Pelvic pain scale: a systematic approach to chronic pelvic pain patients

Abstract

A pain score is being used to monitor women with a history of chronic pelvic pain. The total score for each day of the month is plotted into a graph and is later correlated to patient's daily activities in order to help with the diagnosis of baseline gynecological conditions.

Introduction

Chronic pelvic pain (CPP) is a common gynecological problem. It is estimated that it affects 1 in 7 women in the US between 18-50 years of age. 1 There is no community based study of the prevalence of CPP in the UK, but the prevalence rate for CPP in a single study of women undergoing laparoscopy for sterilization or investigation of infertility was 37%. 2 There is no data in Brazil of the prevalence of CPP. According to the Minister of Health in 1997 there were over 1.8 million gynecological consultations requiring special diagnostic procedures and 292,450 hospital admissions for gynecological problems in women aged 15 to 69 years. An unknown proportion of these procedures were related to CPP.

Several studies have shown that CPP can reduce the quality of life and general well-being of women. It has been related to psychosocial problems as well as to the presence of many organic disorders. 1,2 However, complaint is highly influenced by woman's recall and perception of pain and discomfort. This delays correct diagnose and treatment and may lead to unnecessary diagnostic procedures such as laparoscopy.

A new approach to CPP in outpatient clinics is being used to monitor on a daily basis information on sexual life and other potentially important factors and the occurrence of pain measured with a score composed of 4 items: intensity, duration, medication use and constraints to life routine. Patients are required to take home two tables and a graph and fill them daily for at least one month (Figure 1). Every morning they respond about the day before and indicate the presence of any of the nine factors listed: sexual life on previous day (sexual arouse, intercourse, orgasm), menstrual cycle, emotional changes, physical exercises, intestinal functioning, vaginal discharge and temperature. In a second table, the four-level score is given to classify and describe any pelvic pain in the previous day. Absence of pain counts zero and severe pain counts 3 points to the final score. Duration of pain, use of analgesic drugs and degree of constraint imposed by the pain to daily activities are all measured in the same way. Finally, these scores are added up and the total for each day is transferred into a graph so that at the end of a month we can have the pain cycle.

Comments

The pelvic pain scale allows the doctor to examine pain oscillation in relation to basic and personal factors that might shed light into the underlying cause of the pain, give clue to possible etiologic factors and reduce diagnostic costs. The pelvic pain scale can also help during treatment monitoring the effect of medical procedures on pain score and comparing them in a time series for the same patient. Another advantage of the pelvic pain scale is to increase woman's self awareness of possible psychological problems that might interfere with symptoms and response to treatment. Willingness to cooperate is itself an indicator of patient's real interest to cooperate during treatment.

Figure 1 Pelvic Pain Scale

References:

References

1. Mathias SD, Kupperman M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol, 1987:3,321-7.

2. Zondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review. Br J Obstet Gynaecol: 1998: 105(1), 93-9.

Belo Horizonte, Minas Gerais, Brazil

Division of Obstetrics and Gynecology,

Clinical Hospital,

Federal University of Minas Gerais and Research Center René Rachou ,

Oswaldo Cruz Foundation, Ministry of Health.

Reprint requests:

Alexandre Ravski, MD, Divisão de toco-ginecologia, Setor de Reprodução

Humana, Hospital das Clínicas da UFMG, Av. Alfredo Balena 110, 9º andar. Belo Horizonte,

MG, Brazil. CEP 30.130.100.

e-mail: ravski@task.com.br

Business fax/phone: 55-31-241.3788

Corresponding author:

Sandhi Barreto, Ph.D., Associate Researcher, Laboratório de Epidemiologia e AntropologiaMédica, Centro de Pesquisa René Rachou, FIOCRUZ, Ministério da Saúde,

Av. Augusto de Lima 1715, Belo Horizonte, MG, Brazil, CEP 30.130.002.

e-mail: sbarreto@netra.cpqrr.fiocruz.br

Business fax: 55-31-2953115 / phone: 55-31-295.3566