Prevalence Of Chronic Pelvic Pain Research Articles

Prevalencia y factores de riesgo de dolor pélvico

ObjetivesTo determine the prevalence of Chronic Pelvic Pain (CPP) symptoms in Malaga and its province and to identify risk factors associated. Methoda cross-sectional study was carried out in Malaga and its province, 18-65 years-old throughout a non-probability sampling by quotas (n=887), stratified by sex, age and counties. All participants completed the QCPP-M, a self-administered questionnaire, validated tool due to its ability to discriminate patients with and without CPP. Resultsprevalence of symptoms of CPP in subjects between 18-65 years-old was 22.8% in general population (30.9% women and 15.6% men) (RR=1.974 for women versus men, 95% CI 1.53-2.55, P<.001). After correction by sex and age individuals who practice physical activity had a lower score in QCPP-M that others who do not not (mean difference −0.65±0.27). They were significantly associated with higher scores in the following factors: lifting and/or moving weights in activities of daily life (1.34±0.33), laxatives intake and/or high-fiber diet (2.09±0.48), having suffered from urogenital infectious disease in the past: vulvovaginitis, cystitis and prostatitis (1.77±0.55), hemorrhoids/anal fissure (1.31±0.40) or pelvic trauma (1.21±0, 61) respectively. Individuals who spend more time standing had a tendency to have higher scores on QCPP-M (coefficient of regression adjusted for sex and age of 0.078 points/hour, SE=0.04, P<.068). ConclusionsHigh prevalence of CPP symptoms in Málaga (22.8%), this is related with significantly several risk factors.

Caesarean section wound infiltration with ropivacaine versus placebo: Survey of chronic pelvic pain after 4 years' follow-up

Objective. To test the hypothesis that optimal management of postoperative pain may reduce the risk of developing chronic pelvic pain in women who undergo caesarean section. Methods. In a randomised trial in 2006/2007, ropivacaine was infiltrated through all the layers of the anterior abdominal wound in patients undergoing caesarean section. The outcome was a reduction in severe pain or the need for rescue narcotic analgesia within 1 hour after the operation in the ropivacaine group compared with a placebo group (relative risk 0.51; 95% confidence interval 0.38 - 0.69). A follow-up study 4 years later was designed to assess the prevalence of chronic pelvic pain by carrying out telephonic interviews with these women, of whom 77 were contactable and 75 were analysed. Data and statistical analysis were done using Microsoft Excel (2007), Epi Info (version 343) statistical and Review Manager 5 software. Results. Three out of 40 women in the ropivacaine group and 3/35 in the placebo group had persistent pelvic pain (total rate of chronic pelvic pain 8.1%). Conclusion. There was no significant difference in the prevalence of chronic pelvic pain between the ropivacaine wound infiltration group (7.5%) and the placebo group (8.6%) after 4 years’ follow-up.

Dor pélvica crônica não visceral: tratamento multidisciplinar. Relato de caso

JUSTIFICATIVA E OBJETIVOS: A prevalência de dor pélvica crônica no sexo feminino é de aproximadamente 4%, similar à prevalência da enxaqueca (2,1%), asma (3,7%) e dor lombar (4,1%). Seu diagnóstico e tratamento constitui um grande desafio para a equipe de saúde. Este estudo teve por objetivo mostrar a dificuldade no diagnóstico e tratamento de dor pélvica crônica e a importância da equipe multidisciplinar no alívio do quadro doloroso. RELATO DO CASO: Paciente de 45 anos, com quadro de dor pelviperineal há 6 anos, após histeroscopia para exérese de pólipo uterino. A dor que iniciou no pós-operatório imediato, de forte intensidade, evoluiu ao longo desse período sem melhora e motivou-a a buscar o Ambulatório de Dor Abdominal, Pélvica e Perineal Crônica do Centro Interdisciplinar de Dor do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo. CONCLUSÃO: O tratamento multidisciplinar que abrangeu o uso de fármacos, inativação dos pontos-gatilho (infiltração com anestésicos, agulhamento seco, acupuntura), fisioterapia, reeducação postural e suporte psicossocial, proporcionou melhora significativa da dor e da qualidade de vida da paciente.

Highlights in basic autonomic neurosciences: Cross-organ sensitization between the bladder and bowel

Chronic pelvic pain (CPP) and visceral pain (VP) are common, debilitating conditions which present a major challenge to health care providers around the world. Both are characterised by generalised, diffuse pain sensation, coupled with alterations in organ function. Often CPP and VP arise following the resolution of an acute infection and in some cases can induce functional alterations and pain from a different unaffected region. This is consistent with the concept of cross-organ sensitization. Clinical data provides compelling evidence for cross-organ sensitization between the bladder and bowel. Roughly 30% of patients presenting with irritable bowel syndrome (IBS) also present with bladder symptoms such as increased or incomplete bladder emptying, urgency, nocturia and pain (Malykhina, 2007). The same has also been reported in patients with overactive bladder syndrome (OABS) and interstitial cystitis/painful bladder syndrome (IC/PBS) who exhibit symptoms of IBS (Whorwell et al., 1986). Cross-organ sensitization has also been demonstrated between the uterus, pelvic urethra and vagina and in males cross-organ sensitization between the prostate and other pelvic organs has also been suggested. Despite the prevalence of CPP, VP and cross-organ sensitization, the underlying mechanisms are not fully understood.

Discriminating power of CPPQ‐Mohedo: a new questionnaire for chronic pelvic pain

In the absence of a gold-standard tool to measure chronic pelvic pain (CPP), most studies on the prevalence of CPP use the NIH-chronic prostatitis symptom index (CPSI) questionnaire. However, its suitability and relevance for use in both sexes have not yet been evaluated, and generalized interpretation of the results is therefore questionable. Accordingly, we designed a questionnaire that discriminates between patients with and without symptoms of CPP. We undertook a study to test the discriminating capacity for chronic pelvic pain questionnaire (CPPQ)-Mohedo test for CPP among healthy and unhealthy individuals, and if this discrimination was similar for men and women. We did a matched study - 40 unhealthy men were matched by age with 40 unhealthy women - and each of those was matched with six healthy controls by age and sex (480 in total). To elaborate the questionnaire (CPPQ-Mohedo), we started with the NIH-CPSI, adapting the items referring to anatomic areas for women, changing the type of response and including various items on pelvic pain not previously recorded. The NIH-CPSI questionnaire [area under the receiver operating characteristic (ROC curve), 0.946] was very similar to that of the CPPQ-Mohedo questionnaire (area under the ROC curve, 0.968), but the first required more items. CPPQ-Mohedo showed similar discriminant capacity between men and women. The dimensions involved (pain and quality of life) showed internal consistency (Cronbach's alpha: 0.75). The CPPQ-Mohedo questionnaire presented discriminating power in men and women with symptoms of CPP. This questionnaire may be used as a screening tool to identify patients and include them in treatment programmes, as an outcome assessment tool for treatment and clinical trials, or as a tool to assess the prevalence of CPP in epidemiologic studies.

High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery

INTRODUCTION:Chronic pelvic pain is a disease that directly affects the social and professional lives of women.OBJECTIVE:To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil.METHODS:A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10) and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95% confidence interval with p<0.05.RESULTS:The disease was found in 11.5% (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level.CONCLUSION:The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.

Dolor pélvico en la embarazada. Disfunción de la sínfisis púbica. Revisión de la literatura

Pubic symphysis diastasis in pregnancy is a frequent and underestimated problem that has important repercussions on maternal morbidity and high prevalence of chronic pelvic pain in women. The functional impotence that it causes and the associated severe pain, entails the use of a number of therapeutic alternatives, ranging from bed rest to complex corrective surgery, reinforcing the importance and necessity of a correct approach to this pathology. Our aim is, after studying many cases referred to the Pain Treatment Unit at our centre, to carry out a review of this pathology, contacting patients, reviewing the therapeutic alternatives available for these types of conditions and their repercussions on the quality of life of the maternal-foetal binomial and chronic pain.

WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity

BackgroundHealth 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.MethodsWe identified data available from Medline (1966 to 2004), Embase (1980 to 2004), PsycINFO (1887 to 2003), LILACS (1982 to 2004), Science Citation index, CINAHL (January 1980 to 2004) and hand searching of reference lists. Two reviewers extracted data independently, using a piloted form, on participants' characteristics, study quality and rates of CPP. We considered a study to be of high quality (valid) if had at least three of the following features: prospective design, validated measurement tool, adequate sampling method, sample size estimation and response rate >80%. We performed both univariate and multivariate meta-regression analysis to explore heterogeneity of results across studies.ResultsThere were 178 studies (459975 participants) in 148 articles. Of these, 106 studies were (124259 participants) on dysmenorrhoea, 54 (35973 participants) on dyspareunia and 18 (301756 participants) on noncyclical pain. There were only 19/95 (20%) less developed and 1/45 (2.2%) least developed countries with relevant data in contrast to 22/43 (51.2%) developed countries. Meta-regression analysis showed that rates of pain varied according to study quality features. There were 40 (22.5%) high quality studies with representative samples. Amongst them, the rate of dysmenorrhoea was 16.8 to 81%, that of dyspareunia was 8 to 21.8%, and that for noncyclical pain was 2.1 to 24%.ConclusionThere were few valid population based estimates of disease burden due to CPP from less developed countries. The variation in rates of CPP worldwide was due to variable study quality. Where valid data were available, a high disease burden of all types of pelvic pain was found.

A Model of Neural Cross-Talk and Irritation in the Pelvis: Implications for the Overlap of Chronic Pelvic Pain Disorders

Irritable bowel syndrome, interstitial cystitis, and other chronic pelvic pain (CPP) disorders often occur concomitantly. Neural cross-talk may play a role in the overlap of CPP disorders via the convergence of pelvic afferents. We investigated the hypothesis that afferent irritation of one pelvic organ may adversely influence and sensitize another via neural interactions. We measured pelvic organ smooth muscle and striated muscle reflexes during micturition and colorectal distention (CRD) in urethane-anesthetized rats. The effects of acute cystitis on distal colonic sensory thresholds to CRD and the effects of acute colonic irritation on micturition parameters were assessed. External urethral sphincter (EUS) electromyography (EMG) was typical for the rat, with phasic firing during micturition. External anal sphincter EMG also showed phasic firing during micturition in synchrony with EUS activity but, in addition, showed both tonic bursts and phasic firing independent of EUS activity. Before bladder irritation, graded CRDs to 40 cm H2O produced no notable changes in abdominal wall EMG activity. Following acute bladder irritation, dramatic increases in abdominal wall EMG activity in response to CRD were observed at much lower distention pressures, indicating colonic afferent sensitization. Analogously, following acute colonic irritation, bladder contraction frequency increased 66%, suggesting sensitization of lower urinary tract afferents. We report compelling evidence of bidirectional cross-sensitization of the colon and lower urinary tract in a novel experimental model. This cross-sensitization may account for the substantial overlap of CPP disorders; however, further studies are needed to fully characterize these pathways.

Epidemiology of chronic pelvic pain

The epidemiology of chronic pelvic pain (CPP) is very difficult to investigate because of: 1) a lack of consensus of its clinical definition across studies; 2) its multi-causal origin; and 3) study design complications. Using the most common definition of CPP ( lower abdominal pain of at least 6 months' duration, excluding pain solely related to pregnancy, menstruation, or intercourse), the prevalence of CPP among women of reproductive age in the general population is estimated to be as high as 25%. The level to which women are affected by their symptoms varies, but concern regarding the cause of the pain is common place. Despite this concern, many women with CPP in the general population do not seek health care, or, if they do, do not get referred to secondary care and cease seeking medical advice after a period of time. Indeed, the diagnoses most commonly received–IBS and ‘stress’–are diagnostic labels given in primary care that do not necessarily require specialist investigations. Women seen in secondary or tertiary referral clinics are a highly selected group who often have had symptoms for several years. The investigation of the aetiology of CPP through assessment of ‘risk factors’ remains highly complicated because of the complexity of the condition, but more so because prospective cohort studies are required to assess unbiased exposure prior to onset of symptoms.

Der chronische Unterbauchschmerz der Frau und seine Komorbidität

Fragestellung: Da repräsentative Angaben zur Prävalenz von chronischen Unterbauchschmerzen von Frauen in der Bevölkerung bislang fehlen, wurden Häufigkeit, Altersverteilung und Komorbidität erhoben.

Chronic pelvic pain in New Zealand: prevalence, pain severity, diagnoses and use of the health services

Chronic pelvic pain (CPP) in women is often debilitating and isolating. Problems with diagnosis continue to make CPP one of the most perplexing conditions in gynaecology, and one of the most difficult to treat.Objectives: This paper reports the findings of a population‐based study in New Zealand in 2001 designed to investigate the prevalence of chronic pelvic pain in women between the ages of 18 and 50. Chronic pelvic pain was defined as pain that is neither associated with the menstrual cycle nor sexual activity. The prevalence of dysmenorrhoea and dyspareunia was also sought. It further aimed to examine pain severity, diagnoses, and the use of the health services as these facets of CPP affect different groups of women within New Zealand.Methods: A random sample of 2,261 was generated from the New Zealand Electoral Roll, and a postal questionnaire was administered during 2001. The response rate was 66% (adjusted for non‐receivers), giving a study group of 1,160 respondents.Results: The three‐month CPP prevalence rate was 25.4% (95% CI 22.8–27.9). Half of those women reporting CPP (47.7%) remained undiagnosed. The three‐month prevalence of dysmenorrhoea was 55.2%, and dyspareunia 19.7%. Recent or past consulters of health services for CPP contained a higher proportion of women with a high pain burden than those not consulting health services. Only one‐third of New Zealand women (34%) reported no form of chronic pelvic pain (i.e. no CPP, dysmenorrhoea or dyspareunia). These prevalence rates indicate that CPP should receive greater public education and clinical attention.

Chronic pelvic pain in the community—Symptoms, investigations, and diagnoses

Objectives: This study was undertaken to investigate the overlap between chronic pelvic pain, dysmenorrhea, dyspareunia, irritable bowel syndrome, and genitourinary symptoms in the community and also to examine associated investigations and diagnoses. Study Design: A postal questionnaire was used to survey 3916 women aged 18 through 49 randomly selected from the Oxfordshire Health Authority Register. The number of responders was 2304 (74% of 3106 questionnaire recipients). Chronic pelvic pain was described as recurrent or constant pelvic pain of ≥6 months’ duration unrelated to periods, intercourse, or pregnancy. Case patients (n = 483) were subgrouped as follows: (1) chronic pelvic pain only, (2) chronic pelvic pain and irritable bowel syndrome, (3) chronic pelvic pain and genitourinary symptoms, and (4) chronic pelvic pain, genitourinary symptoms, and irritable bowel syndrome. Results: Half the women with chronic pelvic pain also had either genitourinary symptoms or irritable bowel syndrome, or both. Prevalences of dysmenorrhea and dyspareunia were higher among women with chronic pelvic pain (81% and 41%, respectively) than among women without chronic pelvic pain (58% and 14%, respectively); rates did not differ among the chronic pelvic pain subgroups. Irritable bowel syndrome and stress were the most common diagnoses received by patients with chronic pelvic pain, but 50% had never received a diagnosis. Conclusions: There is substantial overlap between chronic pelvic pain and other abdominal symptoms in the community. Despite a high prevalence of chronic pelvic pain, many women have never had the condition diagnosed. (Am J Obstet Gynecol 2001;184:1149-55.)

Epidemiology of chronic pelvic pain

An overview is given of the current knowledge of the epidemiology of chronic pelvic pain (CPP) in terms of prevalence, incidence, and associated risk factors. However, the lack of a consensus on the definition of CPP greatly hinders epidemiological studies.Although data are limited, the prevalence of CPP in the general population appears to be high. A single study found a 3-month prevalence (pelvic pain of at least 6 months' duration) of 15% in women aged 18–50 in the general US population. In the UK, an annual prevalence in primary care of 38/1000 was found in women aged 15–73, a rate comparable to that of asthma (37/1000) and back pain (41/1000). The monthly incidence in primary care was 1·6/1000. No incidence figures exist for the general population.Analysis of risk factors for CPP is highly complicated owing to its multifactorial aetiology. At present, it is only of some value using women with CPP identified at community level, since those in primary, secondary or tertiary care are likely to constitute highly selected sub-groups.

The prevalence of chronic pelvic pain in women in the United Kingdom: A systematic review: Zondervan K.T.; Yudkin P.L.; Vessey M.P.; Dawes M.G.; Barlow D.H.; Kennedy S.H. UK Br J Obstet Gynecol 1998 105/1 (93–99)

The prevalence of chronic pelvic pain in women in the United Kingdom: A systematic review: Zondervan K.T.; Yudkin P.L.; Vessey M.P.; Dawes M.G.; Barlow D.H.; Kennedy S.H. UK Br J Obstet Gynecol 1998 105/1 (93–99)

The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review.

To obtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data. Systematic review of published papers. The general population or hospitals in the United Kingdom. Women participating in relevant community surveys or control women participating in hospital-based studies. Papers were retrieved by systematically searching the databases MEDLINE, EMBASE and PsycLit, and by hand searching. Studies were included if they 1. were community-based and reported prevalence rates of chronic pelvic pain, dyspareunia, dysmenorrhoea, or abdominal pain, or 2. referred to a clinical population but reported prevalence rates in a disease-free control group. Prevalence rates for chronic pelvic pain including any overlap with dyspareunia, dysmenorrhoea and abdominal pain. No community-based study has been performed that provides an estimate of the prevalence of chronic pelvic pain in the general UK population. A rate of 39% was reported in women undergoing laparoscopy for sterilisation or investigation of infertility in the single study from the United Kingdom investigating chronic pelvic pain unrelated to menstruation or intercourse. Prevalence rates for dyspareunia, dysmenorrhoea, and abdominal pain found in UK community-based studies were 8%, 45% to 97%, and 23% to 29%, respectively, but definitions used varied greatly. Because chronic pelvic pain can reduce the quality of life and general wellbeing, there is a need for a community-based study into the prevalence of chronic pelvic pain and its effect upon the lives of women in the UK.

Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates

To determine the prevalence of chronic pelvic pain in U.S. women aged 18-50 years, and to examine its association with health-related quality of life, work productivity, and health care utilization. In April and May 1994, the Gallup Organization telephoned 17,927 U.S. households to identify women aged 18-50 years who experienced chronic pelvic pain, ie, of at least 6 months' duration. Those who reported chronic pelvic pain were surveyed on severity, frequency, and diagnosis; quality of life; work loss and productivity; and health care utilization. Among 5263 eligible women who agreed to participate, 773 (14.7%) reported chronic pelvic pain within the past 3 months. Those who reported chronic pelvic pain had significantly lower mean scores for general health than those who did not (70.5 versus 78.8,P<.05), and 61% of those with chronic pelvic pain reported that the etiology was unknown. Women diagnosed with endometriosis reported the most health distress, pain during or after intercourse, and interference with activities because of pain. Estimated direct medical costs for outpatient visits for chronic pelvic pain for the U.S population of women aged 18-50 years are $881.5 million per year. Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity. Frequently, the cause of chronic pain is undiagnosed, although it affects approximately one in seven U.S. women. Increased awareness of its cost and impact on quality of life should promote increased medical attention to this problem.

The prevalence of chronic pelvic pain and irritable bowel syndrome in two university clinics

AbstractVery little is known about the prevalence of chronic pelvic pain or its comorbidity with irritable bowel syndrome. In order to obtain a prevalence estimate of chronic pelvic pain, a questionnaire was given to 651 women in two university clinics. Approximately 38% of the women had a lifetime prevalence of chronic or intermittent pelvic pain, and 12% reported current pain. Women with pelvic pain were also significantly more likely than women without pain to express other pain and aversive symptoms such as bowel problems, menstrual and sexual dysfunction, and to have higher psychological distress scores on the General Health Questionnaire. Of the 250 women who reported pelvic pain, 79% also met criteria for probable irritable bowel syndrome. Patients meeting criteria for both chronic pelvic pain and irritable bowel syndrome were more likely to have relatives with pain, meet caseness criteria for psychiatric diagnosis on the General Health Questionnaire and had a greater number of other types of pain ...