ASRM2012: Central sensitivity syndrome and endometriosis-associated symptoms

San Diego, 24 October 2012

Women with chronic pelvic pain related to endometriosis demonstrate many of the clinical features described in central sensitivity syndrome, according to Dr Julie Anne Gemmill, who presented her research at the 68th Annual Meeting of the ASRM in San Diego.

Dr Julie Anne Gemmill at the 68th Annual Meeting of the ASRM

It has previously been reported in the literature that women with endometriosis frequently experience more comorbid conditions than the general population including interstitial cystitis, migraines, fibromyalgia, and chronic fatigue syndrome [1,2,3].

These overlapping pain syndromes and endometriosis share similar clinical presentations, which include multifocal pain coupled with somatic symptoms like:

  • fatigue
  • insomnia
  • cognitive/memory problems
  • psychological distress
  • anxiety
  • depression

These syndromes may share a similar pathophysiologic mechanism of central nervous system pain and central sensitisation. A difficult aspect of evaluating patients with pain and sensitisation is in understanding how their pain impacts their day to day life and functioning.

In order to better understand how pain affects women with chronic pelvic pain related to endometriosis, Dr Gemmill and her team assessed the interrelationship among chronic regional and multifocal pain, sleep disturbances, anxiety, and depression.

Senior author, Professor Pamela Stratton, with Dr Julie Anne Gemmill - both from the NICHD/NIH Programme in Reproductive and Adult Endocrinology

The team looked at the relationship among different facets of pelvic pain in the context of chronic pelvic pain and found significant correlations among pelvic and back, pelvic and menstrual and back, and menstrual pain.

They also looked at the interrelationship among pain, pain severity, and sleep and found that women reporting more severe pelvic, back and menstrual pain were significantly more likely to have generalised body pain and headaches. Sleep disturbances were related to having more severe generalised body pain, headaches, and pelvic pain.

When the team assessed the interrelationship among anxiety and pain, they found that anxiety was correlated with more severe pelvic, menstrual, and body pain, as well as migraines.

Women with chronic pelvic pain and endometriosis and chronic pelvic pain alone reported more anxiety than healthy volunteers. Those with more anxiety also reported more sleep difficulties.

The interrelationship among these symptoms affects women’s quality of life and may reflect central pain sensitisation. Research to better understand the interrelationship among generalised body pain, migraines, sleep disturbances, and psychological distress such as anxiety and depression and other aspects of quality of life in women with chronic pelvic pain related to endometriosis may guide future treatments.

said Dr Gemmill.

References
  1. Dell JR, Mokrzycki ML, Jayne CJ. Differentiating interstitial cystitis from similar conditions commonly seen in gynecologic practice. Eur J Obstet Gynecol Reprod Biol 2009;144(2):105-9.
  2. Karp BI, Sinaii N, Nieman LK, Silberstein SD, Stratton P. Migraine in women with chronic pelvic pain with and without endometriosis. Fertil Steril 2011;95(3):895-9.
  3. Sinaii N, Cleary SD, Ballweg ML, Nieman LK, Stratton P. High rates of autoimmune and endocrine disorders,fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod 2002;17(10):2715-24.
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