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A common pro-nociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain.

A common pro-nociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain.
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Keren G, Michal G, Lior L, Liora A, Irit WF,


Keren G, Michal G, Lior L, Liora A, Irit WF, (click to view)

Keren G, Michal G, Lior L, Liora A, Irit WF,

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Pain 2017 02 07() doi 10.1097/j.pain.0000000000000869
Abstract

Provoked vestibulodynia (PVD) and painful bladder syndrome (PBS), subgroups of chronic pelvic pain syndromes (CPPS), are considered to share common bio-physiological peripheral mechanisms. In addition, indications of a pro-nociceptive pain profile co-existing with psychological vulnerability suggests common dysfunctional pain processing and pain modulation in these two subgroups of CPPS. We therefore aimed at comparing the pain profile and psychological traits of PVD and PBS patients to see whether the pain profile contributes to inter-subject variability of clinical pain symptoms. PVD (n=18) and PBS (n=21) patients were compared to healthy controls (n=20) in their responses to: 1) pain psychophysical tests applied to both referred (supra pubis) and remote (hand) body areas, and 2) pain-related psychological factors (pain catastrophizing, depression, anxiety, and somatization). We found a similar pro-nociceptive pain profile in the two subgroups of CPPS; enhanced facilitation (i.e. hyperalgesia in the referred body area (p<0.001) and inefficient inhibition (i.e. reduced conditioned pain modulation (p<0.001) that were associated with both enhanced pain ratings evoked during trigger point examination (p<0.037) and higher Brief Pain Inventory ratings (p=0.002). The latter was also correlated with pain catastrophizing (r=0.504, p=0.001) and depression symptoms (r=0.361, p=0.024). The findings suggest common mechanisms underlying a dysfunctional nociceptive system in both PVD and PBS. The inter-subject variability in the level of dysfunction and its association with disease severity recommends a personalized pain treatment that may alleviate daily pain and dysfunction in CPPS patients.

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