The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors.
The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors.
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痛经与非循环骨盆疼痛的关联，占心理因素的关系。
DOI：
10.1016/j.ajog.2013.08.020
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发表时间：
2013-11
影响因子：
9.8
通讯作者：
Hellman, Kevin M.
中科院分区：
文献类型：
--
作者：
Westling, Allyson M.;Tu, Frank F.;Griffith, James W.;Hellman, Kevin M.
人们对骨盆疼痛的原因知之甚少。具体地说，痛经和心理因素在间质性膀胱炎和肠易激综合征等非周期性盆腔疼痛的病因中的相对影响尚不清楚。为了进一步确定盆腔疼痛的特征，我们比较了有和没有严重非周期性盆腔疼痛症状的女性月经、躯体感觉和心理危险因素的频率。共有1012名育龄妇女完成了一份包含112个项目的问卷，内容包括情绪、疲劳、体力活动、躯体抱怨和疼痛。问卷项目包括月经不适的现有项目和来自定性访谈的新编写项目。痛经和非周期性盆腔疼痛主诉(性交困难、经痛或排尿困难)的关系通过分位数回归进行建模。在有规律月经的女性中，有痛经者的严重非周期性盆腔疼痛(54/402，13%)比没有痛经的女性(5/432，1%；优势比，13；95%可信区间，5-33)不成比例地高。在多变量调整的模型中，痛经(β=0.17)、活动能力(β=0.17)、躯体不适(β=0.17)和躯体疼痛(β=0.12)是非周期性盆腔疼痛的主要预测因素。抑郁(β=0.03)和焦虑(β=0.01)没有显著的预测性。痛经、躯体主诉和低活动能力的存在可以预测90%的非周期性盆腔疼痛患者。痛经和非周期性盆腔疼痛之间的联系表明，月经痛是非周期性盆腔疼痛的病因因素，而抑郁和焦虑可能是次要影响。需要进行纵向研究，以确定痛经是否会对非周期性盆腔疼痛的发生产生因果影响，或者是否具有共同的潜在神经机制。
The factors that underlie pelvic pain are poorly understood. Specifically, the relative influence of dysmenorrhea and psychological factors in the etiology of noncyclic pelvic pain conditions, such as interstitial cystitis and irritable bowel syndrome, is unknown. To further characterize pelvic pain, we compared the frequency of menstrual, somatosensory, and psychological risk factors between women with and without severe noncyclic pelvic pain symptoms. A total of 1012 reproductive-aged women completed a 112-item questionnaire with domains including mood, fatigue, physical activity, somatic complaint, and pain. Questionnaire items included existing items for menstrual distress and newly written items derived from qualitative interviews. The relationship of dysmenorrhea and noncyclic pelvic pain complaints (dyspareunia, dyschezia, or dysuria) was modeled using quantile regression. Among women who menstruate regularly, those with dysmenorrhea had disproportionally more severe noncyclic pelvic pain (54/402, 13%) than women without dysmenorrhea (5/432, 1%; odds ratio, 13; 95% confidence interval, 5–33). In a multivariate-adjusted model, dysmenorrhea (β = .17), activity capability (β = .17), somatic complaint (β = .17), and bodily pain (β = .12) were the primary predictors of noncyclic pelvic pain. Depression (β = .03) and anxiety (β = .01) were not significantly predictive. The presence of dysmenorrhea, somatic complaint, and low activity capability predicted 90% of the cases of women with noncyclic pelvic pain. The association between dysmenorrhea and noncyclic pelvic pain suggests that menstrual pain is an etiological factor in noncyclic pelvic pain, whereas depression and anxiety may be secondary effects. Longitudinal studies are needed to determine whether dysmenorrhea causally influences development of noncyclic pelvic pain or shares common underlying neural mechanisms.
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影响因子：
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通讯作者：
WILDMAN, BG
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