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. 2023 Feb 1;24(2):207-218.
doi: 10.1093/pm/pnac122.

Chronic Pelvic Pain Profiles in Women Seeking Care in a Tertiary Pelvic Pain Clinic

Rui Li  1 , Donna A Kreher  2 , Ashley L Gubbels  3 , Tonya M Palermo  1   4
Affiliations

Chronic Pelvic Pain Profiles in Women Seeking Care in a Tertiary Pelvic Pain Clinic

Rui Li et al. Pain Med. .

Abstract

Objective: Female chronic pelvic pain (CPP) has multiple pain generators and significant psychosocial sequalae. Biopsychosocial-based phenotyping could help identify clinical heterogeneity that may inform tailored patient treatment. This study sought to identify distinct CPP profiles based on routinely collected clinical information and evaluate the validity of the profiles through associations with social histories and subsequent health care utilization.

Methods: Women (18-77 years, n = 200) seeking care for CPP in a tertiary gynecological pelvic pain clinic between 2017 and 2020 were included. Baseline data of pain intensity, interference, catastrophizing, acceptance, overlapping pelvic pain syndromes, and co-occurring psychiatric disorders were subject to a partition around medoids clustering to identify patient profiles. Profiles were compared across social history and subsequent treatment modality, prescribed medications, and surgeries performed.

Results: Two profiles with equal proportion were identified. Profile 1 was vulvodynia and myofascial pelvic pain-dominant characterized by lower pain burden and better psychological functioning. Profile 2 was visceral pain-dominant featuring higher pain interference and catastrophizing, lower pain acceptance, and higher psychiatric comorbidity. Patients in Profile 2 had 2-4 times higher prevalence of childhood and adulthood abuse history (all P < .001), were more likely to subsequently receive behavioral therapy (46% vs 27%, P = .005) and hormonal treatments (34% vs 21%, P = .04), and were prescribed more classes of medications for pain management (P = .045) compared to patients in Profile 1.

Conclusions: Treatment-seeking women with CPP could be separated into two groups distinguished by pain clusters, pain burden, pain distress and coping, and co-occurring mental health disorders.

Keywords: Central Sensitization; Chronic Pelvic Pain; Health Care Utilization; Phenotype; Psychosocial.

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