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Semin Reprod Med 2020; 38(02/03): 227-234
DOI: 10.1055/s-0040-1718943
Review Article

Interdisciplinary Teams in Endometriosis Care

Catherine Allaire 
1   Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada
2   BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
,
Alicia Jean Long
1   Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada
2   BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
,
Mohamed A. Bedaiwy
1   Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada
2   BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
,
Paul J. Yong
1   Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada
2   BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, Canada
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Abstract

Endometriosis-associated chronic pelvic pain can at times be a complex problem that is resistant to standard medical and surgical therapies. Multiple comorbidities and central sensitization may be at play and must be recognized with the help of a thorough history and physical examination. If a complex pain problem is identified, most endometriosis expert reviews and guidelines recommend multidisciplinary care. However, there are no specific recommendations about what should be the components of this approach and how that type of team care should be delivered. There is evidence showing the effectiveness of specific interventions such as pain education, physical therapy, psychological therapies, and pharmacotherapies for the treatment of chronic pain. Interdisciplinary team models have been well studied and validated in other chronic pain conditions such as low back pain. The published evidence in support of interdisciplinary teams for endometriosis-associated chronic pain is more limited but appears promising. Based on the available evidence, a model for an interdisciplinary team approach for endometriosis care is outlined.

Keywords

interdisciplinary - multidisciplinary - pelvic pain - endometriosis


Publication History

Article published online:
20 October 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Simoens S, Dunselman G, Dirksen C. et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012; 27 (05) 1292-1299
    CrossrefPubMedGoogle Scholar
  • 2 Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020; 382 (13) 1244-1256
    CrossrefPubMedGoogle Scholar
  • 3 Shafrir AL, Farland LV, Shah DK. et al. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol 2018; 51: 1-15
    CrossrefPubMedGoogle Scholar
  • 4 Nnoaham KE, Hummelshoj L, Webster P. et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96 (02) 366-373 , e368
    CrossrefPubMedGoogle Scholar
  • 5 Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil Steril 2017; 108 (01) 125-136
    CrossrefPubMedGoogle Scholar
  • 6 Abbott JA, Hawe J, Clayton RD, Garry R. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod 2003; 18 (09) 1922-1927
    CrossrefPubMedGoogle Scholar
  • 7 Singh SS, Gude K, Perdeaux E, Gattrell WT, Becker CM. Surgical outcomes in patients with endometriosis: a systematic review. J Obstet Gynaecol Can 2020; 42 (07) 881-888.e11
    CrossrefPubMedGoogle Scholar
  • 8 Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod Update 2009; 15 (02) 177-188
    CrossrefPubMedGoogle Scholar
  • 9 Vitonis AF, Vincent K, Rahmioglu N. et al. WERF EPHect Working Group. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: II. Clinical and covariate phenotype data collection in endometriosis research. Fertil Steril 2014; 102 (05) 1223-1232
    CrossrefPubMedGoogle Scholar
  • 10 Jarrell JF, Vilos GA, Allaire C. et al. Chronic Pelvic Pain Working Group, SOGC. Consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can 2005; 27 (08) 781-826
    CrossrefPubMedGoogle Scholar
  • 11 Vilasagar S, Bougie O, Singh SS. A practical guide to the clinical evaluation of endometriosis-associated pelvic pain. J Minim Invasive Gynecol 2020; 27 (02) 270-279
    CrossrefPubMedGoogle Scholar
  • 12 Allaire C, Aksoy T, Bedaiwy M. et al. An interdisciplinary approach to endometriosis-associated pelvic pain. J Endometr Pelvic Pain Disord 2017; 9 (02) 77-86
    CrossrefPubMedGoogle Scholar
  • 13 Mearin F, Lacy BE, Chang L. et al. Bowel disorders. Gastroenterology 2016; (epub ahead of print) DOI: 10.1053/j.gastro.2016.02.031.
    CrossrefPubMedGoogle Scholar
  • 14 Lee CE, Yong PJ, Williams C, Allaire C. Factors associated with severity of irritable bowel syndrome symptoms in patients with endometriosis. J Obstet Gynaecol Can 2018; 40 (02) 158-164
    CrossrefPubMedGoogle Scholar
  • 15 Hanno PM, Burks DA, Clemens JQ. et al. Interstitial Cystitis Guidelines Panel of the American Urological Association Education and Research, Inc. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 2011; 185 (06) 2162-2170
    CrossrefPubMedGoogle Scholar
  • 16 Abrams P, Cardozo L, Fall M. et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol 2002; 187 (01) 116-126
    CrossrefPubMedGoogle Scholar
  • 17 Wu CC, Chung SD, Lin HC. Endometriosis increased the risk of bladder pain syndrome/interstitial cystitis: a population-based study. Neurourol Urodyn 2018; 37 (04) 1413-1418
    CrossrefPubMedGoogle Scholar
  • 18 Yosef A, Allaire C, Williams C. et al. Multifactorial contributors to the severity of chronic pelvic pain in women. Am J Obstet Gynecol 2016; 215 (06) 760.e1-760.e14
    CrossrefPubMedGoogle Scholar
  • 19 Stratton P, Khachikyan I, Sinaii N, Ortiz R, Shah J. Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol 2015; 125 (03) 719-728
    CrossrefPubMedGoogle Scholar
  • 20 Yong PJ, Mui J, Allaire C, Williams C. Pelvic floor tenderness in the etiology of superficial dyspareunia. J Obstet Gynaecol Can 2014; 36 (11) 1002-1009
    CrossrefPubMedGoogle Scholar
  • 21 Orr NL, Noga H, Williams C. et al. Deep dyspareunia in endometriosis: role of the bladder and pelvic floor. J Sex Med 2018; 15 (08) 1158-1166
    CrossrefPubMedGoogle Scholar
  • 22 Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 2008; 17 (06) 794-819
    CrossrefPubMedGoogle Scholar
  • 23 Mui J, Allaire C, Williams C, Yong PJ. Abdominal wall pain in women with chronic pelvic pain. J Obstet Gynaecol Can 2016; 38 (02) 154-159
    CrossrefPubMedGoogle Scholar
  • 24 Brawn J, Morotti M, Zondervan KT, Becker CM, Vincent K. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update 2014; 20 (05) 737-747
    CrossrefPubMedGoogle Scholar
  • 25 Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping chronic pain conditions: implications for diagnosis and classification. J Pain 2016; 17 (09) T93-T107
    CrossrefPubMedGoogle Scholar
  • 26 Veasley C, Clare D, Clauw DJ. et al. Impact of chronic overlapping pain conditions on public health and the urgent need for safe and effective treatment. Chronic Pain Research Alliance. 2015 . Available at: www.chronicpainresearch.org. Accessed September 30, 2020
    PubMedGoogle Scholar
  • 27 Malykhina AP. Neural mechanisms of pelvic organ cross-sensitization. Neuroscience 2007; 149 (03) 660-672
    CrossrefPubMedGoogle Scholar
  • 28 As-Sanie S, Harris RE, Napadow V. et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. Pain 2012; 153 (05) 1006-1014
    CrossrefPubMedGoogle Scholar
  • 29 As-Sanie S, Kim J, Schmidt-Wilcke T. et al. Functional connectivity is associated with altered brain chemistry in women with endometriosis-associated chronic pelvic pain. J Pain 2016; 17 (01) 1-13
    CrossrefPubMedGoogle Scholar
  • 30 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 (01) 114.e1-114.e12
    CrossrefPubMedGoogle Scholar
  • 31 Jarrell J, Ross S, Robert M. et al. Prediction of postoperative pain after gynecologic laparoscopy for nonacute pelvic pain. Am J Obstet Gynecol 2014; 211 (04) 360.e1-360.e8
    CrossrefPubMedGoogle Scholar
  • 32 Martin CE, Johnson E, Wechter ME, Leserman J, Zolnoun DA. Catastrophizing: a predictor of persistent pain among women with endometriosis at 1 year. Hum Reprod 2011; 26 (11) 3078-3084
    CrossrefPubMedGoogle Scholar
  • 33 Carey ET, Martin CE, Siedhoff MT, Bair ED, As-Sanie S. Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis. Int J Gynaecol Obstet 2014; 124 (02) 169-173
    CrossrefPubMedGoogle Scholar
  • 34 Weijenborg PT, Ter Kuile MM, Gopie JP, Spinhoven P. Predictors of outcome in a cohort of women with chronic pelvic pain - a follow-up study. Eur J Pain 2009; 13 (07) 769-775
    CrossrefPubMedGoogle Scholar
  • 35 Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7 (04) 524-532
    CrossrefPubMedGoogle Scholar
  • 36 Leyland N, Casper R, Laberge P, Singh SS. SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can 2010; 32 (07) (Suppl. 02) S1-S32
    CrossrefPubMedGoogle Scholar
  • 37 Johnson NP, Hummelshoj L. World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod 2013; 28 (06) 1552-1568
    CrossrefPubMedGoogle Scholar
  • 38 Kuznetsov L, Dworzynski K, Davies M, Overton C. Guideline Committee. Diagnosis and management of endometriosis: summary of NICE guidance. BMJ 2017; 358: j3935
    CrossrefPubMedGoogle Scholar
  • 39 Nijs J, Paul van Wilgen C, Van Oosterwijck J, van Ittersum M, Meeus M. How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines. Man Ther 2011; 16 (05) 413-418
    CrossrefPubMedGoogle Scholar
  • 40 Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain 2004; 8 (01) 39-45
    CrossrefPubMedGoogle Scholar
  • 41 Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Arch Phys Med Rehabil 2010; 91 (08) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 42 Van Oosterwijck J, Meeus M, Paul L. et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial. Clin J Pain 2013; 29 (10) 873-882
    CrossrefPubMedGoogle Scholar
  • 43 van Ittersum MW, van Wilgen CP, van der Schans CP, Lambrect L, Groothoff JW, Nijs J. Written pain neuroscience education in fibromulagia: a multicenter randomized controlled trial. Pain Pract 2014; 14 (08) 689-700
    CrossrefPubMedGoogle Scholar
  • 44 Butler DS, Moseley GL. Explain Pain. 2nd ed. Adelaide, South Australia: Noigroup Publications; 2013
    Google Scholar
  • 45 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 (01) 114.e1-114.e12
    CrossrefPubMedGoogle Scholar
  • 46 Arribas-Romano A, Fernández-Carnero J, Molina-Rueda F, Angulo-Diaz-Parreño S, Navarro-Santana MJ. Efficacy of physical therapy on nociceptive pain processing alterations in patients with chronic musculoskeletal pain: a systematic review and meta-analysis. Pain Med 2020; pnz366
    PubMedGoogle Scholar
  • 47 Hanney WJ, Masaracchio M, Liu X, Kolber MJ. The influence of physical therapy guideline adherence on healthcare utilization and costs among patients with low back pain: a systematic review of the literature. PLoS One 2016; 11 (06) e0156799
    CrossrefPubMedGoogle Scholar
  • 48 Siedentopf F, Weijenborg P, Engman M. et al. ISPOG European Consensus statement - chronic pelvic pain in women (short version). J Psychosom Obstet Gynaecol 2015; 36 (04) 161-170
    CrossrefPubMedGoogle Scholar
  • 49 Goldfinger C, Pukall CF, Gentilcore-Saulnier E, McLean L, Chamberlain S. A prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J Sex Med 2009; 6 (07) 1955-1968
    CrossrefPubMedGoogle Scholar
  • 50 Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J Pelvic Floor Dysfunct 2018; 29 (05) 631-638
    CrossrefPubMedGoogle Scholar
  • 51 Ghaderi F, Bastani P, Hajebrahimi S, Jafarabadi MA, Berghmans B. Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial. Int Urogynecol J Pelvic Floor Dysfunct 2019; 30 (11) 1849-1855
    CrossrefPubMedGoogle Scholar
  • 52 Zoorob D, South M, Karram M. et al. A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain. Int Urogynecol J Pelvic Floor Dysfunct 2015; 26 (06) 845-852
    CrossrefPubMedGoogle Scholar
  • 53 FitzGerald MP, Payne CK, Lukacz ES. et al. Interstitial Cystitis Collaborative Research Network. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol 2012; 187 (06) 2113-2118
    CrossrefPubMedGoogle Scholar
  • 54 Abbott JA, Jarvis SK, Lyons SD, Thomson A, Vancaille TG. Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol 2006; 108 (04) 915-923
    CrossrefPubMedGoogle Scholar
  • 55 Klotz SGR, Schön M, Ketels G, Löwe B, Brünahl CA. Physiotherapy management of patients with chronic pelvic pain (CPP): a systematic review. Physiother Theory Pract 2019; 35 (06) 516-532
    CrossrefPubMedGoogle Scholar
  • 56 Aerts L, Grangier L, Streuli I. et al. Psychosocial impact of endometriosis: from co-morbidity to intervention. Best Pract Res Clin Obstet Gynaecol 2018; 50: 2-10
    CrossrefPubMedGoogle Scholar
  • 57 Facchin F, Barbara G, Dridi D. et al. Mental health in women with endometriosis: searching for predictors of psychological distress. Hum Reprod 2017; 32 (09) 1855-1861
    CrossrefPubMedGoogle Scholar
  • 58 Mellado BH, Falcone AC, Poli-Neto OB, Rosa E Silva JC, Nogueira AA, Candido-Dos-Reis FJ. Social isolation in women with endometriosis and chronic pelvic pain. Int J Gynaecol Obstet 2016; 133 (02) 199-201
    CrossrefPubMedGoogle Scholar
  • 59 Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2012; 11: CD007407
    CrossrefPubMedGoogle Scholar
  • 60 Pike A, Hearn L, Williams AC. Effectiveness of psychological interventions for chronic pain on health care use and work absence: systematic review and meta-analysis. Pain 2016; 157 (04) 777-785
    CrossrefPubMedGoogle Scholar
  • 61 Gardner-Nix J, Costin-Hall L. The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management. New Harbinger Publications; 2009
    Google Scholar
  • 62 Turk DC. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clin J Pain 2002; 18 (06) 355-365
    CrossrefPubMedGoogle Scholar
  • 63 Ussher M, Spatz A, Copland C. et al. Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. J Behav Med 2014; 37 (01) 127-134
    CrossrefPubMedGoogle Scholar
  • 64 Rosenbaum TY. An integrated mindfulness-based approach to the treatment of women with sexual pain and anxiety: promoting autonomy and mind/body connection. Sex Relationship Ther 2013; 28 (1–2): 20-28
    CrossrefPubMedGoogle Scholar
  • 65 Van Niekerk L, Weaver-Pirie B, Matthewson M. Psychological interventions for endometriosis-related symptoms: a systematic review with narrative data synthesis. Arch Women Ment Health 2019; 22 (06) 723-735
    CrossrefPubMedGoogle Scholar
  • 66 Evans S, Fernandez S, Olive L, Payne LA, Mikocka-Walus A. Psychological and mind-body interventions for endometriosis: a systematic review. J Psychosom Res 2019; 124: 109756
    CrossrefPubMedGoogle Scholar
  • 67 Dworkin RH, O'Connor AB, Audette J. et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010; 85 (03) S3-S14
    CrossrefPubMedGoogle Scholar
  • 68 Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states--maybe it is all in their head. Best Pract Res Clin Rheumatol 2011; 25 (02) 141-154
    CrossrefPubMedGoogle Scholar
  • 69 Lewis SC, Bhattacharya S, Wu O. et al. Gabapentin for the management of chronic pelvic pain in women (GaPP1): a pilot randomised controlled trial. PLoS One 2016; 11 (04) e0153037
    CrossrefPubMedGoogle Scholar
  • 70 Vincent K, Baranowski A, Bhattacharya S. et al. GaPP2, a multicentre randomised controlled trial of the efficacy of gabapentin for the management of chronic pelvic pain in women: study protocol. BMJ Open 2018; 8 (01) e014924
    CrossrefPubMedGoogle Scholar
  • 71 Gogovor A, Visca R, Ware MA. et al. Determinants of patient experience with low back pain interdisciplinary care: a pre-post interventional study. J Pain Res 2019; 12: 3203-3213
    CrossrefPubMedGoogle Scholar
  • 72 Nanapragasam A, Lim CK, Maskell G. Patient involvement and shared decision-making in the management of back pain: a proposed multidisciplinary team model. Clin Radiol 2019; 74 (01) 76-77
    CrossrefPubMedGoogle Scholar
  • 73 Chou R, Loeser JD, Owens DK. et al. American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine 2009; 34 (10) 1066-1077
    CrossrefPubMedGoogle Scholar
  • 74 Peters AA, van Dorst E, Jellis B, van Zuuren E, Hermans J, Trimbos JB. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstet Gynecol 1991; 77 (05) 740-744
    PubMedGoogle Scholar
  • 75 Kamper SJ, Apeldoorn AT, Chiarotto A. et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015; 350: h444
    CrossrefPubMedGoogle Scholar
  • 76 Dragioti E, Björk M, Larsson B, Gerdle B. A meta-epidemiological appraisal of the effects of interdisciplinary multimodal pain therapy dosing for chronic low back pain. J Clin Med 2019; 8 (06) E871
    CrossrefPubMedGoogle Scholar
  • 77 Moradi B, Hagmann S, Zahlten-Hinguranage A. et al. Efficacy of multidisciplinary treatment for patients with chronic low back pain: a prospective clinical study in 395 patients. J Clin Rheumatol 2012; 18 (02) 76-82
    CrossrefPubMedGoogle Scholar
  • 78 Salsbury SA, Goertz CM, Vining RD. et al. Interdisciplinary practice models for older adults with back pain: a qualitative evaluation. Gerontologist 2018; 58 (02) 376-387
    PubMedGoogle Scholar
  • 79 Guzmán J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2002; (01) CD000963
    PubMedGoogle Scholar
  • 80 Davin S, Lapin B, Mijatovic D. et al. Comparative effectiveness of an interdisciplinary pain program for chronic low back pain, compared to physical therapy alone. Spine 2019; 44 (24) 1715-1722
    CrossrefPubMedGoogle Scholar
  • 81 Gregg CD, Hoffman CW, Hall H, McIntosh G, Robertson PA. Outcomes of an interdisciplinary rehabilitation programme for the management of chronic low back pain. J Prim Health Care 2011; 3 (03) 222-227
    CrossrefPubMedGoogle Scholar
  • 82 Bitenc-Jasiejko A, Konior K, Lietz-Kijak D. Meta-analysis of integrated therapeutic methods in noninvasive lower back pain therapy (LBP): the role of interdisciplinary functional diagnostics. Pain Res Manag 2020; 2020: 3967414
    CrossrefPubMedGoogle Scholar
  • 83 D'Hooghe T, Hummelshoj L. Multi-disciplinary centres/networks of excellence for endometriosis management and research: a proposal. Hum Reprod 2006; 21 (11) 2743-2748
    CrossrefPubMedGoogle Scholar
  • 84 Ebert AD, Ulrich U, Keckstein J. et al. Endometriosis Research Foundation, and the European Endometriosis League. Implementation of certified endometriosis centers: 5-year experience in German-speaking Europe. Gynecol Obstet Invest 2013; 76 (01) 4-9
    CrossrefPubMedGoogle Scholar
  • 85 Saridogan E, Byrne D. The British Society for Gynaecological Endoscopy Endometriosis Centres Project. Gynecol Obstet Invest 2013; 76 (01) 10-13
    CrossrefPubMedGoogle Scholar
  • 86 Lillemon JN, Nardos R, Kaul MP, Johnson AN, Choate A, Clark AL. Complex female pelvic pain: a case series from a multidisciplinary clinic in urogynecology and physiatry. Female Pelvic Med Reconstr Surg 2019; 25 (02) e34-e39
    CrossrefPubMedGoogle Scholar
  • 87 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 (04) 233-240
    CrossrefPubMedGoogle Scholar
  • 88 Yong PJ, Williams C, Bodmer-Roy S. et al. Prospective cohort of deep dyspareunia in an interdisciplinary setting. J Sex Med 2018; 15 (12) 1765-1775
    CrossrefPubMedGoogle Scholar