Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Obstetrics and Gynecology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
Acta Obstet Gynecol Scand. 2023 Oct;102(10):1396-1408. doi: 10.1111/aogs.14678. Epub 2023 Sep 12.
There has been increased interest in addressing chronic pelvic pain and its complexity in women. The often multifactorial etiology of chronic pelvic pain and its heterogeneous presentation, however, make the condition challenging to manage. Overlap with other pain-related conditions is frequently reported, and chronic pelvic pain may impact sexual function. Nevertheless, little is known about the symptom burden of chronic pelvic pain and more complex pelvic pain in different groups of women. Thus, the aim of our study was to use a newly validated Norwegian version of the Amsterdam Complex Pelvic Pain Symptom Scale (ACPPS) to describe and compare the symptom severity of complex pelvic pain in three cohorts of women and to assess associations between demographic and gynecological characteristics and the severity of the condition.
In our cross-sectional study, we collected self-reported data from patients referred to gynecological outpatient clinics, members of vulvodynia or endometriosis patient associations, and healthy volunteers. The 397 participants (47% response rate) completed an online survey about their demographic and gynecological characteristics and symptoms related to complex pelvic pain, including the Norwegian ACPPS. Score means on questionnaires, with standard deviations and 95% confidence intervals, were recorded. We used Pearson's chi-square test, Analysis of variance and multivariable linear regression were used to assess associations of demographic and gynecological characteristics with ACPPS scores.
Members of the patient associations had significantly higher self-reported symptom burden than patients and volunteers. Symptom burden was lower among older and postmenopausal women, and unemployed women scored higher than employed ones. Especially high scores on the ACPPS were found among women with complaints of chronic pelvic pain, at least moderate pelvic pain intensity, and/or chronic vulvar pain. Women who had experienced sexual assault and/or reported low sexual function also reported high scores. In multivariable regression, fibromyalgia, low mental health and past sexual assault were found to be associated with high scores on the ACPPS.
Many women in our study reported complex pelvic pain, and overlap with other pain-related conditions, low mental health and past sexual assault was associated with high symptom burden. Those findings support taking a biopsychosocial approach to treating women who present with such complaints.
人们对治疗女性慢性盆腔疼痛及其复杂性越来越感兴趣。然而，慢性盆腔疼痛的多因素病因及其异质性表现使得该疾病的治疗具有挑战性。经常有报道称与其他与疼痛相关的疾病有重叠，慢性盆腔疼痛可能会影响性功能。尽管如此，对于不同女性群体中慢性盆腔疼痛和更复杂盆腔疼痛的症状负担知之甚少。因此，我们的研究目的是使用经过验证的挪威版阿姆斯特丹复杂盆腔疼痛症状量表（ACPPS）来描述和比较三组女性中复杂盆腔疼痛的症状严重程度，并评估人口统计学和妇科特征与疾病严重程度之间的关联。
在我们的横断面研究中，我们从妇科门诊就诊患者、外阴痛或子宫内膜异位症患者协会成员和健康志愿者中收集了自我报告的数据。397 名参与者（47%的回复率）完成了一项关于他们的人口统计学和妇科特征以及与复杂盆腔疼痛相关症状的在线调查，包括挪威 ACPPS。记录问卷的分数平均值、标准差和 95%置信区间。我们使用 Pearson's chi-square 检验、方差分析和多变量线性回归来评估人口统计学和妇科特征与 ACPPS 评分的关联。
患者协会成员的自我报告症状负担明显高于患者和志愿者。年龄较大和绝经后的女性症状负担较低，失业女性的评分高于就业女性。患有慢性盆腔疼痛、至少中度盆腔疼痛强度和/或慢性外阴疼痛的女性的 ACPPS 评分尤其高。经历过性侵犯和/或报告性功能低下的女性报告的评分也很高。在多变量回归中，纤维肌痛、心理健康水平低和既往性侵犯与 ACPPS 评分高有关。
我们研究中的许多女性报告了复杂的盆腔疼痛，并且与其他与疼痛相关的疾病、心理健康水平低和既往性侵犯有重叠，与高症状负担有关。这些发现支持对出现此类症状的女性采用生物心理社会方法进行治疗。
