Chronic pelvic pain is a major problem in
most women and requires billions of dollars in treatment costs. However a
diagnosis of pelvic pain is not simple and is related to many causes.
Fenton and colleagues from an Akron, Ohio
Pain Center determined the frequency and distribution of multiple
pain-generating diagnoses in their chronic pelvic pain center and also explored
the relationship to previous abuse and drug-seeking behavior.
One hundred seventy-five consecutive
patients were evaluated and included in this study. Seventy-seven percent had
gynecologic pain, including 35% of the total population diagnosed with
interstitial cystitis. Forty-five percent had myalgia and only 5% had
vulvodynia. Fully 55% of the patients had a history of abuse. The more
diagnoses the patients had, the higher the likelihood of abuse. Ninety percent
of the BPS/IC patients carried another diagnosis as well, and 32% had 3 more
Patients with multiple pain diagnoses were
similar to those with a history of abuse in that they had higher irritative
bowel and bladder scores along with more regions of their body generating pain
in addition to their pelvic pain. They did not have higher pain scores or a
longer duration of pain. Patients with a history of abuse did not complain of
higher levels of pain in any category, however, they did have more irritative
voiding and bowel symptoms and noted pain in more areas of their bodies, even
when controlled for multiple diagnoses or drug seeking.
The type of abuse was not further spelled
out in this paper, and the distribution of diagnoses was undoubtedly skewed by
the inherent specialty of the center, as the authors acknowledge. The study is
interesting as a 30,000 foot overview, and indicates the need for more focused,
stringent, data and hypothesis driven studies in the future.