The Neural Immune Mechanisms and Genetic Influences on Chronic Pelvic Pain

ACTH峰值水平在慢性疼痛患者或疼痛和子宫内膜异位症患者中明显高于正常对照组。 疼痛女性的ACTH反应曲线与对照组不同，在30和45分钟时水平较高。 两组的皮质醇反应曲线相似。在18名患有慢性盆腔疼痛的女性中，10名ACTH反应正常，8名ACTH反应改变。平均抑郁和焦虑评分在慢性盆腔疼痛的正常和异常反应者之间没有差异。患有慢性盆腔疼痛和子宫内膜异位症的女性，以及在较小程度上仅患有慢性盆腔疼痛的女性，在皮质醇水平没有相应变化的情况下，ACTH分泌增加，以响应Corticorelin注射，类似于纤维肌痛和慢性应激观察到的模式。 这种不典型的ACTH反应可能表明相对免疫缺陷，并可能解释在这些妇女中观察到的一些免疫学变化和合并症。 为了更好地了解子宫内膜异位症，慢性盆腔疼痛及其治疗，我们分析了4,334名子宫内膜异位症协会成员报告手术诊断子宫内膜异位症的调查。 我们调查了第一次看医生和青少年症状发作是否影响子宫内膜异位症的诊断过程。 几乎所有的受访者报告盆腔疼痛，50%的人首先咨询妇科医生，45%的人咨询子宫内膜异位症的症状。 妇女和女孩谁报告看到妇科医生第一次子宫内膜异位症的症状更有可能有较短的时间诊断，看到更少的医生，并报告一个更好的经验与他们的医生。 大多数人报告在青春期出现症状，他们报告在获得诊断时的时间更长，经历更差。 我们还通过分析牛津子宫内膜异位症基因（OXEGENE）研究中1,000名妇女的问卷调查，考虑了疾病严重程度与子宫内膜异位症患者特征之间的关系。 女性被分配到第I组（rAFS I-II期，n=423）或第II组（rAFS III-IV期，n=517）。 导致诊断的最常见症状是痛经和骨盆疼痛。 性交困难和抑郁症在I组中更常见。 在第二组中，低生育力和卵巢肿块更常导致诊断。 在整个生育期内，第二组的低生育率仍然更常见，但出生率和流产率相似。 这项研究显示了不同阶段子宫内膜异位症妇女的特征差异，这可能有助于未来的临床和流行病学研究。 值得注意的是，不同疾病阶段的女性之间的诊断时间相似。

Peak ACTH levels were significantly higher among those with chronic pain alone, or those with pain and endometriosis than normal controls. ACTH response curves differed from controls in women with pain, significantly differing with higher levels at 30 and 45 minutes. Cortisol response curves were similar for both groups. Of 18 women with chronic pelvic pain, 10 had a normal and 8 had an altered ACTH response. Mean depression and anxiety scores did not differ between normal and abnormal responders with chronic pelvic pain. Women with chronic pelvic pain and endometriosis, and to a lesser degree those with chronic pelvic pain alone, experience heightened ACTH secretion without corresponding changes in cortisol levels in response to Corticorelin Injection, similar to the pattern observed with fibromyalgia and chronic stress. This atypical ACTH response may indicate a relative immunodeficiency and could account for some of the immunologic changes and co-morbidities observed in these women. To better understand endometriosis, chronic pelvic pain and its treatment, we have analyzed a survey of 4,334 Endometriosis Association members reporting surgically diagnosed endometriosis. We have investigated whether the first doctor seen and adolescent onset of symptoms impact the diagnostic process of endometriosis. Almost all respondents reported pelvic pain with 50% first consulting a gynecologist and 45% a generalist for symptoms of endometriosis. Women and girls who reported seeing a gynecologist first for symptoms of endometriosis were more likely to have a shorter time to diagnosis, see fewer physicians, and report a better experience overall with their physicians. The majority reported onset of symptoms during adolescence, who reported a longer time and a worse experience while obtaining a diagnosis. We have also considered the relationship between disease severity and patient characteristics in endometriosis by analyzing questionnaires from 1,000 women in the Oxford Endometriosis Gene (OXEGENE) Study. Women were assigned to Group I (rAFS Stage I-II, n=423) or Group II (rAFS Stages III-IV, n=517). The most common symptoms leading to a diagnosis were dysmenorrhea and pelvic pain. Dyspareunia and depression were more common in Group I. In Group II, sub-fertility and an ovarian mass more commonly led to a diagnosis. Sub-fertility remained more common in Group II throughout reproductive life, but birth and miscarriage rates were similar. This study shows differences in characteristics of women with different stages of endometriosis, which may aid future clinical and epidemiological studies. Remarkably, the time to diagnosis was similar between women with different stages of disease.