Multimodal hypersensitivity derived from quantitative sensory testing predicts pelvic pain outcome: an observational cohort study.

Abstract

ABSTRACT:

Multimodal hypersensitivity (MMH)-greater sensitivity across multiple sensory modalities (eg, light, sound, temperature, pressure)-is associated with the development of chronic pain. However, previous MMH studies are restricted given their reliance on self-reported questionnaires, narrow use of multimodal sensory testing, or limited follow-up. We conducted multimodal sensory testing on an observational cohort of 200 reproductive-aged women, including those at elevated risk for chronic pelvic pain conditions and pain-free controls. Multimodal sensory testing included visual, auditory, and bodily pressure, pelvic pressure, thermal, and bladder pain testing. Self-reported pelvic pain was examined over 4 years. A principal component analysis of sensory testing measures resulted in 3 orthogonal factors that explained 43% of the variance: MMH, pressure pain stimulus response, and bladder hypersensitivity. The MMH and bladder hypersensitivity factors correlated with baseline self-reported menstrual pain, genitourinary symptoms, depression, anxiety, and health. Over time, MMH increasingly predicted pelvic pain and was the only component to predict outcome 4 years later, even when adjusted for baseline pelvic pain. Multimodal hypersensitivity was a better predictor of pelvic pain outcome than a questionnaire-based assessment of generalized sensory sensitivity. These results suggest that MMHs overarching neural mechanisms convey more substantial long-term risk for pelvic pain than variation in individual sensory modalities. Further research on the modifiability of MMH could inform future treatment developments in chronic pain.

• Authors: Matthew J Kmiecik, Frank F Tu, Daniel J Clauw, Kevin M Hellman
• Journal: Pain (Pain) Vol. 164 Issue 9 Pg. 2070-2083 (09 01 2023) ISSN: 1872-6623 [Electronic] United States
• PMID: 37226937 (Publication Type: Observational Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2023 International Association for the Study of Pain.

Topics

• Humans
• Female
• Adult
• Pain Measurement
• Chronic Pain (diagnosis)
• Pelvic Pain (diagnosis)
• Cohort Studies
• Dysmenorrhea