Editorial

There is a growing literature on chronic pain conditions and the determinants of health service utilization, especially in developing countries. Information relating to epidemiology, pathophysiology, and management is essential for planning of effective services for patients suffering from these conditions. Chronic pain is a chief complaint for patients in the primary care practice, with approximately 10–20% reporting chronic pain []. It is among the most disabling and costly health problems affecting individuals' quality of life. Chronic pain conditions are diverse, with back pain and headache being the most common in both developing and developed countries. Women are more susceptible than men to chronic pain syndromes, they more often report multiple pain sites, more frequent pain, and more intense pain than men []. An important type of chronic pain that has been virtually ignored is chronic pelvic pain (CPP) in women. Developing countries lack good-quality epidemiological data for chronic pain conditions. Variations in definition limit the validity of epidemiological data for CPP. Other methodological differences, such as methods of measuring pain severity, add to the difficulties in comparing data among studies []. Patient self-selection of care providers leads to a nonsystematic evaluation and to a relative inability to know what are the most common causes of CPP among women []. Accordingly, it is difficult to give a precise estimate of the prevalence of CPP. However, it is estimated that one-third of all women will experience CPP in their lifetime []. A systematic review (2006) of 18 studies, including 299 740 women, reported prevalence rates of CPP ranging from 4.0 to 43.4%. The prevalence rates in less developed countries varied, in South East Asia, the rates varied from 5.2% in India to 43.2% in Thailand []. Its prevalence in the general population of women was 24% in the United Kingdom (2001) [] and 25.4% in New Zealand (2004) []. In the case of chronic pain in general, and CPP in particular, elements of pathophysiology are beginning to be elucidated, and certain treatments that were formerly used only in pain clinics are now gaining use in gynecological settings. With regard to the significance of diagnosis, this presents a challenge to the clinician because he must seek a diagnosis to treat any manifest disease, but he, at the same time, should also initiate pain management treatment to limit the pain-related distress and disability, in the absence of a satisfactory diagnosis. It is difficult to reach a precise diagnosis, mainly because of the wide range of possible diagnoses and often overlapping symptoms. In the community setting, as many as 60% of women with CPP have not received a specific diagnosis and up to 20% have not undergone any investigation []. Diagnostic laparoscopy is often carried out by referral to a gynecologist to uncover pathological causes such as endometriosis or adhesions, but is negative in over 50% of cases []. Similar to many other chronic pain syndromes, CPP is a multifactorial condition with possible sources of pain located in the gastrointestinal tract, reproductive, urinary or CNS, or in the musculoskeletal structures. The most common gastrointestinal cause of CPP is irritable bowel syndrome; possible genitourinary causes include interstitial cystitis, the urethral syndrome, endometriosis, and pelvic congestion syndrome. A 30% prevalence of endometriosis in women with CPP was reported []. All these conditions have overlapping symptomatology that contributes to the difficulty in establishing a diagnosis []. Urinary and gastrointestinal systems were more commonly reported than specifical gynecological problems []. In many women, no ‘obvious’ pathological explanation was found. Traditionally, pain in these women has often been attributed to psychological factors []. In this issue, two studies explore the epidemiology of chronic pain conditions in Egypt. The first one is a case–control study focusing on endometriosis prevalence and risk factors. Its main point of importance is that case definition was based on laparoscopic findings. This, however, limited the number of cases included and thereby the generalization of results. The second study presents an overview on the prevalence and characteristics of CPP among women attending Primary Health Care settings in Alexandria, the second important city after Cairo, which is the capital of Egypt. Self-reporting of pain severity was accompanied by double measurement using the Verbal Rating Scale and the Visual Analog Scale. The health-seeking behavior of these women was also explored and will be presented in the coming issues, thus broadening the comprehensive view on the problem. In addition, both studies examined the impact of chronic pain on the quality of life of women. Results of these researches would greatly help in planning effective services to limit the suffering and to improve quality of life of these women. References - 1. Marcus DA Chronic pain: a primary care guide to practical management. 20092nd ed New York Humana Press - 2. Aloisi AMFillingim RB. Sensory effects of gonadal hormones. Sex, gender and pain. 2000 Seattle IASP Press:7–24 - 3. Cheong Y, William Stones R. Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol. 2006;20:695–711 - 4. Learman L. Chronic pelvic pain-Part I: prevalence, evaluation, etiology and comorbidities. Adv Stud Med. 2005;5:306–315 - 5. - 6. Latthe P, Latthe M, Say L, Gulmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006;6:177 - 7. Zondervan KT, Yudkin PL, Vessey MP, Jenkinson CP, Dawes MG, Barlow DH, et al. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract. 2001;51:541–547 - 8. Grace VM, Zondervan KT. Chronic pelvic pain in New Zealand: prevalence, pain severity, diagnoses and use of the health services. Aust N Z J Public Health. 2004;28:369–375 - 9. Guo SW, Wang Y. The prevalence of endometriosis in women with chronic pelvic pain. Gynecol Obstet Invest. 2006;62:121–130