SUPPORTIVE CARE |
||||||
Encouraging open communication and |
||||||
offering emotional support are vital . It is |
||||||
useful to normalise with patients that symptoms |
||||||
are expected to flare from time to time . |
||||||
PHYSICAL THERAPY |
||||||
Pelvic floor physical therapy is a key component |
||||||
of treatment and involves pain neuroscience education to understand the condition , physical myofascial release performed with an appropriately skilled physiotherapist and guided self-release for maintenance following initiation of a treatment program . 9 , 23-26 |
Levator ani |
Figure 1 . Approach to palpating obturator internus and levator ani . |
Figure 2 . Approach to palpating obturator internus ( patient abducting thigh against resistance ). |
|||
It is important to note there is no standardised |
||||||
, evidence-based approach at this time , so the patient ’ s response to treat- |
PHARMACOTHERAPY While medications , including neuromod- |
those who are not responsive to physiotherapy requires further study
29 , 30
.
|
The authors acknowledge the contribution of
Dr Cecilia Ng ( PhD ) for the illustrations used .
|
|||
ment should be the arbiter of continuation of a treatment program , especially given the time and cost implications . |
ulators and muscle relaxants , may be trialled , there is a lack of well-controlled trials to define the specific manage- |
GP role
Patients tend to be more satisfied with
|
References on request from kate . kelso @ adg . com . au |
|||
|
Self-treatment , supported by online resources , is an option for those who are unable to attend therapy immediately ( see online resources ).
PSYCHOTHERAPY Psychological strategies , including CBT ,
27 , 28 may be of benefit for pain management . This may be delivered by a psychologist or evidence-based online psychological
|
ment outcomes associated with these . 22 Cautious intermittent use of medications such as benzodiazepines is recommended given the risks of tolerance and dependence associated with these drugs .
Botulinum toxin ( botox ) injections to the pelvic floor muscles may be considered ; however , physiotherapy should be first-line therapy as quality placebo-controlled studies of botox
|
their care when they believe that healthcare professionals accept they are experiencing pain , acknowledge the impact on their life and address their needs in an
31 , 32 empathetic way .
GPs are well positioned to play a crucial role in providing such care while encouraging patient engagement and facilitating interdisciplinary care with other professionals with an interest in
|
Online resources
• Psychological tools for pain management : mindspot . org . au / assessment
• Pelvic pain resources : bit . ly / 49UoBgP bit . ly / 3y2JicQ
|
|||
treatment tools ( see online resources ). |
are lacking . The exact role for botox in |
pelvic pain . |