Prevalence and impact of comorbidities in women with chronic pelvic pain
Prevalência e impacto de comorbidades em mulheres com dor pélvica crônica
Déborah Alvim Monteiro Batista Alves; Nayara da Silva Fabrício Souza; Weder Silva Borges Junior; Délio Marques Conde; Vânia Meira Siqueira-Campos; José Miguel de Deus
Abstract
BACKGROUND AND OBJECTIVES: Chronic pelvic pain (CPP) is a common condition in women and there are often associated comorbidities. The objective of this study was to evaluate the prevalence of comorbidities in patients with CPP and to seek associations between comorbidities and the manifestations of chronic pain.
METHODS: Observational case-control study with sociodemographic, behavioral and clinical information, including comorbidities, in 246 women, 123 with CPP and 123 without CPP (control group).
RESULTS: Anxiety, depression, migraine and endometriosis were the most frequent comorbidities in women with CPP. The comorbidities assessed in the CPP group were not associated with pain intensity score, history of abortion, physical violence or sexual violence (p>0.05). In the group of women with CPP and endometriosis, the median anxiety and depression score was significantly lower than in the group without endometriosis (14.5; 95% CI: 11.0-14.9) versus (17.0; 95% CI: 14.6-16.7), p=0.012 and (13.0; 95%CI: 11.1-15.9) versus (16.5; 95% CI: 14.5-17.6), p= 0.045, respectively. In patients with migraine, the median depression score was higher in the group of women with CPP compared to the group without CPP (15.0; 95% CI: 14.1-17.8) versus (10.0; 95% CI: 8.5-12.4), p=0.048.
CONCLUSION: The most prevalent comorbidities in women with CPP were mental disorders, migraine and endometriosis. Comorbidities were not related to pain intensity, physical violence or sexual violence. Having a diagnosis of endometriosis is associated with lower anxiety and depression scores in patients with CPP. Overlapping migraine and CPP were associated with a worse depression score.
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A dor pélvica crônica (DPC) é uma condição comum em mulheres e frequentemente há comorbidades associadas. O objetivo deste estudo foi avaliar a prevalência de comorbidades em pacientes de DPC e buscar associações entre comorbidades e as manifestações da dor crônica.
MÉTODOS: Estudo observacional de caso-controle com informações sociodemográficas, comportamentais e clínicas, incluindo comorbidades, em 246 mulheres, sendo 123 com DPC e 123 sem DPC (grupo controle).
RESULTADOS: Ansiedade, depressão, enxaqueca e endometriose foram as comorbidades mais frequentes em mulheres com DPC. As comorbidades avaliadas no grupo com DPC não se associaram com o escore de intensidade da dor, com história de aborto, de violência física nem de violência sexual (p>0,05). No grupo de mulheres com DPC e endometriose, a mediana do escore de ansiedade e de depressão foi significativamente menor do que no grupo sem endometriose (14,5; IC 95%: 11,0-14,9) versus (17,0; IC 95%: 14,6-16,7), p=0,012 e (13,0; IC 95%: 11,1-15,9) versus (16,5; IC 95%: 14,5-17,6), p=0,045, respectivamente. Em pacientes com enxaqueca, a mediana do escore de depressão foi maior no grupo de mulheres com DPC em relação ao grupo sem DPC (15,0; IC 95%: 14,1-17,8) versus (10,0; IC 95%: 8,5-12,4), p=0,048.
CONCLUSÃO: As comorbidades mais prevalentes em mulheres com DPC foram transtornos mentais, enxaqueca e endometriose. As comorbidades não se associaram à intensidade da dor, violência física ou sexual. O diagnóstico de endometriose associou-se a menores escores de ansiedade e de depressão em mulheres com DPC. A sobreposição de enxaqueca e DPC associou-se a um pior escore de depressão.
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Referências
1 Arnold MJ, Osgood At, Aust A. Chronic pelvic pain in women: ACOG Updates Recommendations. Am Fam Physician 2021;103(3):186-8.
2 Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141-7.
3 Coelho LS, Brito LM, Chein MB, Mascarenhas TS, Costa J P, Nogueira AA, Poli-Neto OB. Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil. Braz J Med Biol Res. 2014;47(9):818-25.
4 Vincent K, Evans E. An update on the management of chronic pelvic pain in women. Anaesthesia. 2021;76(S4):96-107.
5 Grinberg K, Sela Y, Nissanholtz-Gannot R. New Insights about chronic pelvic pain syndrome (CPPS). Int J Environ Res Public Health. 2020;17(9):3005.
6 Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic pelvic pain in women: a review. JAMA. 2021;325(23):2381.
7 Howard FM. The role of laparoscopy in the chronic pelvic pain patient. Clin Obstet Gynecol. 2003;46(4):749-66.
8 Williams RE, Hartmann KE, Sandler RS, Miller WC, Steege J F. Prevalence and characteristics of irritable bowel syndrome among women with chronic pelvic pain. Obstet Gynecol. 2004;104(3):452-8.
9 Cheng C, Rosamilia A, Healey M. Diagnosis of interstitial cystitis/bladder pain syndrome in women with chronic pelvic pain: a prospective observational study. Int Urogynecol J 2012;23(10):1361-6.
10 Siqueira-Campos VM, Fernandes LJH, de Deus JM, Conde DM. Parenting Styles, Mental Health, and Catastrophizing in Women with Chronic Pelvic Pain: A Case-Control Study. Int J Environ Res Public Health. 2022;19(20):13347.
11 Moreno AL, Sousa DA, Souza AMFLP, Manfro GG, Salum GA, Koller SH, Osório FL, Crippa JAS. Factor structure, reliability, and item parameters of the Brazilian-Portuguese version of the GAD-7 questionnaire. Temas Psicol. 2016;24:367-76.
12 Patient Health Questionnaire (PHQ) Screeners. Available online:
13 Santos IS, Tavares B F, Munhoz TN, Almeida LS, Silva NT, Tams BD, Patella AM, Matijasevich A. Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral [Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population]. Cad Saude Publica. 2013;29(8):1533-43.
14 Romão A P, Gorayeb R, Romão GS, Poli-Neto OB, dos Reis FJ, Rosa-e-Silva JC, Nogueira AA. High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain. Int J Clin Pract. 2009;63(5):707-11.
15 Siqueira-Campos VME, Da Luz RA, de Deus JM, Martinez EZ, Conde DM. Anxiety and depression in women with and without chronic pelvic pain: prevalence and associated factors. J Pain Res. 2019;12:1223-33.
16 Stratton P, Berkley KJ. Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update. 2011;17(3):327-46.
17 Jarrell JF, Vilos GA, Allaire C, Burgess S, Fortin C, Gerwin R, Lapensee L, Lea RH, Leyland NA, Martyn P, Shenassa H, Taenzer P. No. 164-Consensus Guidelines for the Management of Chronic Pelvic Pain. J Obstet Gynaecol Can. 2018;40(11):e747-e787.
18 Siqueira-Campos VM, de Deus MSC, Poli-Neto OB, Rosa-E-Silva JC, de Deus JM, Conde DM. Current challenges in the management of chronic pelvic pain in women: from bench to bedside. Int J Womens Health. 2022;14:225-44.
19 Aredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med. 2017;35(1):88-97.
20 Warren JW, Morozov V, Howard FM. Could chronic pelvic pain be a functional somatic syndrome? Am J Obstet Gynecol. 2011;205(3):199.e1-5.
Submetido em:
21/01/2024
Aceito em:
23/03/2024
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