Highlights
- •Endometriosis has been shown to increase pain sensitivity in fertile-aged women.
- •Delay in diagnosis of endometriosis may lead to increased pain sensitization.
- •Women with endometriosis showed decreased pain threshold and maximal pain tolerance at age 46.
- •Women with endometriosis reported increased number of pain sites and more severe pain at age 46.
- •Endometriosis should be diagnosed and treated early to ensure minimal comorbidity.
Abstract
Previous studies have shown increased pain sensitivity in fertile-aged women with
endometriosis in response to mechanical stimuli. As yet, population-based studies
on the association of endometriosis with pain sensation and pain symptoms in late
fertile age are lacking. The main objective of this population-based cohort study
was to investigate whether a history of endometriosis is associated with altered pain
sensation and musculoskeletal pain symptoms at age 46 years. Our data are derived
from the Northern Finland Birth Cohort 1966, which contains postal questionnaire data
(72% response rate) as well as clinical data assessing pressure-pain threshold and
maximal pain tolerance. The study population consisted of 284 women with endometriosis
and 3,390 controls. Our results showed that at age 46 women with a history of endometriosis
had a 5.3% lower pressure-pain threshold and 5.1% lower maximal pain tolerance compared
with controls. The most significant contributors besides endometriosis were anxiety,
depression, and current smoking status. Women with endometriosis also reported an
increased number of pain sites (0 pain sites, 9.6 vs 17.9%; 5-8 pain sites, 24.8 vs
19.1%, endometriosis vs controls respectively; P < .001), and their pain was more troublesome and intense. The results were adjusted
for body mass index, smoking, depressive/anxiety symptoms, education, and use of hormonal
contraceptives. These unique data revealed an altered pain sensation and a greater
likelihood of reporting musculoskeletal pain at age 46 years among women with a history
of endometriosis. The results imply that endometriosis has a long-term footprint on
affected women, thus underlying the need for psychological support and medical treatment
beyond fertile age.
Perspective
This population-based cohort study showed decreased pain threshold and maximal pain
tolerance in women with endometriosis in the late fertile age of 46 years. The pain
was also found to be more bothersome and intense compared with controls.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Increased pressure pain sensitivity in women with chronic pelvic pain.Obstet Gynecol. 2013; 122: 1047-1055
- Changes in regional gray matter volume in women with chronic pelvic pain: A voxel-based morphometry study.Pain. 2012; 153: 1006-1014
- Functional connectivity is associated with altered brain chemistry in women with endometriosis-associated chronic pelvic pain.J Pain. 2016; 17: 1-13
- Endometriosis is associated with central sensitization: A psychophysical controlled study.J Pain. 2003; 4: 372-380
- Central changes associated with chronic pelvic pain and endometriosis.Hum Reprod Update. 2014; 20: 737-747
- Pathogenesis and pathophysiology of endometriosis.Fertil Steril. 2012; 98: 511-519
- ESHRE guideline: Management of women with endometriosis.Hum Reprod. 2014; 29: 400-412
- Impact of endometriosis on quality of life and mental health: Pelvic pain makes the difference.J Psychosom Obstet Gynaecol. 2015; 36: 135-141
- Endometriosis and pelvic pain: Epidemiological evidence of the relationship and implications.Hum Reprod Update. 2005; 11: 595-606
- Economic burden of endometriosis.Fertil Steril. 2006; 86: 1561-1572
- Pain thresholds in women with chronic pelvic pain.Curr Opin Obstet Gynecol. 2014; 26: 253-259
- Endometriosis.Lancet. 2004; 364: 1789-1799
- Relationship between stage, site and morphological characteristics of pelvic endometriosis and pain.Hum Reprod. 2001; 16: 2668-2671
- Pain sensitivity in patients with major depression: Differential effect of pain sensitivity measures, somatic cofactors, and disease characteristics.J Pain. 2016; 17: 606-616
- Endometriosis and mechanisms of pelvic pain.J Minim Invasive Gynecol. 2009; 16: 540-550
- Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: A controlled analysis.Arthritis Rheum. 2008; 59: 1424-1431
- Visceral hypersensitivity in endometriosis: A new target for treatment?.Gut. 2012; 61: 367-372
- Cognitive behavioral training reverses the effect of pain exposure on brain-network activity.Pain. 2016; 157: 1895-1904
- Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy.J Pediatr Adolesc Gynecol. 1997; 10: 199-202
- Correspondence between clinical diagnoses of depressive and anxiety disorders and diagnostic screening via the Hopkins Symptom Check List-25 in the Lundby Study.Nord J Psychiatry. 2013; 67: 204-213
- Mechanisms of pain in endometriosis.Eur J Obstet Gynecol Reprod Biol. 2017; 209: 8-13
- Pain threshold and sleep quality in women with endometriosis.Eur J Pain. 2015; 19: 15-20
- Correlation between endometriosis and pelvic pain.J Am Assoc Gynecol Laparosc. 1999; 6: 429-434
- Reproductive and lifestyle factors associated with endometriosis in a large cross-sectional population sample.J Womens Health (Larchmt). 2016; 26: 152-158
- Validity of self-reported endometriosis and endometriosis-related questions in a Swedish female twin cohort.Fertil Steril. 2017; 107 (e2): 174-178
- 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: 2715-2724
- Heightened cold pain and pressure pain sensitivity in young female adults with moderate-to-severe menstrual pain.Pain. 2015; 156: 2468-2478
- The direct and indirect costs associated with endometriosis: A systematic literature review.Hum Reprod. 2016; 31: 712-722
- Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain.Obstet Gynecol. 2015; 125: 719-728
- Use of hormonal therapy is associated with reduced nerve fiber density in deep infiltrating, rectovaginal endometriosis.Acta Obstet Gynecol Scand. 2015; 94: 693-700
- Estimation of relationships for limited dependent variables.Econometrica. 1958; 26: 24-36
- Chronic pelvic pain in endometriosis: An overview.J Clin Med Res. 2013; 5: 153-163
- The Hopkins Symptom Checklist-25 in screening DSM-III-R axis-I disorders.Nord J Psychiatry. 2003; 57: 119-123
- Endometriosis and pelvic pain: Relation to disease stage and localization.Fertil Steril. 1996; 65: 299-304
- Endometriosis: Pathogenesis and treatment.Nat Rev Endocrinol. 2014; 10: 261-275
- Hormones and their interaction with the pain experience.Rev Pain. 2008; 2: 20-24
Article info
Publication history
Published online: February 26, 2018
Accepted:
February 14,
2018
Received in revised form:
February 2,
2018
Received:
November 9,
2017
Footnotes
These data were presented, in part, as an oral presentation at the European Society of Human Reproduction and Embryology (ESHRE) July 2016 meeting in Helsinki, Finland.
The study was funded by The Academy of Finland (project grants 104781, 120315, 129269, 1114194, 268336, SALVE), the Sigrid Jusélius Foundation, the Finnish Medical Foundation, the North Ostrobothnia Regional Fund, Northern Finland Health Care Support Foundation, University Hospital Oulu, Biocenter, University of Oulu, Finland (75617), the European Commission (EURO-BLCS, Framework 5 award QLG1-CT-2000-01643), and the Medical Research Council, UK (PrevMetSyn/SALVE).
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2018 by the American Pain Society
