MasterclassDiagnosis and classification of pelvic girdle pain disorders, Part 2: Illustration of the utility of a classification system via case studies
Introduction
Pelvic girdle pain (PGP) of musculoskeletal origin has become recognised as a clinical entity distinct from that of low back pain. Not unlike low back pain though, clarity in the classification of PGP disorders is regularly lacking in both research and clinical settings. Failure to effectively classify these disorders in a meaningful manner has resulted in confusion about PGP disorders in the same way that a lack of classification of back pain has contributed to the problems surrounding the diagnostic label of ‘non-specific’ low back pain. The failure to meaningfully classify PGP disorders based on their underlying pain mechanism ultimately leads to difficulties in providing appropriate care for the patient, as the treatment may not be directed at the mechanism/s that drive the pain disorder.
In the accompanying article to this paper, a non-exclusive classification system based on a biopsychosocial approach has been presented (O’Sullivan and Beales, 2007a). The underlying basis of this model is one of understanding the mechanism/s involved in the development and maintenance of PGP disorders. It recognises the multi-faceted nature and complex interaction of these mechanisms. This mechanism-based approach directly leads to and facilitates the uptake of appropriate management strategies.
To demonstrate the utility of this classification system three case studies are presented. Note: Where not else stated, subjective data presented in the case studies (fear, beliefs, anxiety, depression scales, etc.) represent a 10-point numerical rating score from data collected from the Orebro Musculoskeletal Pain Questionnaire (Linton, 2005).
Section snippets
Subjective examination findings
39-year-old female; married; two children
Work: home duties
History: 5 year history of chronic PGP that began during her second pregnancy and did not resolve. She reported that after the birth of her second child she became disabled and sought various treatments to manage her disorder. These interventions included manipulation, stabilisation exercises and a pelvic belt. She reported little benefit from these treatments over a period of 2 years. Over this time she had become inactive and very
Summary
These three distinct cases act as clinical examples highlighting the importance of classification and specifically directed management of PGP disorders. Working within a biopsychosocial framework is critical for the management of these disorders. Management strategies that target both the physical and cognitive impairments associated with these disorders has the potential to positively impact on long-term PGP disorders.
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