Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain (original) (raw)
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Clinical profiling of subgroups of women with chronic pelvic pain
Study questionDo subgroups of women with chronic pelvic pain (CPP) report different clinical symptoms and differing impact of pain on their quality of life?Summary answerClinical profiles of women with CPP show variability of clinical symptoms both within and between subgroups. However, there is an obvious negative impact of pain on the patients’ lives across all subgroups with the comorbid endometriosis and bladder pain symptoms group (EABP) presenting with the higher pain intensities and the lower quality of life.What is known alreadyCPP is a common condition affecting up to 26.6% of women, with many suffering for several years before diagnosis and/or treatment. The clinical presentation of CPP is varied and there are frequently comorbid conditions both within and outside the pelvis. Evidence from the literature show that there is an overlap of symptoms in chronic pain conditions whatever the underlying cause which suggests that chronic pain could be a condition itself.Study desig...
Chronic Pelvic Pain in Women: An Epidemiological Perspective
Women's Health, 2015
Chronic pelvic pain (CPP) is common in women of reproductive age and has a significant impact on quality of life, work efficiency and healthcare utilization. CPP can be a manifestation of many different, often multifactorial conditions, and in the absence of an identified cause, the management can be particularly challenging. High quality epidemiological studies would improve the understanding of CPP and identify risk factors which may be targeted for the development of appropriate management strategies. This review focuses on what is known about the prevalence, risk factors, individual and societal burden of CPP and outlines important management strategies.
BMC Public …, 2006
Background: Health care planning for chronic pelvic pain (CPP), an important cause of morbidity amongst women is hampered due to lack of clear collated summaries of its basic epidemiological data. We systematically reviewed worldwide literature on the prevalence of different types of CPP to assess the geographical distribution of data, and to explore sources of variation in its estimates.
Female chronic pelvic pain: the journey to diagnosis and beyond
Pain Management, 2017
Female chronic pelvic pain Chronic pelvic pain (CPP) is defined as persistent pain in the lower abdomen or pelvis of minimum 6-month duration that does not occur exclusively with menstruation, pregnancy or intercourse [1]. Estimates from the UK and the USA suggest that 4-24% of women, aged 18-50 years, report experiencing CPP within the last 3 months [2]. CPP accounts for 20-40% of all gynecology outpatient appointments [3,4] and approximately 3.8% of visits to primary care [5]. The prevalence of CPP within primary care is higher than for migraine 2.1% and comparable to asthma 3.7% and back pain 4.1% [6]. The annual UK treatment costs have been estimated at GB£158 million with further indirect costs of GB£24 million [7]. It is believed that these figures do not truly reflect the size of the problem as it is estimated that only about a third of women with CPP seek medical care [6,8-11]. In addition to the physical symptoms of CPP there is well-documented evidence that patients also experience associated negative psychological, behavioral, cognitive and sexual consequences [7]. The European Association of Urology Guidelines for management of CPP have highlighted the need for treatment of CPP to recognize these consequences as an important c omponent of CPP management [1]. Psychosocial factors have long been considered significant in understanding an integrated and full picture of complex chronic pain conditions [12]. Pain-related distress and the emotional consequences of living with persistent pain can have debilitating and marked effects on an individual's quality of life. Hence, it is little surprise that women with CPP often report depression, anxiety and reduced sexual function [13]. These latter difficulties are commonly linked with desires to start a family, pregnancy and childbirth. Tripp et al. (2013) [14] and Romão et al. (2011) [15] found that CPP affected women's relationships, day-today living, emotions and their perspectives for the future. It has been reported that women often feel unable to plan their daily life, owing to the constant imminence of pain and they report significantly more pain, depression and anxiety symptoms, and were physically more impaired than women in a control group [10,16]. Many aspects of women's quality of life are Commentary
An odyssey through chronic pelvic pain in women
Frontiers in Women’s Health
The five common conditions encountered in patients with chronic pelvic pain (CPP) consist of endometriosis, interstitial cystitis, pelvic floor dysfunction, irritable bowel syndrome and pudendal nerve entrapment. The most unrecognised cause of CPP is the latter which affects only 4% of patients. A thorough work up of patient's pain is necessary prior to subjecting patients to any intervention including surgery as over 40% of gynaecological laparoscopies are performed for long standing pelvic pain. CPP is of multi-source origin which makes it difficult in formulating a plan of care for patients with this condition. If one source of the pain is detected, it is important to rule out other conditions that may also be contributing. All practitioners treating patients with CPP have to be knowledgeable about all of the potential causes of pelvic pain and addressing only the commonest cause like endometriosis is not adequate.
BMJ, 2010
Chronic pelvic pain in women is a debilitating condition that impairs quality of life. Studies using various definitions estimated that its prevalence ranges from 2.1% to 24% of the female population worldwide. 1 It is a common presentation in UK primary care, with 38 per 1000 women affected annually-a rate comparable to those of asthma (37 per 1000) and back pain (41 per 1000). 2 Because pelvic pain is associated with conditions such as endometriosis and interstitial cystitis, a diagnosis is often difficult to establish, leading to a delay in appropriate treatment. Social and psychological factors are strongly associated with chronic pelvic pain, so tailored, effective treatment can be challenging to provide.
Factors predisposing women to chronic pelvic pain: systematic review
British Medical Journal, 2006
Objective To evaluate factors predisposing women to chronic and recurrent pelvic pain. Design, data sources, and methods Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors. Results There were 122 studies (in 111 articles) of which 63 (in 64 286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18 601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12 040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche ( < 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain. Conclusion Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.
Chronic pelvic pain in women of reproductive and post-reproductive age: a population-based study
European Journal of Pain, 2016
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Health and Quality of Life Outcomes, 2011
Background: Pain is strongly related to poor quality of life. We performed a cross-sectional study in a universitary hospital to investigate quality of life in women suffering from chronic pelvic pain (CPP) due to endometriosis and others conditions. Methods: Fifty-seven patients aged between 25 and 48 years-old submitted to laparoscopy because of CPP were evaluated for quality of life and depressive symptoms. Quality of life was accessed by a quality of life instrument [World Health Organization Quality of Life Assessment-Bref (WHOQOL-bref)]. Causes of pelvic pain were determined and severity of CPP was measured with a visual analogue scale. According to the intensity of pelvic pain score, patients were classified in two groups (group Low CPP < 25th percentile visual analogue scale and group High CPP > 25th percentile). Four dimensions on quality of life were measured (physical, psychological, social and environmental). We stratified the analysis of quality of life according CPP causes (presence or not of endometriosis in laparoscopy). Results: Patients with higher pain scores presented lower quality of life status in psychological and environmental dimensions. We found a negative correlation between pain scores and psychological dimension of quality of life (r =-0.310, P = .02). Quality of life scores were similar between groups with and without endometriosis (physical 54.2 ± 12.8