Examining the role of comorbid factors in the development of central sensitization with chronic pelvic pain in cases of adolescent endometriosis
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OBJECTIVES: This study aims to better understand the relationship between psychosocial factors and the development of chronic pelvic pain (CPP) in cases of adolescent endometriosis, specifically mood disorders, pain catastrophizing and quality of life, and to detect the development of central sensitization within this population. METHODS: Eligible candidates were patients between 14 and 22 years old with confirmed diagnosis of endometriosis and chronic pelvic pain who were enrolled in the Women’s Health Study: From Adolescence to Adulthood through the Boston Center for Endometriosis (BCE) and Boston Children’s Hospital. The administration of quantitative sensory testing (QST) to assess mechanical touch perception, pressure pain sensitivity and temporal summation was performed on 48 subjects. Pre-surgical baseline surveys, which included pain catastrophizing and quality of life measures, were obtained from the BCE. Record of diagnosed mood disorder (anxiety/depression) was obtained through medical chart review. Pearson correlations between QST measures, pain catastrophizing, presence of mood disorders or central sensitization and pre-surgical pain scores were conducted. One-way ANOVA calculations, and one sample and paired t-tests were conducted to gain further understanding of these variables as they relate to groups within the cohort. RESULTS: Regarding QST measures, 23 subjects (47.9%) produced a wind-up phenomenon from temporal summation during QST administration, which serves as a surrogate for the presence of central sensitization (+CS). Pressure sensation and pain scores correlated at all test sites (lower and upper abdomen, as well as finger control site) and wind-up phenomenon correlated in the lower and upper abdomen throughout the cohort. For the presence of mood disorders, anxiety and depression were equally distributed across the +CS and –CS groups. Review of pre-surgical pain scores and pain catastrophizing (PCS) within the cohort had significant correlations between pre-surgical pain and PCS subsets of rumination and magnification. PCS total and subset scores also correlated to +CS. One-way ANOVA calculations showed the cohort as a whole presented with clinically significant helplessness. CONCLUSIONS: Results encourage further investigation of the relationship between endometriosis, comorbid conditions, environmental factors and the development of CPP within the adolescent population. More detailed data regarding mental health and documentation of condition progression, as well as establishment of health control values and sample growth are encouraged for the continued progress of this project.
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