Download PDF
CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(03): 170-175
DOI: 10.1055/s-0039-1679879
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Variables Associated with Endometriosis-related Pain: A Pilot Study using a Visual Analogue Scale

Variáveis associadas à dor relacionada à endometriose: estudo piloto usando uma escala analógica visual
Mauro Cozzolino 
1   Department of Biomedical, Experimental and Clinical Sciences – Division of Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Florence, Italy
2   Universidad Rey Juan Carlos, Madrid, Spain
,
Maria Elisabetta Coccia
1   Department of Biomedical, Experimental and Clinical Sciences – Division of Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Florence, Italy
,
Giacomo Lazzeri
3   Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
,
Francesca Basile
4   Department of Human Pathology and Evolutionary Age, University of Messina, Messina, Italy
,
Gianmarco Troiano
5   University of Siena, Siena, Italy
› Author Affiliations
Further Information

Publication History

07 November 2018

22 January 2019

Publication Date:
16 April 2019 (online)

   Permissions and Reprints

Abstract

Objective Endometriosis is a complex disease, and pain is an important component of the syndrome. One of the most used methods to assess pain is the visual analogue scale (VAS). The aim of the present research was to study the pain experienced by patients who referred to our unit for endometriosis, using the VAS to understand the variables that could influence it.

Methods We have conducted a prospective study from February 2012 to December 2016, enrolling 388 patients who referred to a university hospital, in Florence, Italy. We have included in the present study patients during their follow-up for endometriosis; we have also included patients who underwent surgery with a histological diagnosis of endometriosis. We have collected sociodemographic and clinical information regarding age, body mass index (BMI), smoking habit, number of pregnancies, and endometriosis staging. Finally, we have administered the VAS for several symptoms.

Results Dysmenorrhea was the symptom associated with the highest perception of pain (mean VAS score of 5.76). The logistic regression showed that the stage of endometriosis could influence the pain associated to constipation and to dysuria. The linear regression showed that age could influence the pain associated to constipation, to dyspareunia, and to dysmenorrhea. A positive correlation was found between dysmenorrhea and chronic pelvic pain (CPP), between dysmenorrhea and dyspareunia, and between constipation and dysuria.

Conclusion Using a validated method, the VAS, we have studied the pain experienced by a group of patients with a history of endometriosis and observed that smoking habit and BMI did not influence the VAS scores, and that dysmenorrhea was associated with the highest perception of pain.

Resumo

Objetivo A endometriose é uma doença complexa, e a dor é um componente importante da enfermidade. Um dos métodos mais utilizados para avaliar a dor é a escala visual analógica (EVA). O objetivo da presente pesquisa foi estudar a dor sentida pelas pacientes que se referiram à nossa unidade para endometriose, usando a EVA para entender as variáveis que poderiam influenciá-la.

Métodos Realizamos um estudo transversal de fevereiro de 2012 a dezembro de 2016, envolvendo 388 pacientes que se referiram a um hospital universitário, em Florença, Itália. Incluímos nossos pacientes do estudo durante o acompanhamento da endometriose; incluímos também pacientes que se submeteram à cirurgia com diagnóstico histológico de endometriose. Coletamos informações sociodemográficas e clínicas sobre idade, índice de massa corporal (IMC), hábito de fumar, número de gravidezes e estágio da endometriose. Finalmente, administramos a EVA para vários sintomas.

Resultados A dismenorreia foi o sintoma associado à maior percepção de dor (média do escore EVA de 5,76). A regressão logística mostrou que o estágio da endometriose poderia influenciar a dor associada à constipação e à disúria. A regressão linear mostrou que a idade poderia influenciar a dor associada à constipação, à dispareunia e à dismenorreia. Uma correlação positiva foi encontrada entre dismenorreia e dor pélvica crônica, entre dismenorreia e dispareunia, e entre constipação e disúria.

Conclusão Utilizando um método validado, a EVA, estudamos a dor sentida por um grupo de pacientes com história de endometriose e observamos que o hábito de fumar e o IMC não influenciaram os escores EVA, e que a dismenorreia foi associada à maior percepção de dor.

Keywords

chronic pelvic pain - constipation - dyspareunia - dysmenorrhea - endometriosis - visual analogue scale

Palavras-chave

dor pélvica crônica - constipação - dispareunia - dismenorreia - endometriose - escala visual analógica

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.


 

  • References

  • 1 Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10 (05) 261-275 . Doi: 10.1038/nrendo.2013.255
    CrossrefPubMedGoogle Scholar
  • 2 Olive DL, Pritts EA. Treatment of endometriosis. N Engl J Med 2001; 345 (04) 266-275 . Doi: 10.1056/NEJM200107263450407
    CrossrefPubMedGoogle Scholar
  • 3 Verkauf BS. Incidence, symptoms, and signs of endometriosis in fertile and infertile women. J Fla Med Assoc 1987; 74 (09) 671-675
    PubMedGoogle Scholar
  • 4 Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale?. Hum Reprod Update 2015; 21 (01) 136-152 . Doi: 10.1093/humupd/dmu046
    CrossrefPubMedGoogle Scholar
  • 5 Chopin N, Ballester M, Borghese B. , et al. Relation between severity of dysmenorrhea and endometrioma. Acta Obstet Gynecol Scand 2006; 85 (11) 1375-1380 . Doi: 10.1080/00016340600935490
    CrossrefPubMedGoogle Scholar
  • 6 Lemaire GS. More than just menstrual cramps: symptoms and uncertainty among women with endometriosis. J Obstet Gynecol Neonatal Nurs 2004; 33 (01) 71-79 . Doi: 10.1177/0884217503261085
    CrossrefPubMedGoogle Scholar
  • 7 Signorello LB, Harlow BL, Cramer DW, Spiegelman D, Hill JA. Epidemiologic determinants of endometriosis: a hospital-based case-control study. Ann Epidemiol 1997; 7 (04) 267-741 . Doi: 10.1016/S1047-2797(97)00017-3
    CrossrefPubMedGoogle Scholar
  • 8 Bloski T, Pierson R. Endometriosis and chronic pelvic pain: unraveling the mystery behind this complex condition. Nurs Womens Health 2008; 12 (05) 382-395 . Doi: 10.1111/j.1751-486X.2008.00362.x
    CrossrefPubMedGoogle Scholar
  • 9 Ozawa Y, Murakami T, Terada Y. , et al. Management of the pain associated with endometriosis: an update of the painful problems. Tohoku J Exp Med 2006; 210 (03) 175-188
    CrossrefPubMedGoogle Scholar
  • 10 Butrick CW. Chronic pelvic pain: how many surgeries are enough?. Clin Obstet Gynecol 2007; 50 (02) 412-424 . Doi: 10.1097/GRF.0b013e31804b195f
    CrossrefPubMedGoogle Scholar
  • 11 Gerlinger C, Faustmann T, Hassall JJ, Seitz C. Treatment of endometriosis in different ethnic populations: a meta-analysis of two clinical trials. BMC Womens Health 2012; 12: 9 . Doi: 10.1186/1472-6874-12-9
    CrossrefPubMedGoogle Scholar
  • 12 Dunselman GA, Vermeulen N, Becker C. , et al; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (03) 400-412 . Doi: 10.1093/humrep/det457
    CrossrefPubMedGoogle Scholar
  • 13 Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997; 67 (05) 817-821 . Doi: 10.1016/S0015-0282(97)81391-X
    CrossrefPubMedGoogle Scholar
  • 14 Setälä M, Härkki P, Matomäki J, Mäkinen J, Kössi J. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstet Gynecol Scand 2012; 91 (06) 692-698 . Doi: 10.1111/j.1600-0412.2012.01394.x
    CrossrefPubMedGoogle Scholar
  • 15 Tokushige N, Markham R, Russell P, Fraser IS. High density of small nerve fibres in the functional layer of the endometrium in women with endometriosis. Hum Reprod 2006; 21 (03) 782-787 . Doi: 10.1093/humrep/dei368
    CrossrefPubMedGoogle Scholar
  • 16 Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update 2005; 11 (06) 595-606 . Doi: 10.1093/humupd/dmi029
    CrossrefPubMedGoogle Scholar
  • 17 Gabriel B, Nassif J, Trompoukis P, Barata S, Wattiez A. Prevalence and management of urinary tract endometriosis: a clinical case series. Urology 2011; 78 (06) 1269-1274 . Doi: 10.1016/j.urology.2011.07.1403
    CrossrefPubMedGoogle Scholar
  • 18 Triolo O, Laganà AS, Sturlese E. Chronic pelvic pain in endometriosis: an overview. J Clin Med Res 2013; 5 (03) 153-163 . Doi: 10.4021/jocmr1288w
    PubMedGoogle Scholar
  • 19 Howard FM. Endometriosis and mechanisms of pelvic pain. J Minim Invasive Gynecol 2009; 16 (05) 540-550 . Doi: 10.1016/j.jmig.2009.06.017
    CrossrefPubMedGoogle Scholar
  • 20 Seracchioli R, Mabrouk M, Guerrini M. , et al. Dyschezia and posterior deep infiltrating endometriosis: analysis of 360 cases. J Minim Invasive Gynecol 2008; 15 (06) 695-699 . Doi: 10.1016/j.jmig.2008.07.005
    CrossrefPubMedGoogle Scholar
  • 21 Schliep KC, Mumford SL, Peterson CM. , et al. Pain typology and incident endometriosis. Hum Reprod 2015; 30 (10) 2427-2438 . Doi: 10.1093/humrep/dev147
    CrossrefPubMedGoogle Scholar
  • 22 Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod 2007; 22 (01) 266-271 . Doi: 10.1093/humrep/del339
    CrossrefPubMedGoogle Scholar
  • 23 Morassutto C, Monasta L, Ricci G, Barbone F, Ronfani L. Incidence and estimated prevalence of endometriosis and adenomyosis in Northeast Italy: a data linkage study. PLoS One 2016; 11 (04) e0154227 . Doi: 10.1371/journal.pone.0154227
    CrossrefPubMedGoogle Scholar
  • 24 Nnoaham KE, Hummelshoj L, Webster P. , et al; World Endometriosis Research Foundation Global Study of Women's Health consortium. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96 (02) 366-373.e8 . Doi: 10.1016/j.fertnstert.2011.05.090
    CrossrefPubMedGoogle Scholar
  • 25 Messina G, Quercioli C, Troiano G. , et al. Italian medical students quality of life: years 2005–2015. Ann Ig 2016; 28: 245-251 . Doi: 10.7416/ai.2016.2103
    PubMedGoogle Scholar
  • 26 Nante N, Gialluca L, De Corso M, Troiano G, Verzuri A, Messina G. Quality of life in refugees and asylum seekers in Italy: a pilot study. Ann Ist Super Sanita 2016; 52 (03) 424-427 . Doi: 10.4415/ANN_16_03_14
    PubMedGoogle Scholar
  • 27 Levorato S, Bocci G, Troiano G, Messina G, Nante N. Health status of homeless persons: a pilot study in the Padua municipal dorm. Ann Ig 2017; 29 (01) 54-62 . Doi: 10.7416/ai.2017.2132
    PubMedGoogle Scholar
  • 28 Surtees PG, Wainwright NW, Khaw KT, Day NE. Functional health status, chronic medical conditions and disorders of mood. Br J Psychiatry 2003; 183: 299-303 . Doi: 10.1192/bjp.183.4.299
    CrossrefPubMedGoogle Scholar
  • 29 Cozzolino M, Magro-Malosso ER, Tofani L, Coccia ME. Evaluation of sexual function in women with deep infiltrating endometriosis. Sex Reprod Healthc 2018; 16: 6-9 . Doi: 10.1016/j.srhc.2017.12.005
    CrossrefPubMedGoogle Scholar