• Lydia Coxon, Jan Vollert, Danielle Perro, Claire E Lunde, Joana Ferreira-Gomes, Ana Charrua, Pedro Abreu-Mendes, Michal Krassowski, Judy Birch, Jane Meijlink, Lone Hummelshoj, Anja Hoffmann, Qasim Aziz, Lars Arendt-Nielsen, Esther Pogatzki-Zahn, Emma Evans, Lysia Demetriou, Stephen B McMahon, Stacey A Missmer, Christian M Becker, Krina T Zondervan, Andrew W Horne, Francisco Cruz, Christine B Sieberg, Rolf-Detlef Treede, Jens Nagel, and Katy Vincent.
• Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.
• Pain. 2023 Nov 1; 164 (11): 252825392528-2539.

AbstractChronic pelvic pain (CPP), despite its high prevalence, is still relatively poorly understood mechanistically. This study, as part of the Translational Research in Pelvic Pain (TRiPP) project, has used a full quantitative sensory testing (QST) paradigm to profile n = 85 women with and without CPP (endometriosis or bladder pain specifically). We used the foot as a control site and abdomen as the test site. Across 5 diagnostically determined subgroups, we found features which are common across different aetiologies, eg, gain of function in pressure pain threshold (PPT) when assessing responses from the lower abdomen or pelvis (referred pain site). However, disease-specific phenotypes were also identified, eg, greater mechanical allodynia in endometriosis, despite there being large heterogeneities within diagnostic groups. The most common QST sensory phenotype was mechanical hyperalgesia (>50% across all the groups). A "healthy' sensory phenotype was seen in <7% of CPP participants. Specific QST measures correlated with sensory symptoms assessed by the painDETECT questionnaire (pressure-evoked pain [painDETECT] and PPT [QST] [ r = 0.47, P < 0.001]; mechanical hyperalgesia (painDETECT) and mechanical pain sensitivity [MPS from QST] [ r = 0.38, P = 0.009]). The data suggest that participants with CPP are sensitive to both deep tissue and cutaneous inputs, suggesting that central mechanisms may be important in this cohort. We also see phenotypes such as thermal hyperalgesia, which may be the result of peripheral mechanisms, such as irritable nociceptors. This highlights the importance of stratifying patients into clinically meaningful phenotypes, which may have implications for the development of better therapeutic strategies for CPP.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Association for the Study of Pain.

27 keywords...

hide…