在一家三级盆腔疼痛诊所寻求治疗的女性的慢性盆腔疼痛特征。

Chronic Pelvic Pain Profiles in Women Seeking Care in a Tertiary Pelvic Pain Clinic.

机构信息

Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.

Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.

出版信息

Pain Med. 2023 Feb 1;24(2):207-218. doi: 10.1093/pm/pnac122.

DOI:10.1093/pm/pnac122

PMID:35972368

Abstract

OBJECTIVE

Female chronic pelvic pain (CPP) has multiple pain generators and significant psychosocial sequalae. Biopsychosocial-based phenotyping could help identify clinical heterogeneity that may inform tailored patient treatment. This study sought to identify distinct CPP profiles based on routinely collected clinical information and evaluate the validity of the profiles through associations with social histories and subsequent health care utilization.

METHODS

Women (18-77 years, n = 200) seeking care for CPP in a tertiary gynecological pelvic pain clinic between 2017 and 2020 were included. Baseline data of pain intensity, interference, catastrophizing, acceptance, overlapping pelvic pain syndromes, and co-occurring psychiatric disorders were subject to a partition around medoids clustering to identify patient profiles. Profiles were compared across social history and subsequent treatment modality, prescribed medications, and surgeries performed.

RESULTS

Two profiles with equal proportion were identified. Profile 1 was vulvodynia and myofascial pelvic pain-dominant characterized by lower pain burden and better psychological functioning. Profile 2 was visceral pain-dominant featuring higher pain interference and catastrophizing, lower pain acceptance, and higher psychiatric comorbidity. Patients in Profile 2 had 2-4 times higher prevalence of childhood and adulthood abuse history (all P < .001), were more likely to subsequently receive behavioral therapy (46% vs 27%, P = .005) and hormonal treatments (34% vs 21%, P = .04), and were prescribed more classes of medications for pain management (P = .045) compared to patients in Profile 1.

CONCLUSIONS

Treatment-seeking women with CPP could be separated into two groups distinguished by pain clusters, pain burden, pain distress and coping, and co-occurring mental health disorders.

摘要

目的

女性慢性盆腔痛（CPP）有多种疼痛产生机制，并伴有显著的心理社会后果。基于生物-心理-社会的表型分析有助于确定可能为患者提供个性化治疗的临床异质性。本研究旨在根据常规收集的临床信息确定不同的 CPP 特征，并通过与社会史和随后的医疗保健利用相关联来评估这些特征的有效性。

方法

2017 年至 2020 年间，在一家三级妇科盆腔疼痛诊所因 CPP 就诊的女性（18-77 岁，n=200）被纳入本研究。疼痛强度、干扰、灾难化、接受度、重叠的盆腔疼痛综合征和共存的精神障碍等基线数据采用中位数分割聚类进行分析，以确定患者特征。比较不同社会史和随后的治疗方式、处方药物和手术的特征。

结果

确定了两种比例相等的特征。特征 1 为以外阴痛和肌筋膜性盆腔痛为主，其疼痛负担较低，心理功能较好。特征 2 为以内脏痛为主，疼痛干扰和灾难化程度较高，疼痛接受度较低，精神共病率较高。特征 2 组患者的童年和成年期受虐待史的患病率高 2-4 倍（均 P < 0.001），更有可能随后接受行为治疗（46% vs 27%，P = 0.005）和激素治疗（34% vs 21%，P = 0.04），且用于疼痛管理的药物种类也更多（P = 0.045）。