We aimed to explore the factors associated with disability in women with chronic pelvic pain (CPP).
Methods
This is a cross-sectional study conducted in Brazil with women with CPP, between 18 and 45 years old. Disability was measured using the World Health Organisation Disability Assessment Scale (WHODAS 2.0). Socioeconomic and clinical data were collected, and instruments to assess pain intensity and catastrophising, sexual function, kinesiophobia, depression, physical activity and the sit-to-stand test were applied. Correlations of Spearman, Student’s t-test and multiple linear regression were used for data analysis (α = 0.05).
Results
168 women with a median age of 36 (IQR 29 - 40) years were evaluated. Those with greater pain intensity and catastrophising, sexual dysfunction, kinesiophobia, depression, who do not practice regular physical activity and with worse performance in the sit-to-stand test had greater disability on correlation analysis. However, only pain catastrophising (β = 6.40; 95%CI 0.44 - 12.36) and depression (β = 12.03; 95%CI 6.61 - 17.45) were predictors of disability (p < 0.05) in the adjusted linear regression model.
Conclusion
Our results indicate that psychosocial factors (pain catastrophising and depression) have a stronger relationship with disability than pain intensity or physical factors (sit to stand and physical activity). Therefore, all clinicians involved in the care of women with CPP could systematically assess and address pain catastrophising and depression as part of comprehensive management to prevent disability.
CoelhoLSCBritoLMOCheinMBC, et al.Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil. Braz J Med Biol Res2014; 47: 818–825. https://doi.org/10.1590/1414-431x20143710
4.
da SilvaGPde OGdo NascimentoALMichelazzoD, et al.High prevalence of chronic pelvic pain in women in ribeirão preto, Brazil and direct association with abdominal surgery. Clinics2011; 66: 1307–1312. https://doi.org/10.1590/s1807-59322011000800001
BurkeALJMathiasJLDensonLA. Psychological functioning of people living with chronic pain: a meta-analytic review. Br J Clin Psychol2015; 54: 345–360. https://doi.org/10.1111/bjc.12078
7.
TillSRAs-SanieSSchrepfA. Psychology of chronic pelvic pain: prevalence, neurobiological vulnerabilities, and treatment. Clin Obstet Gynecol2019; 62: 22–36. https://doi.org/10.1097/GRF.0000000000000412
8.
PassavantiMBPotaVSansoneP, et al.Chronic pelvic pain: assessment, evaluation, and objectivation. Pain Res Treat2017; 2017: 9472925. https://doi.org/10.1155/2017/9472925
9.
SewellMChurilovLMooneyS, et al.Chronic pelvic pain - pain catastrophising, pelvic pain and quality of life. Scand J Pain2018; 18: 441–448. https://doi.org/10.1515/sjpain-2017-0181
10.
GiubileiGMondainiNMinerviniA, et al.Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments-could it represent a valid option? The physical activity and Male pelvic pain trial: a double-blind, randomized study. J Urol2007; 177: 159–165. https://doi.org/10.1016/j.juro.2006.08.107
11.
MerriwetherENFrey-LawLARakelBA, et al.Physical activity is related to function and fatigue but not pain in women with fibromyalgia: baseline analyses from the fibromyalgia activity study with TENS (FAST). Arthritis Res Ther; 20: 199. https://doi.org/10.1186/s13075-018-1671-3
12.
World Health Organization. ICF: international classification of functioning, disability and health. WHO Publishing, 2001.
13.
ÜstünTB. Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0. World Health Organization, 2010.
14.
BerghmansB. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J2018; 29: 631–638. https://doi.org/10.1007/s00192-017-3536-8
15.
ABESO. Diretrizes brasileiras de obesidade. VI diretrizes brasileiras de obesidade, 2016, pp. 7–186.
16.
DownieWWLeathamPARhindVM, et al.Studies with pain rating scales, 1978.
17.
SehnFChachamovichEVidorLP, et al.Cross-cultural adaptation and validation of the Brazilian Portuguese version of the pain catastrophising scale. Pain Med2012; 13: 1425–1435. https://doi.org/10.1111/j.1526-4637.2012.01492.x
18.
RosenRBrownCHeimanJ, et al.The female sexual function index (fsfi): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther2000; 26: 191–205. https://doi.org/10.1080/009262300278597
19.
SiqueiraFBTeixeira-SalmelaLFMagalhãesLde C. Análise das propriedades psicométricas da versão brasileira da escala tampa de cinesiofobia. Acta Ortopédica Bras2007; 15: 19–24. https://doi.org/10.1590/s1413-78522007000100004
20.
ManeaLGilbodySMcMillanD. A diagnostic meta-analysis of the patient health questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry2015; 37: 67–75. https://doi.org/10.1016/j.genhosppsych.2014.09.009
21.
GuralnikJMFerrucciLSimonsickEM, et al.Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med1995; 332: 556–562. https://doi.org/10.1056/NEJM199503023320902
22.
CastroSSLeiteCF. Translation and cross-cultural adaptation of the world health organization disability assessment schedule - WHODAS 2.0. Fisioterapia e Pesquisa2017; 24: 385–391. https://doi.org/10.1590/1809-2950/17118724042017
23.
CastroSLeiteCFCoenenM, et al.The world health organization disability assessment schedule 2 (WHODAS 2.0): remarks on the need to revise the WHODAS. Cad Saúde Pública; 35: e00000519. https://doi.org/10.1590/0102-311x00000519
24.
BritoGAMartinsNSFrotaIPR, et al.Validation of the Brazilian version of the world health organization disability assessment schedule in women with chronic pelvic pain. BrJP2023; 6: 346–352. https://doi.org/10.5935/2595-0118.20230091-en
25.
FarrarJTYoungJPBLamoreauxL, et al.Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale, 2001.
26.
SullivanMJL. The pain catastrophising scale: user manual. McGill University, 2009. - Pesquisa Google.
27.
PacagnellaRde CMartinezEZVieiraEM. Construct validity of a Portuguese version of the female sexual function index. Cad Saúde Pública2009; 25: 2333–2344. https://doi.org/10.1590/s0102-311x2009001100004
28.
World Health Organization. Global recommendations on physical activity for health. WHO Library Cataloguing-in-Publication.
29.
RidoutAReidHVarneyJ, et al.Physical activity. In: Sport and exercise medicine: an essential guide, pp. 235–251.
PeduzziPConcatoJKemperE, et al.A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol1996; 49: 1373–1379. https://doi.org/10.1016/s0895-4356(96)00236-3
32.
RajaSNCarrDBCohenM, et al.The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain2020; 161: 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
33.
MartinCEJohnsonEWechterME, et al.Catastrophising: a predictor of persistent pain among women with endometriosis at 1 year. Hum Reprod2011; 26: 3078–3084. https://doi.org/10.1093/humrep/der292
34.
AlhowimelASAlotaibiMAAlenaziAM, et al.Psychosocial predictors of pain and disability outcomes in people with chronic low back pain treated conservatively by guideline-based intervention: a systematic review. J Multidiscip Healthc2021; 14: 3549–3559. https://doi.org/10.2147/JMDH.S343494
35.
MontoroCIGalvez-SánchezCM. The mediating role of depression and pain catastrophising in the relationship between functional capacity and pain intensity in patients with fibromyalgia. Behav Neurol. 2022; 2022: 9770047. https://doi.org/10.1155/2022/9770047
36.
YoshidaTHashimotoMHoriguchiG, et al.Pain catastrophising hinders disease activity score 28 - erythrocyte sedimentation rate remission of rheumatoid arthritis in patients with normal C-reactive protein levels. Int J Rheum Dis2021; 24: 1520–1529. https://doi.org/10.1111/1756-185X.14231
SchneiderSJunghaenelDUOnoM, et al.Temporal dynamics of pain: an application of regime-switching models to ecological momentary assessments in patients with rheumatic diseases. Pain2018; 159: 1346–1358. https://doi.org/10.1097/j.pain.0000000000001215
41.
GatchelRJPengYBPetersML, et al.The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull2007; 133: 581–624. https://doi.org/10.1037/0033-2909.133.4.581
42.
StuckiGBickenbachJ. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. Eur J Phys Rehabil Med2017; 53: 134–138. https://doi.org/10.23736/S1973-9087.17.04565-8
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