Relationship between vulvodynia and chronic comorbid pain conditions

Barbara D Reed, Siobán D Harlow, Ananda Sen, Rayna M Edwards, Di Chen, Hope K Haefner, Barbara D Reed, Siobán D Harlow, Ananda Sen, Rayna M Edwards, Di Chen, Hope K Haefner

Abstract

Objective: To estimate the relationship among the presence of vulvodynia, fibromyalgia, interstitial cystitis, and irritable bowel syndrome.

Methods: Validated questionnaire-based screening tests for the four pain conditions were completed by women with and without vulvodynia who were participating in the Michigan Woman to Woman Health Study, a longitudinal population-based survey in southeastern Michigan. Weighted population-based estimates of the prevalence and characteristics of participants with these chronic comorbid pain conditions were calculated using regression analyses.

Results: Of 1,940 women who completed the survey containing all four screening tests, 1,890 (97.4%) answered all screening questions and were included. The prevalences of the screening-based diagnoses ranged from 7.5% (95% confidence interval [CI] 6.2-9.0) for interstitial cystitis, 8.7% (95% CI 7.3-10.4) for vulvodynia, 9.4% (95% CI 8.1-11.0) for irritable bowel syndrome, to 11.8% (95% CI 10.1-13.7) for fibromyalgia with 27.1% screening positive for multiple conditions. The presence of vulvodynia was associated with the presence of each of the other comorbid pain conditions (P<.001, odds ratio 2.3-3.3). Demographic risk factors for each condition varied. Increasing age was not associated with greater numbers of comorbid conditions, and only low socioeconomic status was associated with having multiple comorbid conditions concurrently.

Conclusion: Chronic pain conditions are common, and a subgroup of women with vulvodynia is more likely than those without vulvodynia to have one or more of the three other chronic pain conditions evaluated.

Figures

Figure 1
Figure 1
The (weighted) prevalence of vulvodynia and the other three chronic comorbid pain conditions are shown, stratified by whether the women screened positive for one, two, three, or all four of the comorbid conditions shown.
Figure 2
Figure 2
Prevalence of other chronic comorbid pain conditions, individually or in combination, in women with and without vulvodynia (weighted data). *P≤0.001. †P=.03.
Figure 3
Figure 3
Prevalence of screen-based diagnoses of vulvodynia and the other three chronic comorbid pain conditions, stratified by years of age (weighted data).

References

    1. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Wom Assoc. 2003;58:82–8.
    1. Reed BD, Harlow SD, Sen A, Legocki LJ, Edwards RM, Arato N, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol. 2012;206:170.e1–9.
    1. White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol. 1999;26:1570–6.
    1. Parsons CL, Dell J, Stanford EJ, Bullen M, Kahn BS, Waxell T, et al. Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. Urology. 2002;60:573–8.
    1. Zondervan KT, Yudkin PL, Vessey MP, Jenkinson CP, Dawes MG, Barlow DH, et al. Chronic pelvic pain in the community--symptoms, investigations, and diagnoses. Am J Obstet Gynecol. 2001;184:1149–55.
    1. Clauw DJ, Schmidt M, Radulovic D, Singer A, Katz P, Bresette J. The relationship between fibromyalgia and interstitial cystitis. J Psychiatr Res. 1997;31:125–31.
    1. Giesecke J, Reed BD, Haefner HK, Giesecke T, Clauw DJ, Gracely RH. Quantitative sensory testing in vulvodynia patients reveals increased peripheral pressure pain sensitivity. Obstet Gynecol. 2004;104:126–33.
    1. Giesecke T, Gracely RH, Grant MAB, Nachemson A, Petzke F, Williams DA, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum. 2004;50:613–23.
    1. Johannesson U, de Boussard CN, Brodda Jansen G, Bohm-Starke N. Evidence of diffuse noxious inhibitory controls (DNIC) elicited by cold noxious stimulation in patients with provoked vestibulodynia. Pain. 2006;130:31–9.
    1. Pukall CF, Strigo IA, Binik YM, Amsel R, Khalife S, Bushnell MC. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain. 2005;115:118–27.
    1. Lautenbacher S, Rollman GB. Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain. 1997;13:189–96.
    1. King CD, Wong F, Currie T, Mauderli AP, Fillingim RB, Riley JL., 3rd Deficiency in endogenous modulation of prolonged heat pain in patients with Irritable Bowel Syndrome and Temporomandibular Disorder. Pain. 2009;143:172–8.
    1. Meeus M, Nijs J, Van de Wauwer N, Toeback L, Truijen S. Diffuse noxious inhibitory control is delayed in chronic fatigue syndrome: an experimental study. Pain. 2008;139:439–48.
    1. Reed BD, Haefner HK, Harlow SD, Gorenflo DW, Sen A. Reliability and validity of self-reported symptoms for predicting vulvodynia. Obstet Gynecol. 2006;108:906–13.
    1. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991;18:728–33.
    1. Berry SH, Bogart LM, Pham C, Liu K, Nyberg L, Stoto M, et al. Development, validation and testing of an epidemiological case definition of interstitial cystitis/painful bladder syndrome. J Urol. 2010;183:1848–52.
    1. Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE. Rome II: The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment: A Multinational Consensus. McLean (VA): Degnon Associates; 2000.
    1. Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine; 2011.
    1. Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, et al. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol. 2010;184:1358–63.
    1. Whitehead WE, Palsson OS, Levy RR, Feld AD, Turner M, Von Korff M. Comorbidity in irritable bowel syndrome. Am J Gastroenterol. 2007;102:2767–76.
    1. Hoffmann RG, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW., Jr Temporomandibular disorders and associated clinical comorbidities. Clin J Pain. 2011;27:268–74.
    1. Gardella B, Porru D, Nappi RE, Dacco MD, Chiesa A, Spinillo A. Interstitial cystitis is associated with vulvodynia and sexual dysfunction-a case-control study. J Sex Med. 2011;8:1726–34.
    1. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med. 2000;160:221–7.
    1. Rodriguez MA, Afari N, Buchwald DS National Institute of Diabetes, Digestive Kidney Diseases Working Group on Urological Chronic Pelvic Pain. Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol. 2009;182:2123–31.
    1. Levy RL, Whitehead WE, Von Korff MR, Feld AD. Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterol. 2000;95:451–6.
    1. Warren JW, Clauw DJ, Wesselmann U, Langenberg PW, Howard FM, Morozov V. Sexuality and reproductive risk factors for interstitial cystitis/painful bladder syndrome in women. Urology. 2011;77:570–5.
    1. Harlow BL, Vazquez G, MacLehose RF, Erickson DJ, Oakes JM, Duval SJ. Self-reported vulvar pain characteristics and their association with clinically confirmed vestibulodynia. J Womens Health (Larchmt) 2009;18:1333–40.
    1. Arnold LD, Bachmann GA, Rosen R, Rhoads GG. Assessment of vulvodynia symptoms in a sample of US women: a prevalence survey with a nested case control study. Am J Obstet Gynecol. 2007;196:128 e1–6.
    1. Carrico DJ, Sherer KL, Peters KM. The relationship of interstitial cystitis/painful bladder syndrome to vulvodynia. Urol Nurs. 2009;29:233–8.
    1. Zolnoun DA, Rohl J, Moore CG, Perinetti-Liebert C, Lamvu GM, Maixner W. Overlap between orofacial pain and vulvar vestibulitis syndrome. Clin J Pain. 2008;24:187–91.
    1. Arnold LD, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol. 2006;107:617–24.
    1. Wu EQ, Birnbaum H, Mareva M, Parece A, Huang Z, Mallett D, et al. Interstitial cystitis: cost, treatment and co-morbidities in an employed population. Pharmacoeconomics. 2006;24:55–65.
    1. Warren JW, Howard FM, Cross RK, Good JL, Weissman MM, Wesselmann U, et al. Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome. Urology. 2009;73:52–7.
    1. Warren JW, Wesselmann U, Morozov V, Langenberg PW. Numbers and types of nonbladder syndromes as risk factors for interstitial cystitis/painful bladder syndrome. Urology. 2011;77:313–9.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться