The role of the multi-disciplinary team and multi-disciplinary therapeutic protocol in the management of the chronic pelvic pain: There is strenght in numbers!

The aim of the study is to evaluate the effectiveness of a Multi-disciplinary team (MDT) and multi-disciplinary approach in the treatment of Chronic Pelvic Pain (CPP).

The data of all consecutive patients referred for a CPP from 11/2016 to 2/2019 has been prospectively collected. The sample was divided in two groups: Group A, made by patients managed after the institution of our MDT, and Group B, made of patients managed before this date. The MDT is composed by three urogynecologists, a psychologist and a physiotherapist. All Group A patients underwent a weekly bladder instillation with dimethyl sulfoxide (DMSO), kinesiotherapy for trigger points and Percutaneous Tibial Nerve Stimulation for 10 consecutive weeks. Patients were asked to perform a self-treatment following the Stanford Protocol and to adhere to a specific diet. All Group B patients were managed only with DMSO instillations and a strict diet.

The Group A was made of 41 females and 6 males while the Group B was made of 38 females and 5 males. The Group A patients showed a statistically significant improvement in the Pelvic Pain Urgency Frequency, in the frequency times reported at the 6 months voiding diary, and a better Patient Global Impression of Improvement.

Our data support the efficacy of the MDT in the management of CPP. The multimodal approach might represent an effective and reproducible non-invasive option to manage successfully CPP. Downloads Wozniak S. Chronic pelvic pain. Ann Agric Environ Med. 2016;23:223-6. DOI: https://doi.org/10.5604/12321966.1203880 Gambadauro P, Carli V, Hadlaczky G. Depressive symptoms among women with endometriosis: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019; 220:230-241. DOI: https://doi.org/10.1016/j.ajog.2018.11.123 Polackwich AS, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis. 2016; 19:132-8. DOI: https://doi.org/10.1038/pcan.2016.8 Stamatiou K, Magri V, Perletti G, et al. How urologists deal with chronic prostatitis? The preliminary results of a Mediterranean survey. Arch Ital Urol Androl. 2020; 92:353-356 DOI: https://doi.org/10.4081/aiua.2020.4.353 Mahran A, Baaklini G, Hassani D, et al. Sacral neuromodulation treating chronic pelvic pain: a meta-analysis and systematic review of the literature. Int Urogynecol J. 2019; 30:1023-1035. DOI: https://doi.org/10.1007/s00192-019-03898-w Possover M, Andersson KE, Forman A. Neuropelveology: An emerging discipline for the management of chronic pelvic pain. Int Neurourol J. 2017; 21:243-246. DOI: https://doi.org/10.5213/inj.1735036.518 Nikkola J, Holm A, Seppänen M, et al. Repetitive transcranial magnetic stimulation for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A prospective pilot study. Int Neurourol J. 2020; 24:144-149. DOI: https://doi.org/10.5213/inj.1938258.129 Lin CC, Huang YC, Lee WC, Chuang YC. New frontiers or the treatment of interstitial cystitis/bladder pain syndrome - focused on stem cells, platelet-rich plasma, and low-energy shock wave. Int Neurourol J. 2020; 24:211-221. DOI: https://doi.org/10.5213/inj.2040104.052 Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018; 29:631-638. Clemens JQ, Mullins C, Ackerman AL, et al. MAPP Research Network Study Group. Urologic chronic pelvic pain syndrome: insights from the MAPP Research Network. Nat Rev Urol. 2019; 16:187-200. DOI: https://doi.org/10.1038/s41585-018-0135-5 Engeler D, Baranowski AP, Berghmans B, et al. EAU 2020 Guidelines on Chronic Pelvic Pain. European Association of Urology, 2020 – www.uroweb.org Magri V, Boltri M, Cai T, et al. Multidiscplinary approach to prostatitis.Arch Ital Urol Androl. 2019; 90:227-248 DOI: https://doi.org/10.4081/aiua.2018.4.227 Anderson RU, Wise D, Sawyer T, et al. Equal improvement in men and women in the treatment of urologic chronic pelvic pain syndrome using a multi-modal protocol with an internal myofascial trigger point wand. Appl Psychophysiol Biofeedback. 2016; 41:215-24. DOI: https://doi.org/10.1007/s10484-015-9325-6 Sammarco AG, Kobernik EK, Haefner HK, et al. Lower urinary tract symptoms in a chronic pelvic pain population. Female Pelvic Med Reconstr Surg. 2019 Jan 8. DOI: https://doi.org/10.1097/SPV.0000000000000689 Guan Y, Yu G, Wang G, Bai Z. The negative effect of urologic chronic pelvic pain syndrome on female sexual function: a systematic review and meta-analysis. Int Urogynecol J. 2019; 30:1807-1816. DOI: https://doi.org/10.1007/s00192-019-03984-z Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018; 29:631-638. DOI: https://doi.org/10.1007/s00192-017-3536-8 Ambrosini F, Di Stasio A, Mantica G, et al. COVID-19 pandemic and uro-oncology follow-up: A "virtual" multidisciplinary team strategy and patients' satisfaction assessment. Arch Ital Urol Androl. 2020; 92:78-79 DOI: https://doi.org/10.4081/aiua.2020.2.78 Pillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev. 2016;42:56-72. DOI: https://doi.org/10.1016/j.ctrv.2015.11.007 Brendbekken R, Harris A, Ursin H, et al. Multidisciplinary Intervention in Patients with Musculoskeletal Pain: a Randomized Clinical Trial. Int J Behav Med. 2016; 23:1-11. DOI: https://doi.org/10.1007/s12529-015-9486-y Coppack RJ, Bilzon JL, Wills AK, et al. A comparison of multidisciplinary team residential rehabilitation with conventional outpatient care for the treatment of non-arthritic intra-articular hip pain in UK Military personnel - a protocol for a randomised controlled trial. BMC Musculoskelet Disord. 2016; 17:459. DOI: https://doi.org/10.1186/s12891-016-1309-z Sahai-Srivastava S, Sigman E, Uyeshiro Simon A, et al. Multidisciplinary Team Treatment Approaches to Chronic Daily Headaches. Headache. 2017; 57:1482-1491. DOI: https://doi.org/10.1111/head.13118 Gupta P, Gaines N, Sirls LT, Peters KM. A multidisciplinary approach to the evaluation and management of interstitial cystitis/bladder pain syndrome: an ideal model of care. Transl Androl Urol. 2015; 4:611-9. Baranowski AP, Mandeville AL, Edwards S, et al. Male chronic pelvic pain syndrome and the role of interdisciplinary pain management. World J Urol. 2013; 31:779-84. DOI: https://doi.org/10.1007/s00345-013-1083-6 Allaire C, Williams C, Bodmer-Roy S, et al. Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort. Am J Obstet Gynecol. 2018; 218:114.e1-114.e12. DOI: https://doi.org/10.1016/j.ajog.2017.10.002 Twiddy H, Lane N, Chawla R, et al. The development and delivery of a female chronic pelvic pain management programme: a specialised interdisciplinary approach. Br J Pain. 2015; 9:233-40. DOI: https://doi.org/10.1177/2049463715584408 Lillemon JN, Nardos R, Kaul MP, et al. Complex female pelvic pain: a case series from a multidisciplinary clinic in urogynecology and physiatry. Female Pelvic Med Reconstr Surg. 2019; 25:e34-e39. DOI: https://doi.org/10.1097/SPV.0000000000000662 How to Cite PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.