14. Quantitative Sensory Testing in Females with Endometriosis and Chronic Pelvic Pain

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Sinah Esther Kim , Catherine Stamoulis , Christine Sieberg , Jenny Gallagher , Beth Schwartz , Stephen Scott , Michele Hacker , Amy DiVasta
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引用次数: 0

Abstract

Background

Chronic pelvic/abdominal pain (CPP) due to endometriosis can be unresponsive to standard therapies due to excessive sensitivity to pain known as central sensitization. We studied whether quantitative sensory testing (QST), a psychophysical method examining how the somatosensory nervous system responds to stimuli, differed between females with endometriosis and pain-free individuals.

Methods

Females with laparoscopically-confirmed endometriosis and CPP despite hormonal medication use (pain ≥3/ 0-10 scale, ≥14 days/mo) were eligible, and underwent baseline QST for an IRB-approved, multi-site clinical trial. We measured pressure pain threshold (minimum pressure evoking pain) using an algometer, and wind-up temporal summation (perception of pain due to repetitive equally intense stimuli) using electronic Von Frey, in the lower abdomen and control areas (non-dominant third finger nailbed/deltoid). Age-matched data from 107 pain-free females were used as a reference sample. Unadjusted statistical comparisons were conducted using the Mann–Whitney U test. Statistical models with adjustments for age, race, and BMI were developed to examine statistical differences in pain outcomes. Data are reported as median (interquartile range).

Results

We enrolled n=85 females with endometriosis (age: 25.3 (13.4)y). Our pain-free cohort included n=107 females (age: 20 (30.0)y; Table 1). Females with endometriosis experienced median (IQR) 3(3) intensity pain, >1 day/week, had lower median pain pressure thresholds (7.4 (8.1)) than the pain-free sample (16.0 (12.9); p< 0.01 based on unadjusted comparisons), and higher median temporal summation of pain (2.0 (2.5) vs. 0.5 (1.0); p< 0.01). These differences remained in adjusted analyses: lower pressure-pain thresholds (regression coefficient (β)=-0.28, 95% confidence interval (CI)= [-0.39, -0.18]) and higher temporal summation (β=1.69, 95% CI= [1.06, 2.31]). In females with endometriosis, median pressure pain threshold was lower on the abdomen compared with the finger (7.4 (8.1) vs. 17.1 (14.7), p< 0.01). No site difference (abdomen vs. deltoid) in temporal summation was estimated (p=0.15).

Conclusions

Females with endometriosis had lower pressure-pain thresholds, indicating higher sensitivity to pain, and higher temporal summation measures, reflecting greater increase in pain perception from exposure to repetitive stimuli, compared with pain-free females. The pressure-pain threshold was lower at the lower abdomen vs. finger in those with endometriosis, but temporal summation was the same. Clinicians should consider treatments aimed at reducing central sensitization to pain in those with CPP due to endometriosis.
14. 子宫内膜异位症和慢性盆腔疼痛的定量感觉测试
背景:子宫内膜异位症引起的慢性盆腔/腹部疼痛(CPP)可能对标准治疗无反应,因为对疼痛过度敏感,称为中枢致敏。我们研究了定量感觉测试(QST),一种检测体感觉神经系统对刺激反应的心理物理学方法,是否在子宫内膜异位症女性和无痛个体之间存在差异。方法腹腔镜确诊子宫内膜异位症和CPP的女性,尽管使用激素治疗(疼痛≥3/ 0-10评分,≥14天/月),符合条件,并接受基线QST,进行irb批准的多地点临床试验。我们使用计量器测量了压力痛阈值(引起疼痛的最小压力),并使用电子Von Frey测量了下腹和控制区域(非主导的第三指指甲/三角肌)的上弦时间总和(由重复的同等强度刺激引起的疼痛感)。以107名无痛女性的年龄匹配数据作为参考样本。使用Mann-Whitney U检验进行未经调整的统计比较。采用年龄、种族和BMI进行调整的统计模型来检验疼痛结果的统计差异。数据以中位数(四分位数范围)报告。结果入选子宫内膜异位症女性85例(年龄25.3(13.4)岁)。我们的无痛队列包括107名女性(年龄:20(30.0)岁;表1)子宫内膜异位症女性经历中位数(IQR) 3(3)强度疼痛,每周1天,中位数疼痛压力阈值(7.4(8.1))低于无痛组(16.0 (12.9));术中;0.01(未经调整的比较),疼痛的中位时间总和更高(2.0 (2.5)vs. 0.5 (1.0);术中;0.01)。这些差异在校正分析中仍然存在:较低的压力-疼痛阈值(回归系数(β)=-0.28, 95%置信区间(CI)=[-0.39, -0.18])和较高的时间总和(β=1.69, 95% CI=[1.06, 2.31])。在患有子宫内膜异位症的女性中,腹部的中位压痛阈值低于手指(7.4(8.1)比17.1(14.7))。0.01)。估计时间总和的部位(腹部与三角肌)无差异(p=0.15)。结论与无痛女性相比,子宫内膜异位症女性有较低的压力-疼痛阈值,表明对疼痛的敏感性更高,并且时间累积测量更高,反映了暴露于重复刺激后疼痛感知的增加。子宫内膜异位症患者的下腹部压痛阈值比手指低,但颞叶总和相同。临床医生应考虑降低因子宫内膜异位症引起的CPP患者对疼痛的中枢敏化。
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来源期刊
CiteScore
3.90
自引率
11.10%
发文量
251
审稿时长
57 days
期刊介绍: Journal of Pediatric and Adolescent Gynecology includes all aspects of clinical and basic science research in pediatric and adolescent gynecology. The Journal draws on expertise from a variety of disciplines including pediatrics, obstetrics and gynecology, reproduction and gynecology, reproductive and pediatric endocrinology, genetics, and molecular biology. The Journal of Pediatric and Adolescent Gynecology features original studies, review articles, book and literature reviews, letters to the editor, and communications in brief. It is an essential resource for the libraries of OB/GYN specialists, as well as pediatricians and primary care physicians.
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