Psychological Factors in Chronic Pelvic Pain in Women: Relevance and Application of the Fear-Avoidance Model of Pain

Alappattu, Meryl; Bishop, Mark D.

doi:10.2522/ptj.20100368

Cited by 79 publications

(81 citation statements)

References 79 publications

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“…CPP patients have eight times more psychosomatic symptoms than controls 7 . The presence of family issues in most CPP patients suggests the importance of using psychotherapy to treat these females, as already emphasized by the literature 8,18 . Further qualitative studies may probably better explain possible CPP triggering factors.…”

Section: Discussionmentioning

confidence: 88%

“…There has been even further VAS decrease in patients submitted to cognitive-behavioral therapy being that this has only been applied to six cases, which has not provided statistical significance. It has to be stressed that patients were very resistant to accept psychotherapeutic aid, inasmuch that ¾ have not accepted it although being already a recommendation of the literature 1,2,8,18 . This is possibly a factor impairing ambulatory discharge of such patients.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of 230 women with chronic pelvic pain assisted at a public hospital

Deus¹,

Santos²,

Bosquetti³

et al. 2014

Revista Dor

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BACKGROUND AND OBJECTIVES:Chronic pelvic pain is prevalent, presents difficult treatment and has been poorly investigated. The objective of this study was to analyze 230 patients from the chronic pelvic pain ambulatory of Hospital das Clíni-cas, Federal University of Goiás. METHODS:Cross-sectional and intervention study, from [2007][2008][2009][2010][2011]. RESULTS: Mean age was 38.3±10.0 years. Most women were mulatto, married/cohabitating, attended elementary school, financially dependent, had an income of up to five minimum wages, normal body mass index, up to three children and sexual activity. Almost 30% had abortions, 15.8%, physical abuse and 11%, sexual abuse. Previous surgeries were common. Most had normal bowel and bladder function. Pain lasted over 16 days/month; it worsened in perimenstrual period and started, on average, 6.7 years before. In over 70% of cases there was a coincident event with the onset of pain, and conflict and/or trauma were the most commonly reported. Physical examination and ultrasound were normal in most of these women. Adhesion and/or endometriosis were found in almost 2/3 of 41 laparoscopies performed. There was an average reduction of 39.2% of the pain scale (3.1/7.9) with various adopted treatments (drugs, psychotherapy and laparoscopy) p<0.001. History of sexual abuse and abortion was associated with less pain reduction. CONCLUSION: This study adds epidemiological and clinical information on women with chronic pelvic pain in Brazil. Clinical and psychotherapeutic treatments induced significant reduction of the pain scale between the first and last visit of patients. Laparoscopy did not potentiate the reduction of pain. Keywords: Epidemiology, Pelvic pain, Psychotherapy, Signs and symptoms, Therapeutics.Analysis of 230 women with chronic pelvic pain assisted at a public hospital* RESULTADOS:A média de idade das mulheres foi de 38,3±10,0 anos. A maioria das mulheres era parda, casada/amasiada, cursou ensino fundamental, dependente financeiramente, tinha renda de até cinco salários mínimos, índice de massa corpórea normal, até três filhos e atividade sexual ativa. Aborto ocorreu em 30%, abuso físico em 15,8% e abuso sexual em 11%. A maioria sofreu cirurgia prévia e possuía função intestinal e urinária normais. A dor permanecia por mais de 16 dias/mês, piorava no período perimenstrual e começou, em média, 6,7 anos antes. Em mais de 70% dos casos foi percebido um evento coincidente com o início da dor, sendo conflitos e/ou traumas os mais citados. Os exames físico e ultrassonográfico foram normais na grande maioria dessas mulheres. Aderências e/ou endometriose foram encontrados em quase 2/3 das 41 laparoscopias realizadas. Houve redução mé-dia de 39,2% da escala de dor (3,1/7,9) com as várias condutas adotadas (farmacológica, laparoscópica e psicoterápica) p<0,001. História de abuso sexual e de aborto provocado associou-se a menor redução da dor. CONCLUSÃO: Este estudo acrescenta informações epidemiológicas e clínicas sobre mulheres com dor pélvica crônica no Brasil. O...

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Analysis of 230 women with chronic pelvic pain assisted at a public hospital

Deus¹,

Santos²,

Bosquetti³

et al. 2014

Revista Dor

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“…Exceptions include Thomas et al18 and Weijenborg et al19 The fear-avoidance model of pain, commonly applied to musculoskeletal pain conditions, has also been found to be relevant to women with CPP 20. This study highlighted the importance of negative beliefs about the pain (“pain catastrophizing”).…”

Section: Introductionmentioning

confidence: 87%

The psychological profile of women presenting to a multidisciplinary clinic for chronic pelvic pain: high levels of psychological dysfunction and implications for practice

Bryant¹,

Cockburn²,

Planté³

et al. 2016

JPR

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ObjectiveChronic pelvic pain (CPP) is widely acknowledged as a common problem with significant consequences for those diagnosed with this condition. There is a lack of studies with good sample size that provide a comprehensive psychological profile of women presenting to specialist chronic pain clinics. Therefore, the objective of this study was to describe the psychological profile of a representative sample of women presenting with CPP at a tertiary referral center.DesignThis was a cross-sectional study. Women were asked to complete a questionnaire assessing symptoms of anxiety and depression, pain severity and interference, pain self-efficacy and catastrophizing beliefs, and sexual functioning.MethodsOne-hundred and seventy-five women with CPP were recruited when they attended their initial assessment at a specialist CPP clinic of the Royal Women’s Hospital, a public hospital in Melbourne, Australia.ResultsOver 75% of the participants had experienced pain for longer than 2 years. Fifty-three percent of women experienced either moderate or severe anxiety, and 26.7% experienced moderate-to-severe depression. There were strong correlations between depressive symptoms and pain interference, pain catastrophizing and self-efficacy beliefs.ConclusionOur findings confirm previous evidence for high levels of psychological distress and functional impairment associated with this condition, and extend these findings by including measures that are highly relevant to treatment planning, such as thinking styles and pain self-efficacy. Therefore, treatment of this complex condition needs to be holistic, and a multidisciplinary approach is likely to be the best way to achieve this.

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“…There is also a growing body of research identifying subgroups of patients who exhibit high fear-avoidance behaviors in order to predict outcomes and match patient psychological characteristics with specific interventions. 112,113 Functionally, Sawamoto et al 114 found that negative expectation regarding a pain-producing stimulus increased brain activation in the ACC and IC compared to controls, and that negative expectation of a painful stimulus amplified perceived unpleasantness of an innocuous stimulus. Both Koyama et al 109 and Keltner et al 107 found that mPFC, ACC, and IC activations were directly related to expectation.…”

Section: Classical Conditioning and Expectationmentioning

confidence: 98%

The role of associative learning and fear in the development of chronic pain – a comparison of chronic pain and post-traumatic stress disorder

Sueki

Dunleavy

Puentedura

et al. 2014

Physical Therapy Reviews

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Background: Associative learning is the theory that two stimuli can be paired to produce similar behavioral responses. In this model, a previously innocuous stimulus can become paired with a noxious stimulus to a point that this previously innocuous stimulus can result in the perception of pain. Objectives: This review discusses concepts related to neural activation and structural alterations in the presence of both chronic pain and post-traumatic stress disorder (PTSD). The role of associative learning and protective memory-based behavioral responses in the perception of pain is explored to provide a framework to inform clinical management of individuals with chronic pain and will be linked to the presence of actual or perceived threat or fear. Major Findings: Current research demonstrates that in individuals with chronic pain, cortical and subcortical processing of information shifts from normal nocioceptive processing areas to the medial prefrontal, anterior cingulate, and insular cortices, as well as the hippocampus (Hip) regions, all of which also show dysregulation, signs of gray matter atrophy, and changes in epigenetic coding. Because these regions are involved in memory, emotional processing, learning, and conditioning, it is reasonable to suggest that associative learning may be involved in the processing of both pain and PTSD. Conclusions: Clinically, rehabilitation paradigms that incorporate early intervention, positive expectation, therapeutic neuroscience education, visual imagery, movement retraining, and manual therapy all have the potential to change not only pain behavior but also the neural circuitry, epigenetic coding, and cortical morphology underlying chronic pain.

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Psychological Factors in Chronic Pelvic Pain in Women: Relevance and Application of the Fear-Avoidance Model of Pain

Cited by 79 publications

References 79 publications

Analysis of 230 women with chronic pelvic pain assisted at a public hospital

Analysis of 230 women with chronic pelvic pain assisted at a public hospital

The psychological profile of women presenting to a multidisciplinary clinic for chronic pelvic pain: high levels of psychological dysfunction and implications for practice

The role of associative learning and fear in the development of chronic pain – a comparison of chronic pain and post-traumatic stress disorder

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