Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
EQness, Sydney, New South Wales, Australia.
Women Health. 2021 Nov-Dec;61(10):937-946. doi: 10.1080/03630242.2021.1993423. Epub 2021 Oct 31.
Chronic pelvic pain is the main symptom in women with endometriosis. Evidence suggests that psychological stress and autonomic regulation contribute to symptoms and pathophysiological modulation. We investigated the relationship between endometriosis-related pain severity, perceived stress, and autonomic balance in a sample of 81 women suffering chronic pelvic pain with deep endometriosis. Perceived stress and pelvic pain symptoms were assessed using the 10-item version of the Perceived Stress Scale (PSS-10) and the Numeric Pain Rating Scale (NPRS), respectively. Autonomic nervous system regulation was evaluated using vagally mediated components of the heart rate variability (vmHRV). Our results showed that pain unpleasantness and perceived stress were positively correlated, and women with mood disorders had higher perceived stress. The women with low resting vmHRV experience more intense pelvic pain, pain unpleasantness, and a higher number of severe endometriosis-related pain descriptors. The positive association between perceived stress, mood disorder, and pain unpleasantness demonstrates the additive effect between these aversive experiences. The inverse association between parasympathetic tone and pain suggests contributions of the Descending Inhibitory Pain pathway efficiency to symptom severity in women with endometriosis.
慢性盆腔疼痛是子宫内膜异位症患者的主要症状。有证据表明，心理压力和自主调节会导致症状和病理生理调节。我们调查了 81 名患有深部子宫内膜异位症慢性盆腔疼痛的女性中，子宫内膜异位症相关疼痛严重程度、感知压力和自主平衡之间的关系。感知压力和盆腔疼痛症状分别使用 10 项感知压力量表（PSS-10）和数字疼痛评分量表（NPRS）进行评估。自主神经系统调节使用心率变异性（vmHRV）的迷走神经介导成分进行评估。我们的结果表明，疼痛不适和感知压力呈正相关，且患有情绪障碍的女性感知压力更高。静息时 vmHRV 较低的女性经历更强烈的盆腔疼痛、疼痛不适和更多严重的子宫内膜异位症相关疼痛描述。感知压力、情绪障碍和疼痛不适之间的正相关表明这些痛苦体验具有累加效应。副交感神经活动与疼痛之间的反比关系表明，下行抑制疼痛通路效率对子宫内膜异位症女性症状严重程度的贡献。
