2019 News from the Research Team Articles
Article Summary by IPPS Research Committee Member Dr. Georgine Lamvu, who is also the primary author
Patterns of Prescription Opioid Use in Women With Endometriosis: Evaluating Prolonged Use, Daily Dose, and Concomitant Use With Benzodiazepines
Lamvu, Georgine, MD, MPH; Soliman, Ahmed M., PhD; Manthena, Shivaji R., MS; Gordon, Keith, PhD; Knight, Julie, PharmD; Taylor, Hugh S., MD
Obstetrics & Gynecology 2019 June
Summary: This was a retrospective large database analysis of 53,847 women diagnosed with endometriosis. Compared to matched controls, the women with endometriosis were almost 4 times more likely to fill an opioid prescription. Endometriosis was also associated with long term opioid use and concomitant benzodiazepine use.
Full article available HERE.
Article Summary by IPPS Research Committee Members Dr. Douglas Sherlock and Dr. Georgine Lamvu Dr. Laura Payne
Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society)
Jacob Bornstein, Mario Preti, James A. Simon, Sawsan As-Sanie, Colleen K. Stockdale, Amy Stein, Sharon J. Parish, Gianluigi Radici, Pedro Vieira-Baptista, Caroline Pukall, Micheline Moyal-Barracco, Andrew Goldstein, and on behalf of the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women's Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS)
PubMed 2019 Apr 23
Summary: The 2015 vulvodynia terminology and classification released by these three societies did not include definitions for the 11 descriptors that can be used when describing vulvodynia. This new publication is a guideline to consensus terminology to allow communication and research of Vulvar pain. Common causative etiologies are listed. The definition of vulvodynia (vulvar pain of 3 months duration with no identifiable cause) and the consensus descriptions are outlined including:
- Localized to the lower portion of the vulva (vestibule), clitoris, etc.
- Generalized involvement of the whole vulva
- Provoked by physical contact
- Spontaneous where the symptom can occur without provoking physical contact
- Primary onset where the symptoms occurs with first physical contact
- Secondary, where onset of symptoms did not occur with first provoking physical contact
- Temporal patters were defined as persistent, intermittent, immediate or delayed
An example description of adolescent congenital case may be localized, provoked, primary, persistent vulvodynia. This will be a helpful way to communicate the clinical case in a standard format. Additionally, there is a commitment of the organizations involved to review the terminology as more data are available.
Conclusion: Using the vulvar pain consensus terminology as outlined will allow for improved clinical and research communication.
Article Summary by IPPS Research Committee Members Dr. Laura Payne
Pathophysiology of Endometriosis-Associated Pain:
A Review of Pelvic and Central Nervous System Mechanisms
Lydia Coxon, Andrew W. Horne, and Katy Vincent
Epub 2018 Feb 15
Summary: Pain associated with endometriosis may arise from a number of potential mechanisms. Peripheral pain mechanisms, such as nerve fibers and inflammatory markers, are very likely involved in generating pain in endometriosis. However, results have been mixed with some studies finding more nerve fibers in peritoneal endometriotic lesions in women with endometriosis compared to controls, and other studies showing no differences. Few studies have examined the relationship of nerve fibers to self-reported pain, but existing research suggests a positive correlation between nerve growth/nerve fiber density and pain symptoms. Inflammatory markers may also be elevated in the peritoneal fluid of women with endometriosis. Central changes in structure and functional connectivity of brain regions may also be evident in women with endometriosis; however, these alterations appear to be related to reported pain experience more than endometriosis itself. The relationship between HPA axis functioning and endometriosis is more complex, but limited existing data suggests self-reported pain may be the biggest predictor of salivary cortisol levels. Depression, anxiety, and pain catastrophizing is also elevated in women with endometriosis, which likely contributes to ongoing pain and disability, while more research on autonomic nervous system functioning is needed in this population to be able to generate conclusions about sympathetic and parasympathetic functioning. Given the multiple potential causes and factors contributing to pain in this population, stratifying patients with endometriosis based on pain characteristics may help inform both research and treatment approaches.
Conclusion: Endometriosis-associated pain likely stems from a variety of factors, including peripheral and central mechanisms, and shares many similarities with chronic pain conditions.
2019 Archived Research News