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3. Neuropathic pain in endometriosis

Author

Coxon, Lydia, Wiech, Katja-Antoinett, and Vincent, Katy

Subjects
Pain, Endometriosis
Abstract

Chronic pelvic pain is one of the main symptoms of endometriosis which affects 1 in 10 women of reproductive age. Historically, despite the prevalence of this condition and the impact it has on those affected, endometriosis-associated pain (EAP) has been poorly understood. In this thesis I explore endometriosis-associated pain, specifically the presence of neuropathic pain (pain due to lesion/disease of the somatosensory system). To do this, I use a variety of different techniques including questionnaires, functional magnetic resonance imaging (fMRI) and quantitative sensory testing (QST). To determine the prevalence of neuropathic pain in a large population is difficult. In this thesis I use an online questionnaire on patient support websites to give an estimation of the proportions of women experiencing neuropathic pain. I investigate differences between those with and without neuropathic pain with respect to pain symptoms, psychological and cognitive function, number of surgeries to the abdomen and duration of pain. I also sub-divided women further based on their sensory symptom profiles. I replicate these findings in a novel cohort and relate them to treatment response. Central nervous system changes have been demonstrated in people with neuropathic pain. In this thesis I investigate the association between neuropathic pain features and functional connectivity of the brain in women with endometriosis-associated pain. Sensory testing is an important aspect of neuropathic pain research and in this thesis I use QST to investigate sensory perception. A range of stimuli are used to determine whether there are changes in sensory processing in women with endometriosis-associated pain. Overall, the aims of the research described in this thesis are to advance knowledge regarding the prevalence of neuropathic pain in endometriosis; how women can be stratified using questionnaires and whether that relates to treatment response; what changes associated with neuropathic pain can be seen in the activity of the brain at rest; and the sensory profiles of women with EAP. Research in the area of EAP is critical to inform clinical practice and improve treatment.

Published
2021

5. Clinical predictors of treatment response to gabapentin in women with unexplained chronic pelvic pain.

Author

Coxon, Lydia, Amer, Maryam, Daniels, Jane, Doust, Ann M., Mackenzie, Scott C., Horne, Andrew W., and Vincent, Katy

Subjects
TREATMENT effectiveness, PELVIC pain, MEDICAL scientists, PAIN management, CHRONIC pain
Abstract

Introduction: Chronic pelvic pain affects up to 24% of women worldwide and for up to 55% of these there is no associated pathology. Despite this there are no established treatments in this cohort. This is a secondary analysis of a randomised-controlled trial (GaPP2) to explore if there are measures which enable us to predict treatment outcome. Methods: GaPP2 recruited women with chronic pelvic pain and no identified pathology and compared the response to gabapentin and placebo. This analysis used variables collected at baseline including validated questionnaires. Binary logistic regression was used to create models to explore whether baseline variables predicted treatment response. Treatment response was determined using 30% reduction in average pain intensity, 30% reduction in worst pain intensity and the Patient Global Impression of Change ('marked' or 'very marked' improvement) individually. We also explored whether baseline variables predicted the occurrence of side-effects (dizziness, visual disturbances and drowsiness). Results: Using the Patient Global Impression of Change questionnaire, we found a significant binary logistic regression (p = 0.029, explaining 31% of the variance), with those with lower worst pain intensity (odds ratio (OR) of 0.393, 95% CI [0.217, 0.712]), lower bladder symptom score (OR = 0.788, CI [0.628, 0.989]), and higher mental component quality of life score (OR = 0.911, CI [0.840, 0.988]), more likely to have 'marked' or 'very marked' improvement when treated with gabapentin. We could not identify predictors of experiencing side-effects to gabapentin. However, we did find predictors of these in the placebo group (binary logistic regression (p = 0.009) and explained 33% of the variance). Worse mental health (OR = 1.247, CI [1.019, 1.525]) and lower baseline pain interference (OR = 0.687, CI [0.483, 0.978]) were associated with having side effects, whilst the use of hormones reduced the risk of experiencing side effects (OR = 0.239, CI [0.084, 0.676]). Discussion: Researchers and clinicians are increasingly aware of the importance of personalised medicine and treatment decisions being driven by knowledge of what treatments work for whom. Our data suggests an important role of the Patient Global Impression of Change in clinical trials as it may better reflect balance between symptoms reduction and side-effects and therefore be more useful in clinician-patients joint decision making. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Symptom flares in women with chronic pelvic pain: Questionnaire study within a cohort study (translational research in pelvic pain (TRiPP)).

Author

Coxon, Lydia, Lugt, Celia, Horne, Andrew W., Evans, Emma, Abreu‐Mendes, Pedro, Arendt‐Nielsen, Lars, Aziz, Qasim, Becker, Christian M., Birch, Judy, Charrua, Ana, Demetriou, Lysia, Ferreira‐Gomes, Joana, Hoffman, Anja, Hummelshoj, Lone, Krassowski, Michal, Lunde, Claire E., Meijlink, Jane, Missmer, Stacey A., Perro, Danielle, and Zondervan, Krina T.

Subjects
*INTERSTITIAL cystitis, *CHRONIC pain, *TRANSLATIONAL research, *QUALITY of life, *PELVIC pain, *ENDOMETRIOSIS
Abstract

Objective: To quantify the variation, triggers and impact on quality of life of symptom flares in women with chronic pelvic pain (CPP). Design: Cross‐sectional questionnaire within the Translational Research in Pelvic Pain clinical cohort study. Setting: Women with CPP, with subgroups of women with endometriosis (EAP), interstitial cystitis/bladder pain syndrome (BPS), comorbid endometriosis and interstitial cystitis/bladder pain syndrome (EABP), and those with pelvic pain without endometriosis or interstitial cystitis/bladder pain syndrome (PP). Population or Sample: A total of 100 participants. Methods: Descriptive and comparative analysis from flares questionnaire. Main Outcome Measures: The prevalence, characteristics and triggers of short, medium and long symptom flares in CPP. Results: We received 100 responses of 104 questionnaires sent. Seventy‐six per cent of women with CPP have ever experienced symptom flares of at least one length (short, medium and/or long). Flares are associated with painful and non‐painful symptoms. There is large variation for the frequency, duration, symptoms and triggers for flares. Over 60% of participants reported flares as stopping them from doing things they would usually do, >80% reported thinking about symptoms of flares and >80% reported flares being bothersome. Conclusions: Flares are prevalent and clinically very important in CPP. More research is needed to elucidate the mechanisms and characteristics underlying flares. Clinical practice should include an enquiry into flares with the aim of finding strategies to lessen their burden. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Comprehensive quantitative sensory testing shows altered sensory function in women with chronic pelvic pain: results from the Translational Research in Pelvic Pain (TRiPP) Study

Author

Coxon, Lydia, primary, Vollert, Jan, additional, Perro, Danielle, additional, Lunde, Claire E., additional, Ferreira-Gomes, Joana, additional, Charrua, Ana, additional, Abreu-Mendes, Pedro, additional, Krassowski, Michal, additional, Birch, Judy, additional, Meijlink, Jane, additional, Hummelshoj, Lone, additional, Hoffmann, Anja, additional, Aziz, Qasim, additional, Arendt-Nielsen, Lars, additional, Pogatzki-Zahn, Esther, additional, Evans, Emma, additional, Demetriou, Lysia, additional, McMahon, Stephen B., additional, Missmer, Stacey A., additional, Becker, Christian M., additional, Zondervan, Krina T., additional, Horne, Andrew W., additional, Cruz, Francisco, additional, Sieberg, Christine B., additional, Treede, Rolf-Detlef, additional, Nagel, Jens, additional, and Vincent, Katy, additional

Published
2023
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9. Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain

Author

Demetriou, Lysia, primary, Krassowski, Michal, additional, Abreu Mendes, Pedro, additional, Garbutt, Kurtis, additional, Vitonis, Allison F., additional, Wilkins, Elizabeth, additional, Coxon, Lydia, additional, Arendt-Nielsen, Lars, additional, Aziz, Qasim, additional, Birch, Judy, additional, Horne, Andrew W., additional, Hoffman, Anja, additional, Hummelshoj, Lone, additional, Lunde, Claire E., additional, Meijlink, Jane, additional, Perro, Danielle, additional, Rahmioglu, Nilufer, additional, Terry, Kathryn L., additional, Pogatzki-Zahn, Esther, additional, Sieberg, Christine B., additional, Treede, Rolf-Detlef, additional, Becker, Christian M., additional, Cruz, Francisco, additional, Missmer, Stacey A., additional, Zondervan, Krina T., additional, Nagel, Jens, additional, and Vincent, Katy, additional

Published
2023
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10. Comprehensive quantitative sensory testing shows altered sensory function in women with chronic pelvic pain:results from the Translational Research in Pelvic Pain (TRiPP) Study

Author

Coxon, Lydia, Vollert, Jan, Perro, Danielle, Lunde, Claire E, Ferreira-Gomes, Joana, Charrua, Ana, Abreu-Mendes, Pedro, Krassowski, Michal, Birch, Judy, Meijlink, Jane, Hummelshoj, Lone, Hoffmann, Anja, Aziz, Qasim, Arendt-Nielsen, Lars, Pogatzki-Zahn, Esther, Evans, Emma, Demetriou, Lysia, McMahon, Stephen B, Missmer, Stacey A, Becker, Christian M, Zondervan, Krina T, Horne, Andrew W, Cruz, Francisco, Sieberg, Christine B, Treede, Rolf-Detlef, Nagel, Jens, and Vincent, Katy

Abstract

Chronic pelvic pain (CPP), despite its high prevalence, is still relatively poorly understood mechanistically. This study, as part of the Translational Research in Pelvic Pain (TRiPP) project, has used a full quantitative sensory testing (QST) paradigm to profile n = 85 women with and without CPP (endometriosis or bladder pain specifically). We used the foot as a control site and abdomen as the test site. Across 5 diagnostically determined subgroups, we found features which are common across different aetiologies, eg, gain of function in pressure pain threshold (PPT) when assessing responses from the lower abdomen or pelvis (referred pain site). However, disease-specific phenotypes were also identified, eg, greater mechanical allodynia in endometriosis, despite there being large heterogeneities within diagnostic groups. The most common QST sensory phenotype was mechanical hyperalgesia (>50% across all the groups). A "healthy' sensory phenotype was seen in

Published
2023
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11. Understanding Fatigue in Chronic Pelvic Pain patients:a Translational Research in Pelvic Pain (TRiPP) study

Author

Demetriou, Lysimachi, Coxon, Lydia, Perro, Danielle, Mendes, Pedro Abreu, Lunde, Claire, Garbutt, Kurtis, Krassowski, Michal, Vitonis, Allison, Arendt-Nielsen, Lars, Aziz, Qasim, Birch, Judy, Horne, Andrew, Hoffman, Anja, Hummelshoj, Lone, Meijlink, Jane, Pogatzki-Zahn, Esther, Sieberg, Christine, Treede, Rolf-Detlef, Becker, Christian, Cruz, Francisco, Missmer, Stacey, Zondervan, Krina, Nagel, Jens, and Vincent, Katy

Published
2023

12. How quantitative sensory testing (QST) can help us stratify in endometriosis associated pain:Results from the Translational Research in Pelvic Pain (TRiPP) study

Author

Coxon, Lydia, Krassowski, Michal, Vollert, Jan, Rahmioglu, Nilufer, Mendes, Pedro Abreu, Arendt-Nielsen, Lars, Aziz, Qasim, Becker, Christian, Birch, Judy, Cordeiro, Ana Charrua, Demetriou, Lysimachi, DePari, Mary, Evans, Emma, Gomes, Joana Ferreira, Garbutt, Kurtis, Hoffman, Anja, Horne, Andrew, Hummelshoj, Lone, Lunde, Claire, Meijlink, Jane, Obendorf, Maik, Perro, Danielle, Pogatzki-Zahn, Esther, Sasamoto, Naoko, Terry, Kathryn, Vitonis, Allison, Treede, Rolf-Detlef, Missmer, Stacey, Zondervan, Krina T, Cruz, Francisco, Sieberg, Christine, Nagel, Jens, and Vincent, Katy

Published
2023

13. How many treatments do people with chronic pelvic pain try?:Results from the Translational Research in Pelvic Pain (TRiPP) study

Author

Coxon, Lydia, Perro, Danielle, Demetriou, Lysimachi, Horne, Andrew, Lunde, Claire, Gomes, Joana Ferreira, Cordeiro, Ana Charrua, Mendes, Pedro Abreu, Birch, Judy, Meijlink, Jane, Hummelshoj, Lone, Hoffman, Anja, Aziz, Qasim, Arendt-Nielsen, Lars, Pogatzki-Zahn, Esther, Vollert, Jan, Krassowski, Michal, Evans, Emma, Treede, Rolf-Detlef, Missmer, Stacey, Sieberg, Christine, Cruz, Francisco, Nagel, Jens, and Vincent, Katy

Published
2023

14. Comparing Assessments for Chronic Pelvic Pain:A correlation analysis of the Translational Research in Pelvic Pain (TRiPP) Outcome Data

Author

Kuan, Kevin, Demetriou, Lysimachi, Horne, Andrew, Pogatzki-Zahn, Esther, Krassowski, Michal, Coxon, Lydia, Mendes, Pedro Abreu, Perro, Danielle, Garbutt, Kurtis, Vitonis, Allison, Lunde, Claire, Arendt-Nielsen, Lars, Aziz, Qasim, Birch, Judy, Hoffman, Anja, Hummelshoj, Lone, Meijlink, Jane, Sieberg, Christine, Treede, Rolf-Detlef, Becker, Christian, Cruz, Francisco, Missmer, Stacey, Zondervan, Krina, Nagel, Jens, and Vincent, Katy

Published
2023

15. Is conditioned pain modulation (CPM) a useful paradigm in women? A TRiPP study exploring CPM in pain-free women and those living with chronic pelvic pain

Author

Perro, Danielle, Coxon, Lydia, Lunde, Claire E., Gomes, Joana Ferreira, Cordeiro, Ana Charrua, Mendes, Pedro Abreu, Arendt-Nielsen, Lars, Aziz, Qasim, Birch, Judy, Demetriou, Lysia, Garbutt, Kurtis, Horne, Andrew, Hoffman, Anja, Hummelshoj, Lone, Krassowski, Michal, Meijlink, Jane, Pogatzki-Zahn, Esther, Sieberg, Christine, Treede, Rolf-Detlef, Vitonis, Allison, Vollert, Jan, Becker, Christian, Cruz, Franscisco, Wilkins, Elizabeth, Missmer, Stacey, Zondervan, Krina, Nagel, Jens, and Vincent, Katy

Published
2022

16. Widespread pain is associated with poor psychological health, sleep quality, fatigue, and pain catastrophizing in women with chronic pelvic pain:A TRiPP study

Author

Perro, Danielle, Demetriou, Lysia, Coxon, Lydia, Krassowski, Michal, Mendes, Pedro Abreu, Lunde, Claire E., Garbutt, Kurtis, Vitonis, Allison, Arendt-Nielsen, Lars, Aziz, Qasim, Birch, Judy, Horne, Andrew, Hoffman, Anja, Hummelshoj, Lone, Meijlink, Jane, Pogatzki-Zahn, Esther, Sieberg, Christine, Treede, Rolf-Detlef, Becker, Christian, Cruz, Franscisco, Missmer, Stacey, Zondervan, Krina, Nagel, Jens, and Vincent, Katy

Published
2022

17. Clinical profiling of specific diagnostic subgroups of women with chronic pelvic pain

Author

Demetriou, Lysia, primary, Krassowski, Michal, additional, Mendes, Pedro Abreu, additional, Garbutt, Kurtis, additional, Vitonis, Allison F., additional, Wilkins, Elizabeth, additional, Coxon, Lydia, additional, Arendt-Nielsen, Lars, additional, Aziz, Qasim, additional, Birch, Judy, additional, Horne, Andrew W, additional, Hoffman, Anja, additional, Hummelshoj, Lone, additional, Lunde, Claire E, additional, Meijlink, Jane, additional, Perro, Danielle, additional, Rahmioglu, Nilufer, additional, Terry, Kathryn L., additional, Pogatzki-Zahn, Esther, additional, Sieberg, Christine B, additional, Treede, Rolf-Detlef, additional, Becker, Christian M, additional, Cruz, Francisco, additional, Missmer, Stacey A, additional, Zondervan, Krina T, additional, Nagel, Jens, additional, and Vincent, Katy, additional

Published
2022
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19. Deep phenotyping of women with endometriosis-associated pain and bladder pain syndrome: the TRiPP (Translational Research in Pelvic Pain) study protocol

Author

Demetriou, Lysia, primary, Coxon, Lydia, additional, Krassowski, Michal, additional, Rahmioglu, Nilufer, additional, Arendt-Nielsen, Lars, additional, Aziz, Qasim, additional, Becker, Christian M., additional, Birch, Judy, additional, Cruz, Franscisco, additional, Hoffman, Anja, additional, Horne, Andrew W., additional, Hummelshoj, Lone, additional, McMahon, Stephen, additional, Meijlink, Jane, additional, Pogatzki-Zahn, Esther, additional, Sieberg, Christine B., additional, Tracey, Irene, additional, Treede, Rolf-Detlef, additional, Missmer, Stacey A., additional, Zondervan, Krina T., additional, Nagel, Jens, additional, and Vincent, Katy, additional

Published
2022
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