Case study: Sarah's journey with endometriosis

Endometriosis affects approximately 1 in 9 Australian women, with over 830,000 individuals diagnosed nationwide. This complex condition not only causes debilitating pain but also costs the Australian economy an estimated $9.7 billion annually through healthcare costs and lost productivity.

At biio, we recognise the urgent need for effective management strategies, and we've found that interdisciplinary care can provide significant benefits for patients struggling with endometriosis. Today, we'd like to share a case study that illustrates the power of this approach.

Case Presentation

Sarah, a 32-year-old woman, had been suffering from debilitating pelvic pain for over four years. Despite multiple consultations and treatments, her pain remained poorly controlled, significantly impacting her quality of life and ability to work.

Interdisciplinary Approach

Upon referral to biio, Sarah was assessed by our interdisciplinary team, including a pain specialist, pelvic floor physiotherapist, and psychologist. The team identified several factors contributing to her pain:

• Chronic pelvic floor muscle tension
• Central sensitisation
• Anxiety and catastrophising related to pain

Treatment Plan

The team developed a comprehensive care plan that included:

• Specialist Pain Management: Our pain specialist recommended a hypogastric plexus neurotomy to reduce pain signals from the pelvic region.
• Pelvic Floor Physiotherapy: Our physiotherapist designed a program to address muscle tension and improve pelvic floor function.
• Psychological Support: Cognitive-behavioural therapy (CBT) and Pain reprocessing therapy (PRT) were initiated to address anxiety and pain-related fear.
• Lifestyle Modifications: Nutritional guidance and stress reduction techniques were incorporated.
• Education: Pain science education was provided to help Sarah understand the distinction between 'hurt' and 'harm', the fear-avoidance model of pain and practical techniques for self-management.

Intervention and Progress

The hypogastric plexus neurotomy was performed as an initial intervention. This procedure involves interrupting nerve pathways that transmit pain signals from the pelvic region to the brain. The reduction in pain following this procedure allowed Sarah to engage more effectively in pelvic floor physiotherapy.

With reduced pain levels, Sarah was able to perform pelvic floor exercises and participate in manual therapy sessions without excessive discomfort. This progress in physiotherapy, combined with ongoing psychological support, led to significant improvements in her pain levels and overall function.

Outcomes

Six months after initiating interdisciplinary care:

• Sarah reported a 70% reduction in overall pain levels
• She successfully returned to full-time work
• Her depression, anxiety and stress scores showed marked improvement (as measured via a DASS-21 assessment)
• She reported feeling more in control of her condition

Key Takeaways

• Interdisciplinary care allows for addressing multiple aspects of pelvic pain simultaneously.
• Interventional procedures can play a valuable role in enabling participation in other therapies.
• The combination of physical and psychological approaches often yields better results than either alone.
• Tailoring treatment to the individual patient's needs and progress is essential for optimal outcomes.

At biio, we're committed to providing this level of comprehensive, interdisciplinary care for all our patients with chronic pelvic pain. If you, or someone you know, think you might benefit from this approach, we welcome your bookings.