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Grundström, H., Larsson, B., Arendt-Nielsen, L., Gerdle, B. & Kjölhede, P. (2019). Associations between pain thresholds for heat, cold and pressure, and Pain Sensitivity Questionnaire scores in healthy women and in women with persistent pelvic pain. European Journal of Pain, 23(9), 1631-1639
Open this publication in new window or tab >>Associations between pain thresholds for heat, cold and pressure, and Pain Sensitivity Questionnaire scores in healthy women and in women with persistent pelvic pain
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2019 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 23, no 9, p. 1631-1639Article in journal (Refereed) Published
Abstract [en]

Background

The Pain Sensitivity Questionnaire (PSQ) is a self‐rating instrument developed as a time‐ and cost‐saving alternative to quantitative sensory testing (QST). The aims of the study were to assess (a) the associations between PSQ scores and QST in women with persistent pelvic pain and in pain‐free controls and (b) to what extent demographic variables and psychological distress influenced PSQ scores.

Methods

Fifty‐five healthy women and 37 women with persistent pelvic pain participated. All filled in the PSQ and Hospital Anxiety and Depression Scale and had QST (heat, cold and pressure pain thresholds) performed on six locations on the body. Information on age, body mass index, smoking habits and pain duration were collected. Principal component analysis and orthogonal partial least square regressions were used.

Results

The patients scored significantly higher on PSQ than the controls. Significant multivariate correlations between pain thresholds and PSQ scores were found only in the patient group. In the patient group, the heat and cold pain thresholds correlated more strongly with PSQ scores than the pressure pain threshold.

Conclusions

The PSQ score was significantly higher in pelvic pain patients, and correlations between QSTs and the PSQ were only found for patients.

Significance

The PSQ reflects pain sensitivity in women with PPP and can be used as a non‐invasive and painless way to assess this condition in clinical practice.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-158927 (URN)10.1002/ejp.1439 (DOI)000473899400001 ()31192501 (PubMedID)2-s2.0-85068534469 (Scopus ID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Research Council; County council of Ostergotland; Linkoping University; IMI Paincare

Available from: 2019-07-19 Created: 2019-07-19 Last updated: 2020-04-08Bibliographically approved
Grundström, H., Gerdle, B., Alehagen, S., Berterö, C., Arendt-Nielsen, L. & Kjölhede, P. (2019). Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis. Acta Obstetricia et Gynecologica Scandinavica, 98(3), 327-336
Open this publication in new window or tab >>Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 3, p. 327-336Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Endometriosis is a gynecological disorder that may cause considerable pelvic pain in women of fertile age. Determining pain mechanisms is necessary in order to optimize the treatment of the disease. The objective of the study was to evaluate pain thresholds in women with persistent pelvic pain with and without confirmed endometriosis, and healthy, unaffected controls, and analyze how pain thresholds in these cohorts related to duration of pelvic pain, quality of life, and symptoms of anxiety and depression.

MATERIAL AND METHODS: Pain thresholds for heat, cold and pressure were assessed with quantitative sensory testing on six locations on a reference group of 55 healthy women and on 37 women with persistent pelvic pain who had been admitted for diagnostic laparoscopy on the suspicion of endometriosis. Validated instruments were applied to assess quality of life and symptoms of anxiety and depression. Data were analyzed by means of uni- and multivariate analysis of variance and Spearman's rank-order correlation.

RESULTS: The women with persistent pelvic pain had significantly lower pain thresholds compared with the reference women. In the women with pain, no differences were observed in pain thresholds between women with (n = 13) and women without (n = 24) biopsy-proven endometriosis. The duration of pelvic pain correlated significantly positively with reduced pain thresholds, ie, the longer the duration, the more sensitization. In the persistent pelvic pain group, pain thresholds for heat correlated significantly with the Short Form Health Survey 36 dimension of bodily pain, and thresholds for cold correlated with Short Form Health Survey 36 bodily pain and with symptoms of depression.

CONCLUSIONS: Our results showed widespread alterations in pain thresholds in women with persistent pelvic pain that are indicative of central sensitization and a time-dependent correlation. Women with pelvic pain and suspicion of endometriosis should probably be treated more thoroughly to prevent or at least minimize the concomitant development of central sensitization.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
chronic pain, endometriosis, health-related quality of life, pain thresholds, persistent pelvic pain, quantitative sensory testing, sensitization
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-154816 (URN)10.1111/aogs.13508 (DOI)000459481000007 ()30472739 (PubMedID)2-s2.0-85059291957 (Scopus ID)
Note

Funding agencies:  Medical Research Council of Southeast Sweden; Region Ostergotland; Linkoping University

Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-06-28Bibliographically approved
Berterö, C., Alehagen, S. & Grundström, H. (2019). Striving for a biopsychosocial approach: A secondary analysis of mutual components during healthcare encounters between women with endometriosis and physicians. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS, 11(3), 146-151
Open this publication in new window or tab >>Striving for a biopsychosocial approach: A secondary analysis of mutual components during healthcare encounters between women with endometriosis and physicians
2019 (English)In: JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS, ISSN 2284-0265, Vol. 11, no 3, p. 146-151Article in journal (Refereed) Published
Abstract [en]

Objective:

The objective of this study was to identify and describe mutual components during healthcare encounters between women with endometriosis and physicians.

Methods:

Secondary analysis of data was obtained from two original face-to-face interview studies, one with nine women with endometriosis and one including 16 physicians. Data in this secondary analysis were analysed using thematic analysis.

Results:

Three themes were identified. (1) Continuity as a foundation for a biopsychosocial approach. The women and the physicians described the importance of continuity and both parties strived for a biopsychosocial approach whereby the female body was not treated as biomedical defect object, but as a part of the unity that constitutes a human being. (2) Listening sensitively. Women and physicians believed that listening sensitively involved more than just hearing the actual words – it required thoughtfulness, reflection and responsiveness. (3) Timing of diagnosis. The physicians tried to protect the women from worrying by treating the painful menstruations without mentioning endometriosis. However, the women regarded not mentioning endometriosis as a lack of competence on the part of the physicians.

Conclusion:

This study provides new insights into the need for further support in the provision of psychosocial care for women with endometriosis, in the striving towards a biopsychosocial approach.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Endometriosis; pelvic pain; healthcare encounter; secondary analysis; biopsychosocial
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-164439 (URN)10.1177/2284026519865396 (DOI)000483866200005 ()2-s2.0-85072052857 (Scopus ID)
Note

Funding Agencies|Linkoping University [LIO-723061]; Ostergotland County Council

Available from: 2020-03-28 Created: 2020-03-28 Last updated: 2020-04-28Bibliographically approved
Grundström, H. (2018). Disclosing the invisible: experiences, outcomes and quality of endometriosis healthcare. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Disclosing the invisible: experiences, outcomes and quality of endometriosis healthcare
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Many women with endometriosis report that their symptoms are normalized and trivialized when they seek medical care and they often experience diagnostic delays, ineffective treatments and physiological, psychological and social consequences. However, there is a knowledge gap when it comes to women’s experiences of different aspects of endometriosis healthcare, and the quality of that care.

Aim: The aim of this thesis was to identify, describe and analyse the experiences, encounters and outcomes of endometriosis healthcare from different perspectives.

Design and Method: This thesis is a summary of four studies with different methods and designs. Study I and II were qualitative interview studies in which nine women with a laparoscopy-verified endometriosis diagnosis (study I) and 25 healthcare professionals (HCPs) (study II) described their experiences of healthcare encounters related to endometriosis symptoms. The interviews were analysed using interpretive phenomenology (study I) and conventional content analysis (study II). Study III was a cross-sectional observational comparative study measuring pain thresholds, health-related quality of life (HRQoL) and symptoms of anxiety and depression using quantitative sensory testing (QST) and questionnaires in order to determine pain thresholds in healthy women (n=55) and women with persistent pelvic pain (PPP), with (n=14) and without (n=23) a confirmed diagnosis of endometriosis. The correlations between pain thresholds and duration of PPP, HRQoL and symptoms of anxiety and depression were also analysed. Study IV was a quantitative observational study using register data from the National Quality Register for Gynaecological Surgery. Patient-reported experience measures (PREM) and patient-reported outcome measures (PROM) after benign hysterectomy were analysed and compared in women with and without PPP and endometriosis (study IV).

Results: The results of the thesis are summarized in three themes: The struggle to visualize the pain, The endometriosis diagnosis as a key to understanding and enduring persistent pelvic pain and Healthcare encounters as potentially life changing.

In the first theme, women and HCPs described the healthcare encounters concerning endometriosis symptoms as troublesome (study I, II). The women struggled with disclosing, visualizing and communicating their hidden pain to the HCPs (study I), and HCPs expressed insecurity and limited knowledge when caring for these women (study II). Study III showed widespread reduced pain thresholds among women with PPP compared with healthy controls, and a significant positive correlation between duration of PPP and reduced pain thresholds . Study III also showed a reduced HRQoL and higher prevalence of anxiety and depressive symptoms among women with PPP, which were also described by the women (study I).

The importance of getting a diagnosis was described in the second theme by both women and HCPs (study I, II), but women with PPP with and without endometriosis diagnosis did not differ significantly in their pain thresholds or psychosocial outcomes in study III. Likewise, women with PPP with and without endometriosis gave more equal PREM and PROM answers than women in the pain-free comparison group. Overall, women undergoing hysterectomy on benign indications were satisfied with the experience and outcomes of the surgery (study IV).

As described in the last theme, healthcare encounters could be constructive or destructive. Positive experiences could make the symptoms easier to endure. The constructive encounters were often characterized by a holistic approach and a care structured in multidisciplinary teams.

Conclusion and clinical implications: The results suggest that PPP should be taken seriously and treated actively in order to minimize the risk of physiological and psychological consequences, such as reduced pain thresholds, lower HRQoL and symptoms of anxiety and depression. Unrelieved PPP could also be an explanatory factor for long-term physiological consequences, such as lower PREM and PROM after hysterectomy.

High-quality endometriosis healthcare should provide an interaction of physical, psychological and social factors. If women experience that HCPs acknowledge their pain and the effect of pain on HRQoL and mental health, and are offered proper pain-relieving treatment, healthcare encounters could change their lives.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 95
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1621
Keywords
endometriosis, persistent pelvic pain, healthcare professionals, healthcare encounters, health-related quality of life, pain thresholds, quantitative sensory testing, central sensitization, hysterectomy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-151005 (URN)10.3384/diss.diva-151005 (DOI)9789176853153 (ISBN)
Public defence
2018-10-05, Fornborgen,, Vrinnevisjukhuset, Norrköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-09-10 Created: 2018-09-10 Last updated: 2019-09-30Bibliographically approved
Berterö, C. & Grundström, H. (2018). The double-edged experience of healthcare encounters among women with endometriosis: a qualitative study. Journal of Clinical Nursing, 27(1-2), 205-211
Open this publication in new window or tab >>The double-edged experience of healthcare encounters among women with endometriosis: a qualitative study
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 1-2, p. 205-211Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

To identify and describe the experience of healthcare encounters among women with endometriosis.

Background

Endometriosis is a “hidden” chronic gynaecological disease appearing in every 10th woman of fertile age. Different manifestations of pain are the main symptoms, often leading to impaired physical and mental health, and lower quality of life. Previous research on healthcare experiences among women with endometriosis has focused on diagnostic delay and experiences of encountering general practitioners.

Design

A qualitative, interpretive, phenomenological approach was used.

Methods

We interviewed nine women aged 23–55, with a laparoscopy-confirmed diagnosis of endometriosis. The interviews were recorded and transcribed verbatim. The data were analysed following the steps of the interpretive phenomenological approach.

Results

Two themes were identified in the interview transcripts: being treated with ignorance and being acknowledged. The essence: “the double-edged experience of healthcare encounters” emerged from the themes. The women's experience was double-edged as it involved contradictory feelings: the encounters were experienced as both destructive or constructive. On the one hand, the destructive side was characterised by ignorance, exposure and disbelief. On the other hand, the constructive side made the women feel acknowledged and confirmed, boosting their self-esteem.

Conclusions

The new and important aspects of the findings are that the experience of healthcare encounters is for the first time expressed as double-edged: both destructive and constructive. The experience was of specific importance as it affected the women's perceptions of themselves and of their bodies.

Relevance to clinical practice

The information about the constructive side of the experience is of clinical valuable for all healthcare professionals (nurses, midwives and doctors) encountering these women, as it provides a new level of understanding of the experiences. The findings demonstrate both psychological and practical aspects that can help professionals to improve the encounters.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
dysmenorrhoea, endometriosis, experience, healthcare encounter, healthcare professionals, phenomenology, qualitative study
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-141005 (URN)10.1111/jocn.13872 (DOI)000418871000042 ()28493635 (PubMedID)
Note

Funding agencies: County Council of Ostergotland; Linkoping University; Medical Research Council of Southeast Sweden

Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2019-12-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4086-4634

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