Building a framework for a multidisciplinary approach to chronic pelvic pain therapy

“If you want to provide comprehensive care, it is truly impossible as 1 person,” began Jean Uy-Kroh, MD, FACOG, director, Chronic Pelvic Pain Program at the Cleveland Clinic in Cleveland, Ohio, at AAGL’s 50th Global Congress on MIGS in Austin, Texas.

Chronic pelvic pain affects nearly 26% of the world’s female population. Although its origin is not gynecologic in 80% of patients, it accounts for 40% of laparoscopies and 12% of hysterectomies in the United States each year.1 The complex diagnosis of chronic pelvic pain involves multiple conditions and organ systems, making treatment a challenge for the clinician and frustrating for the patient.

To better care for patients, Uy-Kroh started the Chronic Pelvic Pain Program at the Cleveland Clinic almost 10 years ago.

In her session, “An Island of One: Providing Comprehensive Chronic Pelvic Pain Therapy,” Uy-Kroh emphasized the importance of a multidisciplinary approach to chronic pelvic pain therapy, and shared strategies for clinicians to identify assets and barriers to program building, map out a strategic framework, and construct a continuous self-learning program. She also highlighted the struggles she endured in the beginning and offered solutions to common pitfalls.2

The 2 main ingredients for a successful program are knowledgeable colleagues and local and national resources. To begin creating a robust, strategic plan, Uy-Kroh said, it’s imperative to know what drives your clinical landscape, and what drives you personally. “Even though we had a lot of resources around us, they weren’t necessarily ready to engage us and us them once we saw a difference in styles,” she said.

Being honest about your goals when starting a program like this, Uy-Kroh said, is critical because there are important questions you must answer, like,“What percentage of your patients will be restricted to ob/gyn? Will you see patients with neurologic issues and GI dysfunction? What resources will your patients need that your office or hospital system can’t readily provide?Not having the resources to expand and grow was one of the biggest frustrations she and other clinicians faced once they began seeing patients, she said.

Once she started her program, Uy-Kroh learned which resources were available to her and managed to get a part-time nurse practitioner that was able to spend 25% of her time on pelvic pain. She then added colleagues with expertise in pain psychology, pain management, interventional radiology, urology GI, and functional medicine.

“You must also be realistic,” Uy-Kroh said. Consider who your downstream referrals are to, and, if they are ready to accept them. “We had several very interested colleagues. When we actually started seeing patients, we inundated and flooded them, and they couldn’t handle the [number] of referrals we had.”

Resetting how you think about pain is, according to Uy-Kroh, the most impactful thing she can recommend. “That changed everything for me,” she said. “Pain is a complaint, whereas pain perception is a result of an intricate processing system,” she emphasized.

“How many of you recall formal training on pain care in relation to the surgeries you perform? And the diseases you treat?” In short, recalibrating the way you think about pain will give you a different context, and change how and when you offer surgical interventions,” she said.

Pain pathways are very complex, making chronic pelvic pain a difficult diagnosis and treatment process. How can you fix it? Uy-Kroh outlined the framework in 5 steps:

  • Identify patients’ needs
  • Be honest with colleagues and your administration about what you’re trying to achieve
  • Get the resources you need to be successful
  • Determine how your program will be set up
  • Consider: Is it going to be formal or informal? Will it be self-directed, where you are making personal calls in between patients?
  • Build your network of colleagues and don’t be afraid to ask for help

Uy-Kroh left the audience with a metaphor illustrating a multidisciplinary approach to care. “If all you have is a hammer, expand your toolbelt.”

References

  1. Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic Pelvic Pain in Women. JAMA. 2021;325(23):2381. doi:10.1001/jama.2021.2631
  2. Uy-Kroh, J. An Island of One: Providing Comprehensive Chronic Pelvic Pain Therapy. Presented at: AAGL’s 50th Global Congress on MIGS; November 14, 2021, Austin, Texas.