6. EVALUATION OF TREATMENT RESULTS
6.1. Evaluation of treatment
For patients with chronic primary visceral pain, a visit to the clinician is important because they can ask questions, talk about how the process is going, and have time with a caregiver who understands the nature of their pain. The first evaluation should take place after about six weeks to determine whether the treatment has been successful. When necessary, adaptations are made and a next evaluation is planned.
6.1.1. Treatment has not been effective
6.1.1.a. Alternative treatment
In cases where the treatment initiated did not have enough effect, an alternative approach is advised. The first step is a thorough evaluation of patient or caregiver adherence to the initiated treatment. Ask whether the patient has taken the medication according to the prescription, if there were any side effects, and if there were any changes in pain and function. Adjustment of medication or dose schemes might help. Another important step is to review reports from other healthcare professionals, such as the physiotherapist and psychologist. Has the therapy been followed until the end? What was the opinion of the therapist about the changes that were observed? In cases where the sessions were terminated by the patient, ask why they made that decision. Check if the patient has understood the idea behind the therapy that had been prematurely stopped.
6.1.1.b. Referral to next envelope of care
If patients and doctors conclude that none of the therapies showed enough effect, then referral to a next envelope of care is advised. The terminology used to describe the nature and specialisation level of centres that provide specialised care for visceral pain patients is not standardised and is country-based. This does not facilitate easy referral schemes. It is advised that patients are referred to a centre that works with a multidisciplinary team and is nationally recognised as being specialised in pelvic pain. Such a centre will re-evaluate what has been done and, when available, provide specialised care.
6.1.1.c. Self-management and shared care
Patients who find themselves confronted with CPPPS for which there is no specific treatment option available, will have to live with their pain. They will need to manage their pain, meaning that they will have to find a way to deal with the impact of their pain on daily activities in all domains of life. Self-help programmes may be advised and can be of help. The patient may also benefit from shared care, which means a caregiver is available to support self-management strategies. Together with this caregiver, the patient can optimise and use the self-management strategies.
6.1.2. Treatment has been effective
In cases where treatment has been effective, attention must be paid to fall-back prevention. If the patient feels the same pain again, it helps to start at an early stage with the self-management strategies that they have learned during the former treatment. By doing so, they will have the best chance of preventing the redevelopment of pelvic pain syndromes.