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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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


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.

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