119例女性盆腔痛患者的临床特征及疼痛程度相关因素分析*

Clinical characteristics and related factors of pain severity in 117 female patients with chronic pelvic pain

摘要:

目的：分析女性盆腔痛（CPP）患者的临床特征和疼痛程度相关影响因素，为CPP的诊疗提供新的思路。 方法：前瞻性纳入2022至2023年在上海中医药大学附属岳阳中西医结合医院疼痛科就诊并诊断为CPP的女性患者。编制调查问卷，采集CPP患者的基本信息、疼痛特点、疼痛部位等信息，行疼痛灾难化（PCS) 评估，焦虑抑郁评估（GAD-7评分、PHQ-9评分和HAMD评分）和睡眠质量评估（匹兹堡睡眠质量指数PSQI）。依据疼痛VAS评分为轻度疼痛组（VAS1-3分）、中度疼痛组（VAS4-6分）和重度疼痛组（VAS7-10分），对影响因素分别行单因素分析和多因素分析。 结果：研究期间共纳入119例女性CPP患者，其中外阴疼痛综合征51例、慢性肛门痛综合征32例、盆底肌肉疼痛综合征24例、膀胱疼痛综合征12例。轻度疼痛组14例、中度疼痛组69例、重度疼痛组36例。各疼痛组间年龄、婚姻状态、教育程度等无显著性差异。单因素分析显示，各组疼痛诱因、持续时间无显著差异。三组间PCS、抑郁量表PHQ-9评分和HAMD评分差异有统计学意义。多分类Logistic回归分析显示，PCS、抑郁量表PHQ-9评分和PSQI与CPP的疼痛严重程度相关。 结论：CPP患者的疼痛程度与灾难化、抑郁和睡眠障碍的严重度有关，诊疗CPP患者时，除针对疼痛处理外，还需要同时对患者灾难化、抑郁和睡眠障碍的严重度进行评估并治疗。

Abstract:

Objective：To evaluate clinical characteristics and related factors of pain severity in female patients with chronic pelvic pain (CPP) to provide the reference and approach for treatment of CPP. Methods：We prospectively enrolled female patients with the diagnosis of CPP between 2022-2023 in Department of Pain Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine in this study. With the questionnaire, the clinical information in patients with CPP were collected, including basic demography, pain characteristics and location. Patients were received psychiatric and sleep evaluation, including pain catastrophizing scale (PCS), the general anxiety disorder-7 (GAD-7), the patient health questionnaire-9 (PHQ-9), the Hamilton depression rating scale (HDRS) and Pittsburgh sleep quality index (PSQI). Patients were grouped into mild (VAS 1-3 points), moderate (VAS 4-6 points) and severe (VAS 7-10 points) pain according to pain severity, and influential factors on pain severity were assessed by univariable and multiple-variable analyses. Results：A total of 119 female patients with CPP were enrolled, including vulvar pain syndrome (n=51), chronic anal pain syndrome (n=32), pelvic floor muscle pain syndrome (n=24), bladder pain syndrome (n=12). Mild, moderate and severe pain groups had 14, 69 and 36 patients, respectively. Age, marriage status and education levels were comparable among different pain severity groups. Univariate analysis indicated pain cause and pain duration did not differ significantly between pain severity groups, but PCS, PHQ-9 and HAMD showed statistical difference between groups. Multiple Logistic regression demonstrated PCS, PHQ-9 and PSQI were significantly associated with pain severity. Conclusion：The pain intensity of patients with CPP was associated with catastrophizing scale, depression and sleep disturbance, suggesting assessment and intervention on these 3 aspects should be considered in CPP treatment.