Thesis Title: Biopsychosocial Assessment of Endometriosis-Associated Pain
Women (18-49 years) with and without Endometriosis are assessed for the biological and psychosocial contributors to chronic pelvic pain.
The biological aspects are assessed with neuro-psychophysical testing. The aim is to build a somatosensory profile detailing the changes in sensory function in women with and without endometriosis.
The psychophysical aspects are assessed with self-reported instruments. These questionnaires detail the physical, emotional, cognitive and self-belief contributions to pain severity in women with and without endometriosis.
The women with endometriosis are further assessed for the influence their emotions, cognitions and self-belief have on the functional abnormalities observed in their somatosensory profile and the severity of their pain.
Chapter 1: To be done (Literature review)
Chapter Title: Endometriosis
Section 1: Uterine changes in Endometriosis
Sub-section 1A Steroidogeneisis; 0.3 page required
Refs:
Aghajanova L et al 2009; Steroidogenic enzyme and key decidualisation marker dysregulation in endometrial stromal cells from women with versus without endometriosis; Biology of Reproduction
Delvoux, B et al 2014; Inhibition of Type 1 17-beta-hydroxysteoid dehydrogenase impairs the synthesis of 17-beta-estradiol in endometriosis lesions; Journal of Clinical Endocrinology and Metabolism
Gibson D A et al 2013; Endometrial Intracrinology-generation of an estrogen-dominated microenvironment in the secretory phase of women; Journal of Clinical Endocrinology and Metabolism
Aghajanova L et al 2009; The progesterone receptor coactivator Hic-5 is involved in the pathophysiology of endometriosis; Endocrinology
Bunch, K eet al; 2014; Expression Patterns of Progesterone Receptor Membrane Components 1 and 2 in Endomtria from women with and without endometriosis; Reproductive Sciences
Al-Sabbagh, M eet al, 2012; Mechanisms of endometrial progesterone resistance; Molecular and Cellular Endocrinology
Section 1B
Medical Management of Endometriosis; 0.4 page
Please include some info on return of pain once contraceptive control is removed
Black K and Fraser IS, 2012
Fraser IS 2010
Giudice L and Kao 2004
Chapter 2: To be done(Literature review)
Chapter 2:A Biopsychosocial Assessment of Endometriosis-Associated Pain
Section 2A
The Biopsychosocial (BPS) Model of Chronic Pain; 1 page
Please write about background of BPS model of pain – how it came together; and how it is used in the study of chronic pain; why it is used and then drill down into how it is used in chronic pelvic pain and, if necessary, chronic low back pain. (Chronic pelvic pain is closer to endometriosis-associated pain.)
Please include references from the last 5 years.
Chronic pain depends on the biopsychosocial status of the individual.
Engel 1977; The need for a new medical model: A challenge for biomedicine; Science
Gatchel and Baum 1983; An introduction to health psychology
Waddell 1987; A new clinical method for the treatment of low back pain; Spine
Gatchel RJ et al 2004; Comorbidity of chronic pain and mental health: the biopsychosocial perspective; American Psychologist
Gatchel RJ et al 2007; The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions; Psychologcial Bulletin
Melzack R 2001; Pain and the neuromatrix in the brain; Journal of Dental Education
Melzack R 2005; Evolution of the neuromatrix theory of pain; Pain Practice
Koenig Alex L et al 2014; Biopsychosocial functioning and pain self-efficacy in chronic low back pain patients; Journal of Rehabilitation, Research and Development
Ferreira-Valente Maria A et al, 2014; Associations between psychosocial factors and pain intensity, physical functioning and psychological functioning in patients with chronic pain; Clinical Journal of Pain
Section 2B
The Use of BPS Model of Pain and Normative Data; 0.5 page required
Please write about the benefit of the addition of the psychosocial aspect to the assessment of pain. Data on the psychosocial aspect of pain is often gathered by self-report questionnaires. These results of these questionnaires need to be compared to comparable reference data. These data is known as normative data. Normative data needs to come from clinically similar group for any judgements to be useful.
Waddell and Burton 2000; objective physical measurements of injury can tell us about the cause of a particular type of pain but they type of measures cannot tell us about the distress and disability experienced by the individual with that type of pain
Linton 2000; Self-report questionnaires can tell us about distress, disability and coping resources, but, cannot tell us how these things impact the pain. It is known that these items do impact the pain.
Turk DC and Melzack R, 1992; the interpretation of self-report is not possible without some normative data to compare it to. Need normative data from a clinically-similar group so that any outcomes can be judged with a level of confidence
Anastasi 1990; normative data: average performance by a group on a measure
Turk DC et al, 2003; Core outcome domains for chronic pain clinical trials: IMMPACT recommendations; Pain
To make clinically useful judgements about what the numbers mean
Nicholas MK et al 2008; What do the numbers mean? Normative data in chronic pain measures; Pain; Australian normative data for chronic pain population of tertiary-referral centre; can be used for research purposes
Section 2C
Chronic Pain and Quality of Life; 2.0 pages in total required
Chronic pain is associated with diminished Quality of Life across a number of dimensions including physical activity, mood, cognitions and self-belief.
Please include refs from the last 5 years to support that female chronic (pelvic) pain is associated with diminished QoL, in these sections:
i)Chronic Pain and Depression; 0.4 page
Crook et al., 1984,
Von Korff M and Simon G 1996; The relationship between pain and depression; British Journal of Psychiatry
Ojala et al., 2014
Nicholas MK et al 2009; Depressive symptoms in patients with chronic pain; Medical Journal of Australia
- ii) Chronic Pain and Anxiety; 0.4 page
Vonkorff et al., 1988, Wood et al., 2013
iii) Chronic Pain, Stress and Interference in Daily Living; 0.4 page
Rudy et al., 1988, Fahland et al., 2012
- iv) Chronic Pain and catastrophising thoughts and active coping skills; 0.4page
Van DammeStefaan et al, 2008; Coping with Pain: A motivational perspective; Pain
- v) Chronic Pain and self-efficacy (or self-belief); 0.4page
Bandura A 1977; Self-efficacy: toward a unifying theory of behavioral change
Nicholas MK et al 2006; The pain self-efficacy questionnaire: Taking pain into account; Pain
Asghari A, et al 2006; Personality and pain-related beliefs/ coping strategies: A prospective study; Clinical Journal of Pain
Section 2D
The Neuromatrix Theory of Pain; 0.3 page required
Melzack R 2001; Pain and the neuromatrix in the brain; Journal of Dental Education
Melzack R 2005; Evolution of the neuromatrix theory of pain; Pain Practice
Ramachandran V 1998; The perception of phantom limbs; Brain
Wu CL et al 2002; Analgesic effects of intravenous lidocaine and morphine on postamputation pain: A randomised double-blind, active placebo-controlled crossover tiral; Anesthesiology
Section 2E
Quantitative Sensory Testing (QST): 1 page required
QST is psychophysical testing. A battery of individual neuro and psychophysical tests has been amalgamated into one format, known as QST. QST is a standardised approach that is certified by the German Research Network for the Study of Neuropathic Pain (DFNS). The DFNS has complied reference data sets that allow other users of QST to compare their findings with the reference sets made up of healthy controls.
Please write about the background of QST, how it came together, patient groups it was first used on (eg spinal cord injury), that it can be used in research and the advantages of using it over other psychophysical testing – ie it assesses both loss and gain of nerve fibre function and small and large nerve fibres; whereas other tests only measure gain of function in large nerve fibres.
Small nerve fibres and their loss of function are the predominant contributors to small fibre neuropathies.
Please include these refs and any recent refs, particularly the use of QST in chronic, disease related pain.
Treede R-D, 2008; How to detect a sensory abnormality; European Journal of Pain
Treede R-D et al; 2008; Neuropathic Pain: Redefinition and a grading system for clinical and research purposes; Neurology; key point: grading system for neuropathic pain
Rolke R et al 2006; Quantitative Sensory Testing: a comprehensive protocol for clinical trials; European Journal of Pain
Krumova Elena K et al; 2010; Quantitative sensory testing: a diagnostic tool for painful neuropathy; Future neurol; Review article
Rolke R et al; 2006; QST in the DFNS: standardised protocol and reference values; Pain
Magerl W et al; 2010; Reference data for QST: refined stratification for age; Pain
Maier C et al; 2010; QST: somatosensory abnormalities in 1236 patients; Pain
Pfau D et al; 2014; Pain
Section 2F
Mechanism based approach for the management of Pain; 0.5 page required
Please write about the benefits of a mechanism-based approach for the management of chronic pain.
Baron R; 2006; Mechanisms of disease: neuropathic pain – a clinical perspective; Nat ClinPracNeurol
La Motte RH et al; 1991; Neurogenic hyperalgesia: psychophysical studies of underlying mechanisms; J Neurophysiol
Westermann A et al; 2012; Different underlying pain mechanisms despite identical pain characteristics: A case report of a patient with a spinal cord injury
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