Chronic Pelvic Pain (CPP) is associated with changes in regional gray matter volume within the central pain system. Although endometriosis may be an important risk factor for the development of CPP, acting as a cyclic source of peripheral nociceptive input, our data support the notion that changes in the central pain system also play an important role in the development of chronic pain, regardless of the presence of endometriosis.
Both endometriosis and inflammatory bowel disease involve chronic inflammation, impact the bowel, and cause abdominal pain. It has also been suggested by some experts that endometriosis is associated with autoimmune diseases such as systemic lupus ...
Proposals Sought to Support Pain Management Education in Health Professional Schools
The NIH Pain Consortium is encouraging medical, dental, nursing and pharmacy schools to respond to a new funding opportunity to develop Centers of Excellence in Pain Education (CoEPEs). On December 30, 2011, a Request for Proposals (RFP) was released by Altarum Institute and Palladian Partners, an Altarum company, on behalf of the NIH Pain Consortium, to develop and disseminate pain management curriculum resources for health care professionals and to provide leadership for change in pain management education. The RFP can be found at: <http://www.altarum.org/project-highlights-pain-education>.
Chronic pain is thought to lead to altered central sensitization, and adaptation is a centrally mediated process that is sensitive to this condition. This report suggests that similar alterations exist in a subgroup of vulvodynia patients.
These initial results from the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) study provide a voluminous body of high-quality data that confirms many previous discoveries and adds several new possibilities for risk.
In particular, researchers found that TMD sufferers reported a much higher rate of neural and sensory medical conditions, such as earaches, tinnitus or hearing loss, fainting and dizziness, as well as seizures due to epilepsy and other conditions.
As a main finding, functional connectivity analyses revealed an increased functional connectivity between the left anterior IC and pregenual anterior cingulate cortex (ACC) in TMD patients, during both resting state and applied pressure pain. Within the patient group, there was a negative correlation between the anterior IC-ACC connectivity and clinical pain intensity as measured by a visual analog scale. Conclusions.- Since the pregenual region of the ACC is critically involved in antinociception, we hypothesize that an increase in anterior IC-ACC connectivity is indicative of an adaptation of the pain modulatory system early in the chronification process.
In a large, managed care cohort, most diagnoses of IBS were made by generalists, often without endoscopic evaluation. Patients with IBS had consistently higher rates of testing, chronic pain syndromes, psychiatric comorbidity, and operations than controls. Most patients with IBS were treated with psychiatric medications.
Chronic pelvic pain (CPP) is often attributed to psychogenic causation. To determine if women with CPP possess a unique psychological profile, this study examined the comparative painexperience, psychological functioning, and marital/sexual satisfaction of women with either CPP or chronic migraine headache (CH). Patients with CPP reported greater dissatisfaction with their marriage and greater sexual dysfunction. No differences were obtained for ratings of depression, anxiety, mood factors, or additional personality traits. These data suggest that, in general, when psychological disorders are observed in CPP patients, they most likely reflect the effects of chronic pain rather than be causative to it.
The increased expression of Brain-derived neurotrophic factor in colonic mucosa, together with the structural alterations of mucosal innervation, may contribute to the visceral hyperalgesia in IBS.
There are other rheumatologic diseases that can also present with TMJ inflammation [e.g., sarcoidosis, Sjögren disease, mixed connective tissue disease (MCTD)]4,5,6, but the prevalence is less known.
Women with endometriosis have nearly twice the odds of experiencing migraine headaches within a year of diagnosis than do those without the condition, according to a large, population-based, case-control study.
In 2008, the highest rate of emergency department visits for headaches involved people ages 18 to 44. Migraines accounted for 63 percent of all headache-related hospital stays and women were nearly five times more likely than men to be admitted to the hospital for migraines. And, while emergency visits for headaches were higher among rural and low income residents, there was little difference in hospitalization rates by location and income.
Of 178 N-ULC IC/PBS patients, 36 ULC IC/PBS patients, and 425 controls, ULC IC/PBS subjects were older (median 63 years; P < .01) and less employed (P < .01), but groups were similar on other demographic characteristics. N-ULC reported more chronic diagnoses (mean 3.5 ± 2.3) than ULC (2.3 ± 2.0) and controls (1.2 ± 1.5) (P < .01). When N-ULC and ULC IC/PBS patients were compared, more N-ULC IC/PBS patients had fibromyalgia (P = .03), migraines (P = .03), temporomandibular joint disorder (P < .01), and higher CES-D (P = .02) and SIS scores (P = .01). The ULC IC/PBS group voided more frequently during the daytime (P = .03) and nighttime (P < .01) and had smaller mean bladder capacity than N-ULC (P < .01). No significant differences were seen between N-ULC and ULC IC/PBS patients on the ICSI-PI and Rome III.
TMD findings associate with pain in several locations. Female gender and presence of impaired health were particularly related to occurrence of multiple pain conditions.
Headache and endometriosis show some similarities in their clinical and epidemiological features that are probably due to the influence of female sexual hormones on both disorders. Epidemiological studies indicate that they are comorbid disorders. However, the nature of the comorbidity is not known with certainty, but a likely explanation may be common susceptibility genes. Another possibility is that, because they both are related to pain, increased pain sensitivity induced by one of the disorders may lead to a higher likelihood of developing the other, possibly mediated by nitrogen oxide or prostaglandins. A common link to the widespread use of estroprogestins may seem less probable.
For physicians dealing with women with either of these disorders, awareness of the comorbidity may be helpful in the treatment of the patient.
"A number of pain conditions, acute as well as chronic, are much more prevalent in women, such as temporomandibular disorder (TMD), irritable bowel syndrome, fibromyalgia, and migraine. The association of female sex steroids with these nociceptive conditions is well known, but the mechanisms of their effects on pain signaling are yet to be deciphered. We reviewed the mechanisms through which female sex steroids might influence the trigeminal nociceptive pathways with a focus on migraine. Sex steroid receptors are located in trigeminal circuits, providing the molecular substrate for direct effects. In addition to classical genomic effects, sex steroids exert rapid nongenomic actions to modulate nociceptive signaling. Although there are only a handful of studies that have directly addressed the effect of sex hormones in animal models of migraine, the putative mechanisms can be extrapolated from observations in animal models of other trigeminal pain disorders, like TMD. Sex hormones may regulate sensitization of trigeminal neurons by modulating expression of nociceptive mediator such as calcitonin gene-related peptide. Its expression is mostly positively regulated by estrogen, although a few studies also report an inverse relationship. Serotonin (5-Hydroxytryptamine [5-HT]) is a neurotransmitter implicated in migraine; its synthesis is enhanced in most parts of brain by estrogen, which increases expression of the rate-limiting enzyme tryptophan hydroxylase and decreases expression of the serotonin re-uptake transporter. Downstream signaling, including extracellular signal-regulated kinase activation, calcium-dependent mechanisms, and cAMP response element-binding activation, are thought to be the major signaling events affected by sex hormones. These findings need to be confirmed in migraine-specific animal models that may also provide clues to additional ion channels, neuropeptides, and intracellular signaling cascades that contribute to the increased prevalence of migraine in women."
Sex-related Differences in Animal Models of Migraine Headache
"Trigeminal nerve-mediated pain disorders such as migraine, temporomandibular joint disorder, and classical trigeminal neuralgia are more prevalent in women than in men. Female laboratory animals also show greater responses to various nociceptive stimuli than male animals. However, current knowledge of migraine pathogenesis is based primarily on experimental studies conducted in male animals and lack of migraine research with female animals limits clinical relevance. Migraine is triggered by any alteration in the intrinsic or extrinsic milieu and women at reproductive age are continuously prone to waxing and waning effects of female sex hormones. The experimental approach to this problem is complex because the rodent estrous cycle differs from the human cycle, and because exogenous hormone replacement in ovariectomized females has its limitations. The existence of multiple estrogen receptors in the trigeminal system also presents a challenge. Estrogens do not seem to directly affect calcitonin gene-related peptide or 5-HT(1D) receptors in the trigeminal system. Nonetheless, 2 estrogen receptors activate MAPK/ERK signaling pathway that mediates nociceptive processing in trigeminal nucleus caudalis. In addition, estrogen enhances susceptibility to cortical spreading depression, the neurobiological event underlying migraine aura, which may be independent of the estrous cycle. Further studies in female animals are required to clarify mechanisms underlying sex differences with respect to fluctuating sex hormones, cortical spreading depression, and excitability of the trigeminovascular system."
TMD, TMD subtypes, and TMD severity are independently associated with specific headache syndromes and with headache frequency. This differential association suggests that the presence of central facilitation of nociceptive inputs may be of importance, as positive association was observed only when muscular TMD pain was involved.
Interstitial Cystitis is Associated with Vulvodynia and Sexual Dysfunction-A Case-Control Study
We found an increased prevalence of vulvodynia among women with recently diagnosed IC; both conditions seem to have profound consequences on women's sexual function. A potential role for sex hormone-dependent mechanisms into the comorbidity of vulvar and bladder pain is proposed, but further research is warranted.
Men’s and Women’s Immune Systems Respond Differently to Chronic Post-traumatic Stress Disorder
UCSF News Center Men and women had starkly different immune system responses to chronic post-traumatic stress disorder (PTSD), with men showing no response and women showing a strong response, in two studies by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.
Central Sensitization: Implications for the Diagnosis and Treatment of Pain
"Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and post-surgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk in both developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the first discovery of activity-dependent synaptic plasticity in the spinal cord and the revelation that it occurs and produces pain hypersensitivity in patients. Nevertheless, discovering the genetic and environmental contributors to and objective biomarkers of central sensitization will be highly beneficial, as will additional treatment options to prevent or reduce this prevalent and promiscuous form of pain plasticity."
"The aim of this study was to review emerging data from the fields of nursing, rheumatology, dentistry, gastroenterology, gynecology, neurology, and orthopedics that support or dispute pathophysiologic similarities in pain syndromes studied by each specialty. A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional syndromes, and somatization. Each term was linked with pathophysiology and/or central sensitization. This paper presents a review of relevant articles with a specific goal of identifying pathophysiologic findings related to nociceptive processing. The extant literature presents considerable overlap in the pathophysiology of these diagnoses. Given the psychosomatic lens through which many of these disorders are viewed, demonstration of evidence-based links supporting shared pathophysiology between these disorders could provide direction to clinicians and researchers working to treat these diagnoses. “Central sensitivity syndromes” denotes an emerging nomenclature that could be embraced by researchers investigating each of these disorders. Moreover, a shared paradigm would be useful in promoting cross-fertilization between researchers. Scientists and clinicians could most effectively forward the understanding and treatment of fibromyalgia and other common chronic pain disorders through an appreciation of their shared pathophysiology."
"New research offers a possible way to tell apart two conditions with similar symptoms. One disorder is chronic fatigue syndrome. The other is neurologic post-treatment Lyme disease. This is a set of symptoms that linger after the infection that caused Lyme disease is treated."
Gynecological History in Chronic Fatigue Syndrome: A Population-Based Case-Control Study
"The higher prevalence of gynecological conditions and gynecological surgeries in women with CFS highlights the importance of evaluating gynecological health in these patients and the need for more research to clarify the chronologic and the pathophysiological relationships between these conditions and CFS."
Why Migraines are More Likely if You Suffer Pelvic Pain
"They are two of the most common chronic conditions in women - migraine and chronic pelvic pain. And, according to the latest research, the two complaints may be linked.Seven out of ten women with chronic pelvic pain also have migraine, three times the normal rate. Researchers say more investigations are now needed, which could lead to better treatments for both conditions."
"The data provide evidence that Temporomandibular disorders represent a spectrum of disorders with varying pathophysiologies, clinical manifestations, and associated comorbid conditions."
"The authors conclude that the study demonstrates a higher proportion of autonomic dysfunction present in women hospitalized for syncope compared to men. In addition, most of the comorbid autonomic conditions are evident during female reproductive age. Females were slightly older than males and had essentially similar racial distribution and similar length of hospital stay. They found a higher proportion of IC and gastroparesis in younger women with autonomic disorders."
"Results of this prospective study show that interstitial cystitis and endometriosis may frequently coexist in patients with chronic pelvic pain. A positive Potassium Sensitivity Test accurately predicted the presence of interstitial cystitis in 96% of these patients with chronic pelvic pain, as confirmed by cystoscopic hydrodistention. It is necessary to consider the diagnosis of endometriosis and interstitial cystitis concurrently in the evaluation of patients with chronic pelvic pain to avoid unnecessary delay in identifying either condition."
"The findings provide multimeasure and multimethod support for genetic moderation of a maladaptive coping and pain process, which has been previously characterized in a sample of postoperative shoulder pain patients. Further, the findings advance our understanding of the role of COMT in FM, suggesting that genetic variation in the val158met polymorphism may affect FM pain through pathways of pain-related cognition."
"A large academic study has demonstrated structural changes in specific brain regions in female patients with irritable bowel syndrome (IBS), a condition that causes pain and discomfort in the abdomen, along with diarrhea, constipation or both."
"The current study suggests that patients with chronic pain conditions likely suffer from chronic self-regulatory fatigue, and underlines the importance of taking self-regulatory capacity into account when aiming to understand and treat these complex conditions."
"The pattern of gray matter abnormality found in M-TMD individuals suggests the involvement of trigeminal and limbic system dysregulation, as well as potential somatotopic reorganization in the putamen, thalamus, and somatosensory cortex."
This scientific meeting brough together clinical and basic scientists together with patients to consider common underlying mechanisms that may be responsible for TMJ disorders and other shared co-morbidities, as are seen in chronic headache, generalized pain conditions, irritable bowel syndrome, fibromyalgia, low back pain, chronic fatigue syndrome, and rheumatoid arthritis.