Abstract
Introduction. Defining clinical phenotypes based on physical examination is required for clarifying heterogeneous disorders such as chronic pelvic pain (CPP). The objective of this study was to determine the number of classes within 4 examinable regions and then establish threshold and optimal exam criteria for the classes discovered. Methods. A total of 476 patients meeting the criteria for CPP were examined using pain pressure threshold (PPT) algometry and standardized numeric scale (NRS) pain ratings at 30 distinct sites over 4 pelvic regions. Exploratory factor analysis, latent profile analysis, and ROC curves were then used to identify classes, optimal examination points, and threshold scores. Results. Latent profile analysis produced two classes for each region: high and low pain groups. The optimal examination sites (and high pain minimum thresholds) were for the abdominal wall region: the pair at the midabdomen (PPT threshold depression of > 2); vulvar vestibule region: 10:00 position (NRS > 2); pelvic floor region: puborectalis (combined NRS > 6); vaginal apex region: uterosacral ligaments (combined NRS > 8). Conclusion. Physical examination scores of patients with CPP are best categorized into two classes: high pain and low pain. Standardization of the physical examination in CPP provides both researchers and general gynecologists with a validated technique.
Highlights
Defining clinical phenotypes based on physical examination is required for clarifying heterogeneous disorders such as chronic pelvic pain (CPP)
The objective of this study was to apply latent class modeling to the physical examination of patients with chronic pelvic pain, with the ultimate goal of defining clinical phenotypes in these patients
All patients met the American College of Obstetricians and Gynecologists definition for CPP and were evaluated in a standardized manner similar to that suggested by the International Pelvic Pain Society
Summary
Defining clinical phenotypes based on physical examination is required for clarifying heterogeneous disorders such as chronic pelvic pain (CPP). A total of 476 patients meeting the criteria for CPP were examined using pain pressure threshold (PPT) algometry and standardized numeric scale (NRS) pain ratings at 30 distinct sites over 4 pelvic regions. Physical examination scores of patients with CPP are best categorized into two classes: high pain and low pain. Establishing phenotypes for clinical conditions is a fundamental step in the development of diagnostic criteria, which are required for coherent research and evidence based clinical care [1]. The current phenotyping approaches are primarily symptom based and limited to urologic pain [3]. The challenges in this field are many and varied [4]. Phenotyping patients into similar groups can be used clinically to assess prognosis, evaluate potential treatments, or suggest further diagnostic evaluation
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