Cotton-tipped applicator test: validity and reliability in chronic pelvic pain

Nasr-Esfahani, Maryam; Jarrell, John

doi:10.1016/j.ajog.2012.11.005

Cited by 24 publications

(16 citation statements)

References 13 publications

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“…However, it is unlikely that active EM could explain this pain in our study as only one of the 13 women in the CFS+EM group was not menopausal and 85% of the women had undergone hysterectomy. It may reflect increased pain sensitivity that has been observed in women with chronic pelvic pain (41). The CFS+EM group had a very early mean age at menopause−36 years.…”

Section: Discussionmentioning

confidence: 99%

Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study

et al. 2019

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Background: Endometriosis (EM) is a recognized co-morbid condition in women with chronic fatigue syndrome (CFS). This analysis evaluates the impact of EM on the health of women with CFS by comparing selected health characteristics and laboratory parameters in women with CFS with and without EM (CFS+EM and CFS-only). Methods: This secondary analysis included all 36 women with CFS from a cross-sectional study of CFS in Wichita, KS, conducted between 2002 and 2003. The health characteristics and laboratory parameters of interest included functioning, fatigue, CFS-related symptoms, gynecologic history, routine laboratory parameters, inflammatory markers, cortisol levels, allostatic load, and sleep parameters (overnight polysomnography). We used parametric or non-parametric tests to compare group differences in the selected health characteristics and laboratory parameters. For examining the association between EM and variables of interest, logistic regression models were performed and odds ratios (OR) with 95% confidence intervals (CI) were reported for the magnitude of associations. Statistical significance was set at 0.05 (two-sided). Results: The mean age of this study sample was 50.9 years. Of women with CFS, 36.1% reported having EM. Age and body mass index (BMI) did not differ between CFS+EM and CFS-only groups. When examining the impact of EM, compared to women with CFS-only, women with both CFS and EM were more likely to report chronic pelvic pain [OR = 9.00 (95% CI, 1.47–55.25)] and hysterectomy [OR = 10.3 (1.82–58.39)], had more CFS symptoms (6.8 ± 0.3 vs. 5.5 ± 0.3, p = 0.02), younger mean age at menopause onset (36.4 ± 3.0 vs. 47.0 ± 2.7 years, p = 0.03), higher mean number of obstructive apnea episodes per hour (20.3 vs. 4.4, p = 0.05) and reported more negative life events (15.8 vs. 4.4, p = 0.05). Other parameters did not differ significantly between the two groups. Conclusions: We found more than a third of women with CFS reported endometriosis as a comorbid condition. The endometriosis comorbidity was associated with chronic pelvic pain, earlier menopause, hysterectomy, and more CFS-related symptoms. However, endometriosis in women with CFS did not appear to further impact functioning, fatigue, inflammatory markers, or other laboratory parameters. Further investigations including younger women are warranted.

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Section: Discussionmentioning

confidence: 99%

Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study

et al. 2019

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“…Possible increased pain sensitivity may underlie this association. 24 Increased pain sensitivity may exist in several overlapping pain conditions (CFS, fibromyalgia, endometriosis, irritable bowel syndrome, and interstitial cystitis), with women often having more than one condition. 17 Both estrogen and progesterone modulate pain in the nociceptive pathways in the spinal cord and at the central level (via interaction with the serotonin system).…”

Section: Discussionmentioning

confidence: 99%

Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women

2015

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Objective This study aims to examine whether gynecologic conditions are associated with chronic fatigue syndrome (CFS). Methods This study includes a subset of 157 women from a population-based case-control study in Georgia, United States, conducted in 2004-2009. Gynecologic history was collected using a self-administered questionnaire. Crude odds ratios (ORs) with 95% CIs and ORs adjusted for body mass index and other covariates, where relevant, were estimated for gynecologic conditions between 84 CFS cases and 73 healthy controls. Results Cases and controls were of similar age. Women with CFS reported significantly more gynecologic conditions and surgical operations than controls: menopause status (61.9% vs 37.0%; OR, 2.37; 95% CI, 1.21-4.66), earlier mean age at menopause onset (37.6 vs 48.6 y; adjusted OR, 1.22; 95% CI, 1.09-1.36), excessive menstrual bleeding (73.8% vs 42.5%; adjusted OR, 3.33; 95% CI, 1.66-6.70), bleeding between periods (48.8% vs 23.3%; adjusted OR, 3.31; 95% CI, 1.60-6.86), endometriosis (29.8% vs 12.3%; adjusted OR, 3.67; 95% CI, 1.53-8.84), use of noncontraceptive hormonal preparations (57.1% vs 26.0%; adjusted OR, 2.95; 95% CI, 1.36-6.38), nonmenstrual pelvic pain (26.2% vs 2.7%; adjusted OR, 11.98; 95% CI, 2.57-55.81), and gynecologic surgical operation (65.5% vs 31.5%; adjusted OR, 3.33; 95% CI, 1.66-6.67), especially hysterectomy (54.8% vs 19.2%; adjusted OR, 3.23; 95% CI, 1.46-7.17). Hysterectomy and oophorectomy occurred at a significantly younger mean age in the CFS group than in controls and occurred before CFS onset in 71% of women with records of date of surgical operation and date of CFS onset. Conclusions Menstrual abnormalities, endometriosis, pelvic pain, hysterectomy, and early/surgical menopause are all associated with CFS. Clinicians should be aware of the association between common gynecologic problems and CFS in women. Further work is warranted to determine whether these conditions contribute to the development and/or perpetuation of CFS in some women.

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“…The interrater reliability resulted in 98% agreement for the three study groups. The cotton-tipped applicator test showed 73% sensitivity and 100% specificity for differentiating patients with chronic pelvic pain from pain-free patients [14]. At present, there do not appear to be pain-testing techniques that specifically identify endometriosis independent from other visceral diseases.…”

Section: Perineal Cutaneous Allodynia 91%mentioning

confidence: 92%

Pain Testing in Endometriosis for the Clinician

Jarrell¹

2021

Endometriosis

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Clinical pain testing has been used to ascertain the pathophysiology of many clinical conditions, but its use in the management of endometriosis has been limited. Although the testing can require the use of complex testing in the laboratory, this chapter is directed to look at a test for allodynia that can be applied in the clinic. The test for cutaneous allodynia is validated, does not require sophisticated tools, and is readily accepted by woman. The presence of allodynia in certain gynecological presentations can indicate the woman’s pain system has become sensitized. Uses of the test in clinical encounters with women suffering from endometriosis and possible uses in future are presented.

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Cotton-tipped applicator test: validity and reliability in chronic pelvic pain

Cited by 24 publications

References 13 publications

Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study

Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study

Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women

Pain Testing in Endometriosis for the Clinician

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