Chronic Pelvic Pain: Genetics/Neural Immune Mechanisms

慢性盆腔疼痛与子宫内膜异位症是知之甚少。为了更好地了解盆腔疼痛，寻找新的医学方法来理解和治疗盆腔疼痛，本研究将探讨性激素、疼痛处理、免疫系统物质和疼痛相关基因之间的关系。我们还将检查血液、子宫内膜异位症病变和正常子宫内膜组织中激素和免疫物质水平的变化。子宫内膜异位症和慢性盆腔痛的妇女也会出现肌筋膜疼痛。我们将研究如何神经，肌肉和骨骼系统参与骨盆疼痛进行深入的疼痛评估。最后，压力在产生和维持慢性疼痛中起着重要作用。我们将研究如何激素有关的压力反应可能会改变盆腔疼痛。 子宫内膜异位症的合并症包括自身免疫性疾病和其他疾病状态。 我们分析了子宫内膜异位症协会对近4000名手术诊断为子宫内膜异位症的妇女进行的调查。几乎所有的反应者都有疼痛（99%），许多人报告不孕症（41%）。在这个患有子宫内膜异位症的女性队列中，甲状腺功能减退症，纤维肌痛，慢性疲劳综合征，自身免疫性疾病，过敏和哮喘都比美国普通人群中的女性更常见。在接下来的两年里，我们将分析调查的其余部分，以检查这些妇女经历过的药物和手术治疗的类型及其有效性，以及其他合并症。

Chronic pelvic pain associated with endometriosis is poorly understood. This study is an effort to better understand pelvic pain and identify novel medical approaches for understanding it and treating it. We will examine the relations among sex hormones, pain processing, immune system substances and pain related genes. We will also examine changes in levels of hormonal and immune substances in the blood, endometriosis lesions and normal endometrial tissue. Myofascial pain has been noted in women with endometriosis and chronic pelvic pain. We will study how the nerve, muscle and skeletal systems are involved in pelvic pain by performing an in depth pain assessment. Finally, stress plays an important role generating and perpetuating chronic pain. We will examine how the hormones related to the stress response may be altered in pelvic pain. Comorbidities of endometriosis including autoimmune and other disease states. We analyzed a survey of almost 4000 women with surgically diagnosed endometriosis conducted by the Endometriosis Association. Almost all responders had pain (99%), and many reported infertility (41%). In this cohort of women with endometriosis, hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies, and asthma are all significantly more common than in women in the general U.S. population. In the next two years, we are going to analyze the remainder of the survey to examine the types of medical and surgical treatments these women have experienced and their effectiveness, as well as other co-morbidities.