Lower pain thresholds in women with chronic pelvic pain: recognizing the role of anxiety and depression as part of person-centered approaches to treatment

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Published: Jun 25, 2012
DOI: https://doi.org/10.5750/ijpcm.v2i2.225
Keywords:
Anthropometric measures anxiety chronic pelvic pain depression electrical stimulation pain threshold person-centered medicine quality of life

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Liana Gomide
Mary Lourdes Lima de Souza Montenegro
Antônio Alberto Nogueira
Omero Benedicto poli Poli
Júlio César Rosa e Silva
Francisco José Candido dos Reis

Abstract

Aims and objectives: The interdisciplinary approach for managing chronic pelvic pain is based on the foundation that pain perception is not only linked to peripheral nociceptive stimuli, but also strongly influenced by a combination of modulating factors.  We performed a cross-sectional study to compare pain thresholds in women with chronic pelvic pain versus healthy controls, analyzing the influence of anxiety and depression in the thresholds.Methods: A total of 43 women with chronic pelvic pain and 20 healthy female volunteers were evaluated using transcutaneous electrical nerve stimulation. The intensity of clinical pain was measured by the visual analogue scale and the McGill pain questionnaire and the presence of anxiety and depression was verified by the Hospital Anxiety and Depression Scale.Results: The median for the pain thresholds in the study and control groups was 11,66 and 13,3 (p = 0.0009). There was a significant correlation between the visual analogue scale and pain response (r = -0.42, p = 0.005). There was also a significant correlation between pain threshold and anxiety (r = -0.49, p = 0.001) and between depression and pain threshold (r = - 0,46 p = 0.001).Conclusion: Our findings suggest that women with chronic pelvic pain have lower experimental pain thresholds, and this may be influenced by anxiety and depression. We therefore contend that assessments of anxiety and depression should form part of the person-centered approach to the management of chronic pelvic pain.

Article Details

Issue
Vol. 2 No. 2 (2012): June
Section
Regular Articles

References

Montenegro, M.L., Mateus-Vasconcelos, E.C., Candido dos Reis, F.J., Rosa e Silva, J.C., Nogueira, A.A. & Poli Neto, O.B. (2010). Thiele massage as a therapeutic option for women with chronic pelvic pain caused by tenderness of pelvic floor muscles. Journal of Evaluation in Clinical Practice 16 (5) 981-982.

Mathias, S.D., Kuppermann, M., Liberman, R.F., Lipschutz, R.C. & Steege, J.F. (1996). Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstetrics and Gynecology 87 (3) 321-327.

Ong, K.S. & Seymour, R.A. (2004). Pain measurement in humans. Surgeon 2 (1) 15-27.

Hellstrom, B. & Anderberg, U.M. (2003). Pain perception across the menstrual cycle phases in women with chronic pain. Perceptual and Motor Skills 96 (1) 201-211.

Faleiros Sousa, F.A.E. & Da Silva, J.A. (2004). Avaliação e mensuração da dor em contextos clínicos e de pesquisa. Revista Dor: Pesquisa, Clínica e Terapêutica 5 (4) 408-429.

Reiter, R.C. (1998). Evidence-based management of chronic pelvic pain. Clinical Obstetrics and Gynecology 41 (2) 422-435.

Neddermeyer, T.J., Fluhr, K. & Lotsch, J. (2008). Principle components analysis of pain thresholds to thermal, electrical, and mechanical stimuli suggests a predominant common source of variance. Pain 138 (2) 286-291.

Silva, J.A. & Ribeiro-Filho, N.P. (2006). Avaliação e mensuração de dor: pesquisa, teoria e prática. Ribeirão Preto: Funpec.

Diatchenko, L., Slade, G.D., Nackley, A.G., Bhalang, K., Sigurdsson, A., Belfer, I., Goldman, D., Xu, K., Shabalina, S.A., Shagin, D., Max, M.B., Makarov, S.S. & Maixner, W. (2005). Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Human Molecular Genetics 14 (1) 135-143.

Ferin, M., Jewelewiez, R. & Warren, M. (1993). The menstrual cycle. Oxford: Oxford University Press.

Telli, O. & Cavlak, U. (2006). Measuring the pain threshold and tolerance using electrical stimulation in patients with Type II diabetes mellitus. Journal of Diabetes and its Complications 20 (5) 308-316.

Machado, R.B., Tachotti, F., Cavenague, G. & Maia, E. (2006). Effects of two different oral contraceptives on total body water: a randomized study. Contraception 73 (4) 344-347.

Bajaj, P., Arendt-Nielsen, L. & Madsen, H. (2001). Sensory changes during the ovulatory phase of the menstrual cycle in healthy women. European Journal of Pain 5 (2) 135-144.

Tassorelli, C., Sandrini, G., Cecchini, A.P., Nappi, R.E., Sances G, Martignoni E. Changes in nociceptive flexion reflex threshold across the menstrual cycle in healthy women. Psychosom Med. 2002; 64(4): 621-6.

Dick, M.L. (2004). Chronic pelvic pain in women: assessment and management. Australian Family Physician 33 (12) 971-976.

Durnin, J.V. & Womersley, J. (1974). Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. British Journal of Nutrition 32 (1) 77-97.

Kane, R.L., Bershadsky, B., Rockwood, T., Saleh, K. & Islam, N.C. (2005). Visual Analog Scale pain reporting was standardized. Journal of Clinical Epidemiology 58 (6) 618-623.

Melzack, R. (1975). The McGill Pain Questionnaire: major properties and scoring methods. Pain 1 (3) 277-299.

Melzack, R. (2005). The McGill pain questionnaire: from description to measurement. Anesthesiology 103 (1) 199-202.

Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67 (6) 361-370.

Botega, N.J., Ponde, M.P. & Medeiros, P. (1998). Validação da escala hospitalar de ansiedade e depressão (HAD) em pacientes epiléticos ambulatoriais. Jornal Brasileiro de Psiquatria 47 (6) 285-289.

Castro, M.M.C., Quarantini, L. & Neves-Batista, S. (2006). Validade da escala hospitalar de ansiedade e depressão em pacientes com dor crônica. Revista Brasileira de Anestesiologia 56 (5) 470-477.

Kantor, G., Alon, G. & Ho, H.S. (1994). The effects of selected stimulus waveforms on pulse and phase characteristics at sensory and motor thresholds. Physical Therapy 74 (10) 951-962.

Barbosa, M.B. (2006). Avaliação dos limiares nas diferentes fases do ciclo menstrual [Dissertação (Mestrado em Fisioterapia)]. Piracicaba: Universidade Metodista de Piracicaba.

Barbosa, M.B., Montebelo, M.I.L. & Guirro, E.C.O. (2007). Determinação dos limiares de percepção sensorial e de resposta motora nas diferentes fases do ciclo menstrual. Revista Brasileira de Fisioterapia 11 (6) 443-449.

Lund, I., Lundeberg, T., Kowalski, J. & Svensson, E. (2005). Gender differences in electrical pain threshold responses to transcutaneous electrical nerve stimulation (TENS). Neuroscience Letters 375 (2) 75-80.

Ward, A.R. & Robertson, V.J. (1998). Sensory, motor, and pain thresholds for stimulation with medium frequency alternating current. Archieves of Physical Medicine and Rehabilitation 79 (3) 273-278.

Riley, J.L., 3rd, Robinson, M.E., Wise, E.A. & Price, D.D. (1999). A meta-analytic review of pain perception across the menstrual cycle. Pain 81 (3) 225-235.

Romão, A.P.M.S. (2008). O impacto da ansiedade e depressão na qualidade de vida de mulheres com dor pélvica crônica [Dissertação (Mestrado em Biologia da Reprodução)]. Ribeirão Preto: Universidade de São Paulo.

Romao, A.P., Gorayeb, R., Romao, G.S., Poli-Neto, O.B., dos Reis, F.J., Rosa-e-Silva, J.C. & Nogueira, A.A. (2009). High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain. International Journal of Clinical Practice 63 (5) 707-711.

Gomibuchi, H., Taketani, Y., Doi, M., Yoshida, K., Mizukawa, H., Kaneko, M., Kohda, K., Takei, T., Kimura, Y., Liang, S.G., et al. (1993). Is personality involved in the expression of dysmenorrhea in patients with endometriosis? American Journal of Obstetrics and Gynecology 169 (3) 723-725.

Monga, T.N., Tan, G., Ostermann, H.J., Monga, U. & Grabois, M. (1998). Sexuality and sexual adjustment of patients with chronic pain. Disability and Rehabilitation 20 (9) 317-329.

Fráguas Júnior, R. & Figueiró, J.A.B. (2000). Depressões secundárias: peculiaridades da depressão no contexto médico não-psiquiátrico. In: Depressões em medicina interna e em outras condições. (Fráguas Júnior, Figueiró). São Paulo: Atheneu.

Alstergren, P. & Forstrom, J. (2003). Acute oral pain intensity and pain threshold assessed by intensity matching to pain induced by electrical stimuli. Journal of Orofacial Pain 17 (2) 151-159.

Weyerbacher, A.R., Xu, Q., Tamasdan, C., Shin, S.J. & Inturrisi, C.E. (2010). N-Methyl-D-aspartate receptor (NMDAR) independent maintenance of inflammatory pain. Pain 148 (2) 237-246.

Besson, J.M. (1999). The neurobiology of pain. Lancet 353 (9164) 1610-1615.

Butrick, C.W. (2007). Chronic pelvic pain: how many surgeries are enough? Clinical Obstetrics and Gynecology 50 (2) 412-424.

Millan, M.J. (1999). The induction of pain: an integrative review. Progress in Neurobiology 57 (1) 1-164.

Bates, M.S., Edwards, W.T. & Anderson, K.O. (1993). Ethnocultural influences on variation in chronic pain perception. Pain 52 (1) 101-112.

Rhudy, J.L. & Meagher, M.W. (2000). Fear and anxiety: divergent effects on human pain thresholds. Pain 84 (1) 65-75.

Schumacher, R. & Velden, M. (1984). Anxiety, pain experience, and pain report: a signal-detection study. Perceptual and Motor Skills 58 (2) 339-349.

Michelotti, A., Farella, M., Tedesco, A., Cimino, R. & Martina, R. (2000). Changes in pressure-pain thresholds of the jaw muscles during a natural stressful condition in a group of symptom-free subjects. Journal of Orofacial Pain 14 (4) 279-285.

Malison, R.T., Price, L.H., Berman, R., van Dyck, C.H., Pelton, G.H., Carpenter, L., Sanacora, G., Owens, M.J., Nemeroff, C.B., Rajeevan, N., Baldwin, R.M., Seibyl, J.P., Innis, R.B. & Charney, D.S. (1998). Reduced brain serotonin transporter availability in major depression as measured by [123I]-2 beta-carbomethoxy-3 beta-(4-iodophenyl)tropane and single photon emission computed tomography. Biological Psychiatry 44 (11) 1090-1098.

Lautenbacher, S. & Fillingim, R.B. (2004). Pathophysiology of pain perception. New York: Springer.

Clauw, D.J., Williams, D., Lauerman, W., Dahlman, M., Aslami, A., Nachemson, A.L., Kobrine, A.I. & Wiesel, S.W. (1999).Pain sensitivity as a correlate of clinical status in individuals with chronic low back pain. Spine 24 (19) 2035-2041.

Sheps, D.S., McMahon, R.P., Light, K.C., Maixner, W., Pepine, C.J., Cohen, J.D., Goldberg, A.D., Bonsall, R., Carney, R., Stone, P.H., Sheffield, D. & Kaufmann, P.G. (1999). Low hot pain threshold predicts shorter time to exercise-induced angina: results from the psychophysiological investigations of myocardial ischemia (PIMI) study. Journal of the American College of Cardiology 33 (7) 1855-1862.

Bisgaard, T., Klarskov, B., Rosenberg, J. & Kehlet, H. (2001). Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 90 (3) 261-269.

Granot, M., Lowenstein, L., Yarnitsky, D., Tamir, A. & Zimmer, E.Z. (2003). Postcesarean section pain prediction by preoperative experimental pain assessment. Anesthesiology 98 (6) 1422-1426.

Nikolajsen, L., Ilkjaer, S. & Jensen, T.S. (2000). Relationship between mechanical sensitivity and postamputation pain: a prospective study. European Journal of Pain 4 (4) 327-334.

Sheather-Reid, R.B. & Cohen, M.L. (1998). Psychophysical evidence for a neuropathic component of chronic neck pain. Pain 75 (2-3) 341-347.

Werner, M.U., Duun, P. & Kehlet, H. (2004). Prediction of postoperative pain by preoperative nociceptive responses to heat stimulation. Anesthesiology 100 (1) 115-119; discussion 5A.

Edwards, R.R., Doleys, D.M., Lowery, D. & Fillingim, R.B. (2003). Pain tolerance as a predictor of outcome following multidisciplinary treatment for chronic pain: differential effects as a function of sex. Pain 106 (3) 419-426.

Nielsen, P.R., Norgaard, L., Rasmussen, L.S. & Kehlet, H. (2007). Prediction of post-operative pain by an electrical pain stimulus. Acta Anaesthesiologica Scandinavica 51 (5) 582-586.