Background & Aims

Chronic pelvic pain (CPP) is common, affecting up to 26.6% of women, and has a significant impact on the individual’s quality of life and high associated costs. Current clinical practice classifies patients by the presence/appearance of peripheral pathologies (e.g. superficial peritoneal endometriosis) and therapeutic approaches frequently focus on these pathologies. Unfortunately, this approach leaves many with persistent pain.

The Translational Research in Pelvic Pain (TRiPP) project takes a pain-focussed approach to deeply phenotype a cohort of women with CPP associated with endometriosis and/or bladder pain syndrome. Here we integrate questionnaire, physiological and biological datasets from this study to 1) explore differences between women with and without CPP and 2) determine if alternative stratification approaches could be taken that do not focus on clinical diagnosis.

Methods

Participants were women of reproductive age (18-50 years) recruited from the TRiPP cohort comprised of a control group and four pain groups: endometriosis-associated pain (EAP), bladder pain syndrome (BPS), comorbid endometriosis-associated and bladder pain syndrome (EABP), and pelvic pain only (PP). Integrative analysis was conducted in two stages, with all CPP participants combined in a single group.

Stage I assessed differences between CPP and Controls across the TRiPP measures using parametric statistical testing. Stage II employed a Latent Profile Analysis (LPA) to stratify CPP participants based on selected a) pain-relevant measures (PainDetect, quantitative sensory testing (QST), conditioned pain modulation (CPM), Widespreadness), b) additional physiological assessments (cortisol, R-R intervals) and c) other factors relevant to clinical presentation or psychological wellbeing (Depression, anxiety, Personality, Childhood trauma, pain catastrophising, Fatigue).

Results

108 women were recruited and contributed data to this study. ANOVAs and post-hoc tests demonstrated that the CPP group had significantly worse sleep, fatigue, depression, anxiety, pain catastrophising and number and burden of childhood traumatic incidents (p<0.01). However, at a group level there were no differences in any physiological measures (CPM, QST, Cortisol, mean R-R intervals). Sufficient data was available for XX women to include them in stage II analysis. the LPA identified 5 distinct profiles: A: N=10, B: N=11, C: N=45, D: N=29, E: N=13. Significant differences were found between the profiles in post-stressor mean R-R intervals, painDETECT score, pain widespreadness, psychological wellbeing and burden of childhood traumatic events. Subsequent analysis illustrated that these profiles were irrespective of clinical diagnosis (EAP, EABP, BPS, PP) and represented by different patterns of pelvic pain intensities and quality of life (QoL).

Conclusions

Our data emphasizes the burden that CPP has on the QoL and psychological wellbeing compared to pelvic pain-free controls. Interestingly, however, the heterogeneity within the data meant that at a group level there were no significant differences in physiological measures between the groups. LPA suggests that there may be alternative ways to classify those with CPP that potentially better reflect underlying pain-relevant processes than our current clinical approach. Consideration of these mechanisms and subgrouping approaches may highlight novel therapeutic strategies and pave the way to a more personalised medicine approach to the management of CPP.

References

Demetriou, Lysia, et al. “Deep phenotyping of women with endometriosis-associated pain and bladder pain syndrome: the TRiPP (Translational Research in Pelvic Pain) study protocol.” medRxiv (2022): 2022-05.

Demetriou, Lysia, et al. “Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain.” Frontiers in reproductive health 5 (2023): 1140857.

Presenting Author

Lysia Demetriou

Poster Authors

Lysia Demetriou

PhD

University of Oxford

Lead Author

E-mail

Lydia Coxon

University of Oxford

Lead Author

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Emma Evans

Oxford University Hospitals NHS Foundation Trust

Lead Author

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Pedro Abreus Mendes

University of Porto

Lead Author

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Claire E Lunde

Lead Author

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Kurtis Garbutt

University of Oxford

Lead Author

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Michal Krassowski

University of Oxford

Lead Author

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Allison Vitonis

Harvard University

Lead Author

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Lars Arendt-Nielsen

PhD

Aalborg University

Lead Author

E-mail

Qasim Aziz

Queen Mary Univesity

Lead Author

E-mail

Judy Birch

Pelvic Pain Support Network

Lead Author

E-mail

Andrew Horne

University of Edinburgh

Lead Author

E-mail

Anja Hoffman

Bayer AG

Lead Author

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Jane Meijlink

International Painful Bladder Foundation

Lead Author

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Danielle Perro

Lead Author

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Esther Pogatzki-Zahn

University Hospital Muenster

Lead Author

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Rolf-Detlef Treede

Heidelberg University

Lead Author

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Christian Becker

University of Oxford

Lead Author

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Francisco Cruz

University of Porto

Lead Author

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Stacey Missmer

Michigan State University

Lead Author

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Christine Sieberg

Harvard University

Lead Author

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Krina Zondervan

University of Oxford

Lead Author

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Jens Nagel

Merz Therapeutics GmbH, Frankfurt

Lead Author

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Katy Vincent DPhil BSc MBBS MRCOG

University of Oxford

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial