Lifestyle and Chronic Pain in the Pelvis: State of the Art and Future Directions

Abstract

During their lifespan, many women are exposed to pain in the pelvis in relation to menstruation and pregnancy. Such pelvic pain is often considered normal and inherently linked to being a woman, which in turn leads to insufficiently offered treatment for treatable aspects related to their pain experience. Nonetheless, severe dysmenorrhea (pain during menstruation) as seen in endometriosis and pregnancy-related pelvic girdle pain, have a high impact on daily activities, school attendance and work ability. In the context of any type of chronic pain, accumulating evidence shows that an unhealthy lifestyle is associated with pain development and pain severity. Furthermore, unhealthy lifestyle habits are a suggested perpetuating factor of chronic pain. This is of specific relevance during lifespan, since a low physical activity level, poor sleep, or periods of (di)stress are all common in challenging periods of women’s lives (e.g., during menstruation, during pregnancy, in the postpartum period). This state-of-the-art paper aims to review the role of lifestyle factors on pain in the pelvis, and the added value of a lifestyle intervention on pain in women with pelvic pain. Based on the current evidence, the benefits of physical activity and exercise for women with pain in the pelvis are supported to some extent. The available evidence on lifestyle factors such as sleep, (di)stress, diet, and tobacco/alcohol use is, however, inconclusive. Very few studies are available, and the studies which are available are of general low quality. Since the role of lifestyle on the development and maintenance of pain in the pelvis, and the value of lifestyle interventions for women with pain in the pelvis are currently poorly studied, a research agenda is presented. There are a number of rationales to study the effect of promoting a healthy lifestyle (early) in a woman’s life with regard to the prevention and management of pain in the pelvis. Indeed, lifestyle interventions might have, amongst others, anti-inflammatory, stress-reducing and/or sleep-improving effects, which might positively affect the experience of pain. Research to disentangle the relationship between lifestyle factors, such as physical activity level, sleep, diet, smoking, and psychological distress, and the experience of pain in the pelvis is, therefore, needed. Studies which address the development of management strategies for adapting lifestyles that are specifically tailored to women with pain in the pelvis, and as such take hormonal status, life events and context, into account, are required. Towards clinicians, we suggest making use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., dysmenorrhea or pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle and applying appropriate pain management.

Risk factors for persistent pelvic girdle pain pregnancy-related (PPGP): a Systematic Review and meta-analysis approach

“…This type of management would allow for the implementation of chronicity prevention processes aimed at reducing the individual suffering of the woman, the costs for society but above all it would allow to reduce the risk of transition from acute pain to chronic pain [32] . To avoid this transition, in fact, more and more 17 importance has been given, from the current state of the limb to chronic pain in the pelvis, to the factors that affect lifestyle, namely: low level of physical activity, poor sleep, periods of distress [56] .…”

Evaluation and Medical Management of Chronic Pelvic Pain

“…Specific to patients with CPP, exercise has been associated with stress reduction and improvement in pain scores, though most studies lack the ability to draw strong conclusions from the existing data. 17…”

The Key Role of Lifestyle Factors in Perpetuating Chronic Pain: Towards Precision Pain Medicine

“…The Special Issue features state-of-the-art papers addressing key lifestyle factors of importance to patients having persistent pain and written by world leading experts and key opinion leaders in the field. For instance, an exciting state-of-the-art review proposes to clinicians working with patients with chronic pelvic pain to make use of the window of opportunity to prevent a potential transition from localized or periodic pain in the pelvis (e.g., pelvic pain during pregnancy and after delivery) towards persistent chronic pain, by promoting a healthy lifestyle [ 4 ]. In addition, original contributions to this Special Issue include literature reviews (systematic literature reviews with meta-analyses and narrative reviews) and exciting original research (trials, cohort studies, experimental lab work, and case–control studies) focussed on lifestyle and chronic pain.…”

“…The resulting multimodal approach for managing patients with chronic pain implies tailoring treatment to the individual patient characteristics and therefore fits into the global move towards precision medicine [ 2 ]. Evidence supporting such a paradigm shift from a tissue- and disease-based approach towards individually tailored multimodal lifestyle interventions for chronic pain is mounting [ 4 , 12 , 23 , 25 ], but further study is needed. Several papers included in this Special Issue highlighted key areas for future research in this area (e.g., [ 4 , 25 ]).…”

“…Evidence supporting such a paradigm shift from a tissue- and disease-based approach towards individually tailored multimodal lifestyle interventions for chronic pain is mounting [ 4 , 12 , 23 , 25 ], but further study is needed. Several papers included in this Special Issue highlighted key areas for future research in this area (e.g., [ 4 , 25 ]). Such research efforts hold the potential to improve outcomes and decrease the psychological and socioeconomic burden of chronic pain.…”