title: An Exploratory Study into Objective and Reported Characteristics of Neuropathic Pain in Women with Chronic Pelvic Pain.
abstract: Chronic pelvic pain (CPP) affects 5.7-26.6% women worldwide. 55% have no obvious pathology and 40% have associated endometriosis. Neuropathic pain (NeP) is pain arising as a consequence of a lesion/disease affecting the somatosensory system. The prevalence of NeP in women with CPP is not known. The diagnosis of NeP is challenging because there is no gold-standard assessment. Questionnaires have been used in the clinical setting to diagnose NeP in other chronic pain conditions and quantitative sensory testing (QST) has been used in a research setting to identify abnormal sensory function. We aimed to determine if women with chronic pelvic pain (CPP) have a neuropathic pain (NeP) component to their painful symptoms and how this is best assessed. We performed an exploratory prospective cohort study of 72 pre-menopausal women with a diagnosis of CPP. They underwent a clinician completed questionnaire (DN4) and completed the S-LANSS and PainDETECT™ questionnaires. Additionally QST testing was performed by a clinician. They also completed a patient acceptability questionnaire. Clinical features of NeP were identified by both questionnaires and QST. Of the women who were NeP positive, 56%, 35% and 26% were identified by the S-LANSS, DN4 and PainDETECT™ respectively. When NeP was identified by questionnaire, the associated laparoscopy findings were similar irrespective of which questionnaire was used. No subject had entirely unchanged QST parameters. There were distinct loss and gain subgroups, as well as mixed alteration in function, but this was not necessarily clinically significant in all patients. 80% of patients were confident that questionnaires could diagnose NeP, and 90% found them easy to complete. Early identification of NeP in women with CPP with a simple questionnaire could facilitate targeted therapy with neuromodulators, which are cheap, readily available, and have good safety profiles. This approach could prevent unnecessary or fertility-compromising surgery and prolonged treatment with hormones.
authors.affiliation: MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom.
authors.forename: Lucy H R
authors.initials: LH
authors.lastname: Whitaker
authors.affiliation: The University of Edinburgh Medical School, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.
authors.forename: Jen
authors.initials: J
authors.lastname: Reid
authors.affiliation: The University of Edinburgh Medical School, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Choa
authors.affiliation: The University of Edinburgh Medical School, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: McFee
authors.affiliation: Department of Anaesthesia, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom.
authors.forename: Marta
authors.initials: M
authors.lastname: Seretny
authors.affiliation: Department of Anaesthesia, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
authors.forename: Rob A
authors.initials: RA
authors.lastname: Elton
authors.affiliation: Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.
authors.forename: Katy
authors.initials: K
authors.lastname: Vincent
authors.affiliation: MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Horne
mesh_terms: D000293:Adolescent; D000328:Adult; D059350:Chronic Pain / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009437:Neuralgia / Q000503:physiopathology* / Q000628:therapy; D059408:Pain Management; D017699:Pelvic Pain / Q000503:physiopathology* / Q000628:therapy; D011446:Prospective Studies; D011795:Surveys and Questionnaires