French journal Progrès en Urologie published 46 articles in its November issue on
chronic pelvic and perineal pain. The AFU has made a commitment to improving
chronic pelvic pain management in urology and developing means of evaluating
professional practices. The authors of the article on optimizing urologic care
pointed to the need to develop professional guidelines and initial and
continued training for providers and to apply professional practice assessment
and accreditation in chronic pelvic pain care.
A survey of French urologists demonstrated the need. The
survey, answered by 352 urologist members of AFU, showed that chronic pelvic
and perineal pain does consume a small, although not insignificant, proportion
of their practices. More than half the urologists took care of 20 to 100 new
cases every year. But more than two-thirds of the urologists said their
knowledge was fair to insufficient. Three-quarters said they would like to get
another specialist’s opinion for more than a quarter of their pelvic and
perineal pain patients. More than half said that the organization of their
daily consult activity was inadequate to manage pelvic and perineal pain, and
most said additional specific training programs would be useful.
The AFU recognizes more than IC (termed “painful bladder
syndrome”) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) as
pelvic and perineal pain syndromes that urologists need to recognize and treat.
The organization also deems pudendal nerve entrapment syndrome, vulvar pain
syndrome (vulvodynia), epididymotesticular pain syndrome, and complex pelvic
pain syndrome to be conditions that should be included in urologists’ pelvic
and perineal pain knowledge and expertise. Based on a literature review, an
article proposes treatment algorithms for each of these conditions while
emphasizing that these are clinical aids and don’t constitute a comprehensive
approach to management.
Other articles recognize the contributions of endometriosis,
adhesions, irritable bowel syndrome, proctalgia fugax (severe rectal pain), and
musculoskeletal dysfunctions, such as levator ani syndrome, and posterior ramus
syndrome (a problem at a vertebral facet joint that can refer pain), to chronic
pelvic and perineal pain. Treatments from drugs to physical therapy and
neurologic approaches are discussed.
Likely because of work of French pudendal nerve entrapment
syndrome pioneer Professor Roger Robert, a number of articles focus on nerve
damage as a source of pelvic and perineal pain and give guidance on treatment.
Articles are included on nerve damage from surgery and how to manage it, how to
test for nerve problems, how to use nerve blocks (which are called an integral
part of pelvic and perineal pain management), and when pudendal nerve surgery
is appropriate (when all other treatments have failed) and the ways it is
Two articles emphasize the importance of understanding
anatomy (including neuroanatomy) well, doing thorough examinations, and taking
thorough patient histories so urologists can diagnose the sources of pain
correctly and decide on the best treatment approaches. Another article, on the
doctor-patient relationship, emphasizes that doctors should believe the
patient, avoid making the patient feel responsible for failure, avoid overestimating
the secondary benefits, avoid making the patient passive and dependent, learn
to reinterpret the patient's symptoms, ask “how” the pain persists rather than
“why,” clearly define the patient’s needs, and adapt management to realistic
and accessible goals. Because pain is an emotional experience, the type of
relationship the doctor has with the patient determines the quality of management,
said the authors.
You can read summaries for professionals of each article in
the issue at this web page http://www.sciencedirect.com/science/journal/11667087.
Click on “show preview” and scroll down for the English-language summary.
Posted November 23, 2010