Chronic Pelvic Pain In An Interdisciplinary Setting: 1-Year Prospective Cohort Editorial Comment

Chronic pelvic pain (CPP) is a common clinical problem among women. Its etiology is complex and involves an interplay of gynecologic, urologic, gastrointestinal, musculoskeletal, and psychosocial comorbidities. An interdisciplinary treatment approach has been proposed to address these multifactorial comorbidities using different interventions at a single integrated center. Although cross-sectional studies can provide some insight into the association between these comorbidities and CPP severity, prospective longitudinal cohorts are needed to identify comorbidities associated with changes in CPP severity over time.The aim of this prospective 1-year cohort study was to describe trends and factors associated with CPP severity over a 1-year prospective cohort at an interdisciplinary center. The study focused on the role of comorbidities, adjusting for baseline pain, demographic factors, and treatment effects. Exclusion criteria were menopause or age older than 50 years. Among the 525 patients meeting inclusion/exclusion criteria, the response rate for women completing the 1-year follow-up was 57% (296/525). The primary study outcome-CPP severity at 1 year on an 11-point numeric rating scale (0-10)-was categorized for ordinal regression (none-mild 0-3, moderate 4-6, severe 7-10). Secondary outcomes were functional quality of life and health utilization (physician visits or emergency room visits in the last 3 months). Baseline comorbidities included endometriosis, irritable bowel syndrome, abdominal wall pain, pelvic floor myalgia, painful bladder syndrome, and validated questionnaires for depression, anxiety, and catastrophizing. Pain catastrophizing is characterized by rumination, magnification, and helplessness. Multivariable ordinal regression was used to compare baseline comorbidities associated with the primary outcome at 1 year.Chronic pelvic pain severity, on average, decreased 2 points from baseline to 1 year (6/10-4/10, P < 0.001). There was a 13% improvement in functional quality of life (42%-29% on the pain subscale of the Endometriosis Health Profile 30, P < 0.001), a 37% reduction in patients requiring a physician visit (73%-36%, P < 0.001), and a 13% reduction in patients making an emergency visit (24%-11%, P < 0.001) in the last 3 months. Multivariable ordinal regression showed that CPP severity at 1 year was independently associated with a higher score on the Pain Catastrophizing Scale (PCS) at baseline (odds ratio, 1.10; 95% confidence interval, 1.00-1.21; P = 0.04), after adjusting for baseline pain, treatment effects (surgery), age, and referral status.These findings show improvements in CPP severity, quality of life, and health care utilization in a 1-year cohort at an interdisciplinary setting. Moreover, higher pain catastrophizing at baseline is associated with greater CPP severity at 1 year. The data provide additional evidence for the importance of psychological factors in women with pelvic pain. The authors suggest that in future research studies and in clinical practice consideration should be given to stratifying pelvic pain patients by catastrophizing level (rumination, magnification, helplessness).