Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain

Lysia Demetriou; Michal Krassowski; Pedro Abreu Mendes; Kurtis Garbutt; Allison F Vitonis; Elizabeth Wilkins; Lydia Coxon; Lars Arendt-Nielsen; Qasim Aziz; Judy Birch; Andrew W Horne; Anja Hoffman; Lone Hummelshoj; Claire E Lunde; Jane Meijlink; Danielle Perro; Nilufer Rahmioglu; Kathryn L Terry; Esther Pogatzki-Zahn; Christine B Sieberg; Rolf-Detlef Treede; Christian M Becker; Francisco Cruz; Stacey A Missmer; Krina T Zondervan; Jens Nagel; Katy Vincent

doi:10.3389/frph.2023.1140857

Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain

Front Reprod Health. 2023 May 30:5:1140857. doi: 10.3389/frph.2023.1140857. eCollection 2023.

Authors

Lysia Demetriou¹, Michal Krassowski¹, Pedro Abreu Mendes², Kurtis Garbutt¹, Allison F Vitonis^{3

4}, Elizabeth Wilkins¹, Lydia Coxon¹, Lars Arendt-Nielsen^{5

6}, Qasim Aziz⁷, Judy Birch⁸, Andrew W Horne⁹, Anja Hoffman¹⁰, Lone Hummelshoj¹¹, Claire E Lunde^{1

12

13}, Jane Meijlink¹⁴, Danielle Perro¹, Nilufer Rahmioglu¹, Kathryn L Terry^{3

4

15}, Esther Pogatzki-Zahn¹⁶, Christine B Sieberg^{12

13

17}, Rolf-Detlef Treede¹⁸, Christian M Becker¹, Francisco Cruz², Stacey A Missmer^{3

5

19

20}, Krina T Zondervan¹, Jens Nagel²¹, Katy Vincent¹

Affiliations

¹ Oxford Endometriosis Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.
² IBMC/I3S and Faculty of Medicine of Porto, Hospital S João, Porto, Portugal.
³ Boston Center for Endometriosis, Brigham and Women's Hospital and Boston Children's Hospital, Boston, MA, United States.
⁴ Department of Obstetrics and Gynaecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁵ Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
⁶ Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark.
⁷ Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
⁸ Pelvic Pain Support Network, Poole, United Kingdom.
⁹ MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
¹⁰ Research & Development, Pharmaceuticals Experimental Medicine, Bayer AG, Berlin, Germany.
¹¹ Endometriosis.org, London, United Kingdom.
¹² Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States.
¹³ Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children's Hospital, Boston, MA, London, United States.
¹⁴ International Painful Bladder Foundation, Naarden, Netherlands.
¹⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
¹⁶ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.
¹⁷ Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
¹⁸ Department of Neurophysiology, Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, Mannheim, Germany.
¹⁹ Department of Obstetrics, Gynecology, and Reproductive Biology; College of Human Medicine, Michigan State University, Grand Rapids, MI, United States.
²⁰ Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
²¹ Pharmaceuticals Division, Research and Early Development, Therapeutic Area Endocrinology, Metabolism and Reproductive Health, Exploratory Pathobiology, Bayer AG, Wuppertal, Germany.

Abstract

Introduction: Chronic pelvic pain (CPP) is a common condition affecting up to 26.6% of women, with many suffering for several years before diagnosis and/or treatment. Its clinical presentation is varied and there are frequently comorbid conditions both within and outside the pelvis. We aim to explore whether specific subgroups of women with CPP report different clinical symptoms and differing impact of pain on their quality of life (QoL).

Methods: The study is part of the Translational Research in Pelvic Pain (TRiPP) project which is a cross-sectional observational cohort study. The study includes 769 female participants of reproductive age who completed an extensive set of questions derived from standardised WERF EPHect questionnaires. Within this population we defined a control group (reporting no pelvic pain, no bladder pain syndrome, and no endometriosis diagnosis, N = 230) and four pain groups: endometriosis-associated pain (EAP, N = 237), interstitial cystitis/bladder pain syndrome (BPS, N = 72), comorbid endometriosis-associated pain and BPS (EABP, N = 120), and pelvic pain only (PP, N = 127).

Results: Clinical profiles of women with CPP (13-50 years old) show variability of clinical symptoms. The EAP and EABP groups scored higher than the PP group (p < 0.001) on the pain intensity scales for non-cyclical pelvic pain and higher than both the BPS and PP groups (p < 0.001) on the dysmenorrhoea scale. The EABP group also had significantly higher scores for dyspareunia (p < 0.001), even though more than 50% of sexually active participants in each pain group reported interrupting and/or avoiding sexual intercourse due to pain in the last 12 months. Scores for the QoL questionnaire (SF-36) reveal that CPP patients had significantly lower QoL across all SF-36 subscales (p < 0.001). Significant effects were also observed between the pain groups for pain interference with their work (p < 0.001) and daily lives (p < 0.001), with the EABP suffering more compared to the EAP and PP groups (p < 0.001).

Discussion: Our results demonstrate the negative impact that chronic pain has on CPP patients' QoL and reveal an increased negative impact of pain on the comorbid EABP group. Furthermore, it demonstrates the importance of dyspareunia in women with CPP. Overall, our results demonstrate the need for further exploration of interventions targeting QoL more broadly and suggest that novel approaches to classifying women with CPP are needed.

Keywords: bladder pain syndrome; chronic pelvic pain; dysmennorhoea; dyspareunia; endometriosis; pelvic pain.

© 2023 Demetriou, Krassowski, Abreu Mendes, Garbutt, Vitonis, Wilkins, Coxon, Arendt-Nielsen, Aziz, Birch, Horne, Hoffman, Hummelshoj, Lunde, Meijlink, Perro, Rahmioglu, Terry, Pogatzki-Zahn, Sieberg, Treede, Becker, Cruz, Missmer, Zondervan, Nagel and Vincent.

Grants and funding

The study was funded by Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No. 777500. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA. Financial support was provided by the J. Willard and Alice S. Marriott Foundation for establishment of and baseline data collection within the A2A cohort—from which the Boston-based TRiPP population was sampled. Center for Neuroplasticity and Pain (CNAP) is supported by the Danish National Research Foundation (DNRF121).