Abstract
The objective of this prospective study was to determine the plasma levels of nitric oxide (NO) in women with chronic pelvic pain secondary to endometriosis (n=24) and abdominal myofascial pain syndrome (n=16). NO levels were measured in plasma collected before and 1 month after treatment. Pretreatment NO levels (μM) were lower in healthy volunteers (47.0±12.7) than in women with myofascial pain (64.2±5.0, P=0.01) or endometriosis (99.5±12.9, P<0.0001). After treatment, plasma NO levels were reduced only in the endometriosis group (99.5±12.9 vs 61.6±5.9, P=0.002). A correlation between reduction of pain intensity and reduction of NO level was observed in the endometriosis group [correlation = 0.67 (95%CI = 0.35 to 0.85), P<0.0001]. Reduction of NO levels was associated with an increase of pain threshold in this group [correlation = -0.53 (-0.78 to -0.14), P<0.0001]. NO levels appeared elevated in women with chronic pelvic pain diagnosed as secondary to endometriosis, and were directly associated with reduction in pain intensity and increase in pain threshold after treatment. Further studies are needed to investigate the role of NO in the pathophysiology of pain in women with endometriosis and its eventual association with central sensitization.
Highlights
Chronic pelvic pain (CPP) is a highly prevalent (2 to 25%) clinical problem among women [1]
Group 1 included 24 women diagnosed with endometriosis confirmed by histology and classified during laparoscopy according to the American Society for Reproductive Medicine [18] as moderate (n=14) or severe (n=10)
The present study showed that women with CPP secondary to endometriosis had significantly elevated plasma nitric oxide (NO) levels compared with healthy controls and women with CPP secondary to abdominal myofascial pain syndrome
Summary
Chronic pelvic pain (CPP) is a highly prevalent (2 to 25%) clinical problem among women [1]. It is described as continuous or intermittent pain in the anatomic pelvis (anterior abdominal wall at or below the umbilicus) that lasts at least 6 months, is not exclusively related to menstruation or sexual intercourse, and is sufficiently severe to cause functional disability or to lead to medical care [2]. Its etiology is often unknown but may result from a complex interaction between the gastrointestinal, urinary, gynecologic, musculoskeletal, neurologic, and endocrine systems. It is influenced by psychological and sociocultural factors. Abdominal myofascial pain syndrome, characterized by hyperirritable trigger points is another frequent underdiagnosed condition causing CPP, especially in countries where the prevalence of cesarean section and other abdominal surgeries is common [3]
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