Increased Pressure Pain Sensitivity in Women With Chronic Pelvic Pain

Sawsan As‐Sanie, Sawsan As-Sanie, Richard E Harris, Steven E Harte, Frank F Tu, Gina Neshewat, Gina M. Neshewat, Daniel J Clauw
Obstetrics and gynecology · 2013 · vol. 122(5) , pp. 1047–1055 · doi:10.1097/aog.0b013e3182a7e1f5 · PMID:24104772 · W2017486192
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Women with chronic pelvic pain show increased pressure pain sensitivity at a nonpelvic site, regardless of endometriosis presence, severity, or comorbid pain.

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Abstract

OBJECTIVE: To determine whether women with chronic pelvic pain and variable degrees of endometriosis demonstrate altered pain sensitivity relative to pain-free healthy women in a control group and whether such differences are related to the presence or severity of endometriosis or comorbid pain syndromes. METHODS: Four patient subgroups (endometriosis with chronic pelvic pain [n=42], endometriosis with dysmenorrhea [n=15], pain-free endometriosis [n=35], and chronic pelvic pain without endometriosis [n=22]) were each compared with 30 healthy women in a control group in this cross-sectional study. All patients completed validated questionnaires regarding pain symptoms and underwent screening for comorbid pain disorders. Pain sensitivity was assessed by applying discrete pressure stimuli to the thumbnail using a previously validated protocol. RESULTS: While adjusting for age and education, pain thresholds were lower in all subgroups of women with pelvic pain relative to healthy women in the control group (all P values <.01). There was no difference in pain thresholds when comparing patients with endometriosis without pelvic pain with healthy women in the control group (mean difference 0.02 kg/m2, 95% confidence interval -0.43 to 0.47). The presence and severity of endometriosis and number of comorbid pain syndromes were not associated with a difference in pain thresholds. CONCLUSION: Women with chronic pelvic pain demonstrate increased pain sensitivity at a nonpelvic site compared with healthy women in a control group, which is independent of the presence or severity of endometriosis or comorbid pain syndromes. These findings support the notion that central pain amplification may play a role in the development of pelvic pain and may explain why some women with pelvic pain do not respond to therapies aimed at eliminating endometriosis lesions. LEVEL OF EVIDENCE: II.

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Condition tags

mesh:D004412mesh:D004715mesh:D017699endometriosischronic_pelvic_paindysmenorrhea

MeSH descriptors

Chronic Pain Endometriosis Pain Threshold Pelvic Pain Adolescent Adult Case-Control Studies Chronic Pain Chronic Pain Cross-Sectional Studies Dysmenorrhea Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Female Humans Middle Aged Pain Measurement Pain Threshold

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