Abstract
BackgroundChronic pelvic pain (CPP) has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs) and practice nurses manage women with this problem. A clearer understanding of current management is necessary to develop appropriate strategies, in keeping with current health care policy, for the supported self-management of patients with long term conditions. The aim of this study was to explore GPs' and practice nurses' understanding and perspectives on the management of chronic pelvic pain.MethodsData were collected using semi-structured interviews with a purposive sample of 21 GPs and 20 practice nurses, in three primary care trusts in the North West of England. Data were analysed using the principles of Framework analysis.ResultsAnalysis suggests that women who present with CPP pose a challenge to GPs and practice nurses. CPP is not necessarily recognized as a diagnostic label and making the diagnosis was achieved only by exclusion. This contrasts with the relative acceptability of labels such as irritable bowel syndrome (IBS). GPs expressed elements of therapeutic nihilism about the condition. Despite practice nurses taking on increasing responsibilities for the management of patients with long term conditions, respondents did not feel that CPP was an area that they were comfortable in managing.ConclusionsThe study demonstrates an educational/training need for both GPs and practice nurses. GPs described a number of skills and clinical competencies which could be harnessed to develop a more targeted management strategy. There is potential to develop facilitated self- management for use in this patient group, given that this approach has been successful in patients with similar conditions such as IBS.
Highlights
Chronic pelvic pain (CPP) has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs) and practice nurses manage women with this problem
This study suggests that GPs and practice nurses are less comfortable making the diagnosis of chronic pelvic pain (CPP) than they would be with a more recognised, yet similar, condition such as irritable bowel syndrome (IBS)
Grace (2000) notes that reliance on the medical paradigm has promoted the “...failure to develop understandings of the ‘subjective’ aspects of pain, the tendency to reduce causal processes to ‘mechanisms’, and the tendency to consider the psychosocial as purely reactive to the biological...” (p. 525) [17]. This dichomtomising is well described by the respondents in this study and there was agreement amongst GPs and practice nurses that women who present with chronic pelvic pain can be a difficult patient group to manage
Summary
Chronic pelvic pain (CPP) has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs) and practice nurses manage women with this problem. Laparoscopy fails to identify underlying pathology in up to 35% (range 3-92%) of women [5] This means that many women do not receive a ‘medical explanation’ to account for their pain. Past research has tended to focus on differentiating ‘organic’ from ‘nonorganic’ pain using psychological characteristics (e.g. anxiety and depression) and this has led to the emergence of a negative psychological profile for women with CPP, despite a meta-analysis producing findings to the contrary [6]. This negative profile is more commonly associated with women for whom no underlying pathology can be found to account for the pain. They suffer the same stigmatizing characteristics ascribed to other chronic illnesses, such as chronic fatigue syndrome and fibromyalgia, which are difficult to diagnose and have similar uncertain illness trajectories [7,8]
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