Introduction:
Persistent pelvic pain can significantly impact an individual’s quality of life, affecting their physical, emotional, and social well-being. As pelvic health physical therapists, our goal is to help patients find relief and regain control over their lives. In this post, we explore the value of self-reported measures in assessing and managing persistent pelvic pain, with a particular focus on the SAD CLLIFSS framework.
Understanding Persistent Pelvic Pain:
Persistent pelvic pain refers to ongoing pain or discomfort in the pelvic region that lasts for six months or longer. It can stem from various causes such as endometriosis, interstitial cystitis, pelvic floor dysfunction, and more. Since pelvic pain is a complex condition, it requires a multidimensional approach to diagnosis and treatment.
The Limitations of Objective Measures:
Traditional assessment methods for persistent pelvic pain often rely on objective measures such as imaging scans, laboratory tests, and physical examinations. While these tools are valuable, they have limitations when it comes to understanding the patient’s experience and the impact of pain on their daily life. This is where self-reported measures play a crucial role.
Introducing SAD CLLIFSS:
SAD CLLIFSSS is an acronym coined by Carolyn Vandyken and Antony Lo in 2019 and is used widely in Carolyn’s courses at REFRAME REHAB. The acronym stands for Stress, Anxiety/Depression, Castrophization, Low Self Efficacy, Low Positive Effect, Injustice, Fear, Shame/Self Compassion and Sensory-Motor Dysregulation. It represents a comprehensive set of self-reported measures designed specifically for psychosocial constructs that are part of a phenotypic understanding of nocioplastic pain. The questionnaires listed in this approach will help the practitioner triangulate information from multiple self-reported questionnaires rather than relying on only one or two. Some of the conceptual peices accompanying pelvic pain are:
- Sleep: Sleep disturbances commonly accompany persistent pain conditions and can exacerbate symptoms. Assessing the quality and quantity of sleep helps identify potential factors that impact pain levels and overall well-being.
- Anxiety/Depression: Persistent pelvic pain often leads to emotional distress, including anxiety and depression. By evaluating these aspects, healthcare providers can address the psychological impact and tailor treatment accordingly.
- Cognitive Functioning: Chronic pain can interfere with cognitive abilities such as concentration, memory, and decision-making. Understanding these cognitive challenges can guide therapeutic interventions to improve cognitive function.
- Libido/Sexuality: Pelvic pain can significantly affect a person’s sexual health and intimate relationships. Evaluating libido and sexuality helps identify barriers and develop strategies to enhance sexual well-being.
- Fatigue: Chronic pain often leads to fatigue and decreased energy levels. Assessing fatigue provides insights into the impact of pain on daily activities, allowing for targeted interventions to manage energy levels effectively.
- Frequency/Urinary Symptoms: Pelvic pain conditions can manifest alongside urinary symptoms, such as urgency, frequency, or incontinence. Assessing these symptoms helps in differentiating between various pelvic pain disorders and guiding treatment approaches.
- Stool Patterns: Gastrointestinal symptoms, including constipation or diarrhea, frequently coexist with pelvic pain. Evaluating stool patterns aids in identifying potential gastrointestinal contributors to pelvic pain and implementing appropriate management strategies.
The Benefits of SAD CLLIFSS:
By incorporating the SAD CLLIFSS framework, pelvic health physical therapists can obtain a comprehensive understanding of the patient’s experience, beyond physical symptoms alone. This holistic approach enables tailored treatment plans that address the specific challenges and needs of each individual, promoting optimal outcomes. This approach really helps our clients connect the dots between the varying range of symptoms – especially useful when the client is encouraged to discuss their experience while filling out the forms.
Self-reported measures, such as the SAD CLLIFSS framework, provide valuable insights into the impact of persistent pelvic pain on various aspects of a patient’s life. As pelvic health physical therapists, utilizing these measures empowers us to deliver personalized care, promoting improved symptom management, enhanced quality of life, and successful patient outcomes. By acknowledging the significance of self-reported measures, we can foster a patient-centered approach to pelvic health and better support those living with persistent pain.
You can find each questionnaire in the SAD CLLIFSS framework and its scoring sheet below:
These questionnaires are so important to the effective treatment of persistent pelvic pain, I feel each one should have additional insights. Each month I’ll be adding an article to your membership going further in-depth about each of the questionnaires in the SAD CLLIFSS framework.
The first one I want to cover is the Central Sensitivity Index (CSI):
The Central Sensitivity Index (CSI) is a self-report questionnaire used to assess the sensitivity of the central nervous system to pain and other stimuli. It is a tool that helps identify clients who may have heightened sensitivity to pain, known as central sensitization.
Central sensitization is a phenomenon in which the central nervous system becomes hyper-responsive to stimuli, resulting in an increased perception of pain and an exaggerated response to various sensory inputs. It is commonly observed in conditions such as fibromyalgia, chronic fatigue syndrome, and other chronic pain disorders.
The CSI questionnaire consists of a series of questions that inquire about the client’s pain experience, physical symptoms, and emotional well-being. The questionnaire typically includes items related to pain intensity, pain thresholds, sleep disturbances, fatigue, mood disturbances (such as anxiety and depression), and cognitive difficulties.
Clients rate their experiences on a Likert scale, with scores typically ranging from 0 to 13 or higher, depending on the version of the questionnaire being used. Higher scores on the CSI indicate a greater likelihood of central sensitization and heightened sensitivity to pain.
The CSI questionnaire provides valuable insights into a client’s central nervous system’s response to pain and other sensory stimuli.
It helps healthcare providers assess the presence and severity of central sensitization, which can guide the development of treatment strategies tailored to address this specific aspect of the individual’s pain experience.