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The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years

  • Saara Vuontisjärvi
    Affiliations
    Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and PEDEGO Research Unit, Oulu, Finland

    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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  • Henna-Riikka Rossi
    Affiliations
    Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and PEDEGO Research Unit, Oulu, Finland

    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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  • Sauli Herrala
    Affiliations
    Center for Life Course Health Research, University of Oulu, Oulu, Finland
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  • Laure Morin-Papunen
    Affiliations
    Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and PEDEGO Research Unit, Oulu, Finland

    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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  • Juha S. Tapanainen
    Affiliations
    Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and PEDEGO Research Unit, Oulu, Finland

    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland

    Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland
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  • Salla Karjula
    Affiliations
    Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and PEDEGO Research Unit, Oulu, Finland

    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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  • Jaro Karppinen
    Affiliations
    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland

    Center for Life Course Health Research, University of Oulu, Oulu, Finland

    Finnish Institute of Occupational Health, Oulu, Finland
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  • Juha Auvinen
    Affiliations
    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland

    Center for Life Course Health Research, University of Oulu, Oulu, Finland
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  • Terhi T. Piltonen
    Correspondence
    Address reprint requests to Terhi T. Piltonen, MD, Associate Professor, Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, BOX 5000, 90014, Oulu, Finland.
    Affiliations
    Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and PEDEGO Research Unit, Oulu, Finland

    Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
    Search for articles by this author
Published:February 26, 2018DOI:https://doi.org/10.1016/j.jpain.2018.02.005

      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

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