Experimental pain tolerance is decreased and independent of clinical pain intensity in patients with endometriosis

Aken, Mieke van; Oosterman, Joukje M.; Rijn, Tineke van; Woudsma, Kelly J.; Ferdek, Magdalena A.; Ruigt, G.S.F.; Kozicz, Tamás; Braat, D.D.M.; Peeters, Ard; Nap, Annemiek W.

doi:10.1016/j.fertnstert.2018.06.040

Cited by 16 publications

(15 citation statements)

References 75 publications

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“…Dysmenorrhea appears to be highly prevalent in young women and to decrease with age. This may be partly explained by medication and advice used by women to cope with their pain [ 26 , 27 ]. Another hypothesis is that subsequent pregnancies and deliveries, occurring later, may also reduce dysmenorrhea, which could explain this linear decrease [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

Margueritte

Fritel

Zins

et al. 2021

JCM

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Dysmenorrhoea, dyspareunia, and non-menstrual chronic pelvic pain (NMCPP) are symptoms that are probably underreported and neglected. This study aimed to assess the prevalence and overlapping relations between these symptoms among a general population of French women of reproductive age. A cross-sectional study among the nationwide CONSTANCES cohort study recruiting a representative sample of women within different French areas was constructed. Women aged 18–49 years (n = 21,287) who reported periods in the previous three months and experienced intercourse at least once were asked about prevalence of three types of chronic pelvic pain: mild, moderate and severe dysmenorrhea; dyspareunia assessed according to its frequency; NMCPP from a binary question. Between the start of 2012 through the end of 2017, 21,287 women were enrolled, 39.8% of them (95% confidence interval (CI), 39.2–40.5) reported moderate to severe dysmenorrhea; 20.3% (95% CI, 18.7–21.9) of the youngest group (18–24 years) reported severe dysmenorrhea. Dyspareunia was reported to happen often or always by 7.9% (95% CI, 7.5–8.2) and peaked among the youngest women at 12.8% (95% CI, 11.5–14.1). NMCPP was reported by 17.0% (95% CI, 16.5–17.5). Moreover, 7.5% (95% CI, 6.4–8.6) of the women reported two or more types of severe or frequent pain. More attention should be paid to this substantial proportion (7.5%) of French women of reproductive age who experience multiple, severe and frequent pelvic pain symptoms.

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Section: Discussionmentioning

confidence: 99%

The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

Margueritte

Fritel

Zins

et al. 2021

JCM

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“…28 We also found that some women experienced constant pain that increased in intensity during menstruation and for others pain started as cyclical but worsened to be more severe, 33 persistent and pervasive, which has been linked to poor quality of life. 47 Research has suggested that experiencing pain may lead to sensitisation of the nervous system 12,13,48 recognised as a reason for pain to become more pervasive over time 49 however, participants believed that their endometriosis was worsening.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we found that intensity did not always relate to how intrusive pain was to everyday life. 48 Some less intense pain was experienced as more difficult to manage. Research has suggested that these differences in attentional focus are important in understanding how pain affects lives because severe pain can consume every experience 50 or prevent attention being paid to other aspects of experience leading to suffering.…”

Section: Conceptual Understanding Of Endometriosis-related Painmentioning

confidence: 99%

Constellations of pain: a qualitative study of the complexity of women’s endometriosis-related pain

Drabble

Long

Alele

et al. 2020

British Journal of Pain

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Introduction: Prior research into endometriosis-related pain has focused on specific aspects of the pain experience such as cyclical pain, emotional aspects of pain and certain types of pain such as dysmenorrhea and dyspareunia. However, research has paid less attention to the diversity and complexity of women’s pain experiences, which can lead to failure to recognise some symptoms as part of endometriosis and poor symptom management. Methods: We conducted qualitative semi-structured face-to-face interviews with 20 women in the United Kingdom recruited from an endometriosis self-help group with a diagnosis of endometriosis via laparoscopy. A topic guide framed questions around experiences of pain. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using inductive thematic analysis. Results: Women experienced multiple types of pain that they felt were caused by endometriosis and affected many different parts of the body including bowel, bladder, lungs, kidneys, nerves, upper body, lower limbs and head. These pains consisted of different conceptual categories: type, pattern and intensity. These categories came together to create a complex, interrelated experience for each individual that we termed ‘constellations of pain’ because each woman had a complex set of pain categories and no two individuals appeared to have the same pain experience. Conclusion: The complexity and diversity of endometriosis-related pain found in this study has implications for improving diagnosis, medical and non-medical pain management and improving the clinical encounter between women and healthcare professionals.

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“…It has been shown that women with endometriosis experience a decreased pain threshold and therefore a higher pain perception after noxious stimuli [ 17 ]. However, studies of patients with CPP have shown similar findings [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis

Kanellos

Nirgianakis

Siegenthaler

et al. 2021

JCM

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(1) Background: The aim of this study was to evaluate the impact of endometriosis on postoperative pain following laparoscopic hysterectomy; (2) Methods: A total of 214 women who underwent a laparoscopic hysterectomy between January 2013 and October 2017 were divided into four subgroups as follows: (1) endometriosis with chronic pain before the surgery (n = 57); (2) pain-free endometriosis (n = 50); (3) pain before the surgery without endometriosis (n = 40); (4) absence of both preoperative pain and endometriosis (n = 67). Postoperative pain was compared by using Visual Analog Scale (VAS) scores and by tracking the use of painkillers during the day of surgery and the first two postoperative days; (3) Results: Women with chronic pain before the surgery reported higher VAS scores during the first postoperative days, while the use of analgesics was similar across the groups. There was no difference in the postoperative pain when comparing endometriosis patients to non-endometriosis patients; (4) Conclusions: Women with chronic pelvic pain demonstrated increased postoperative pain after laparoscopic hysterectomy, which was independent of the presence or severity of endometriosis. The increased VAS scores did not, however, translate into equally greater use of painkillers, possibly due to the standardised protocols of analgesia in the immediate postoperative period. These findings support the need for careful postsurgical pain management in patients with pain identified as an indication for hysterectomy, independent of the extent of the surgery or underlying diagnosis.

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Experimental pain tolerance is decreased and independent of clinical pain intensity in patients with endometriosis

Cited by 16 publications

References 75 publications

The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

Constellations of pain: a qualitative study of the complexity of women’s endometriosis-related pain

Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis

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