By: Elizabeth Akincilar
Another October, another International Pelvic Pain Society Annual Scientific Meeting has come and gone. This year, we gathered in Toronto, Canada to learn about the latest and greatest in the world of pelvic pain. It seemed fitting that the first lecture of the general meeting would discuss possible early contributors to chronic urogenital pain.
Dr. Julie Christianson, PhD is an associate professor at the University of Kansas Medical Center. Her research focuses on understanding the influence of early life stress on the development of comorbid chronic pain and affective disorders later in life. Therefore, she presented her research on early trauma and its effects on chronic urogenital pain.
Dr. Christianson began by reviewing the results of the 2012 Kaiser Adverse Childhood Experiences (ACES) Study. This study revealed that children who experienced more adverse experiences, or had higher ACE scores, as adults, their morbidity and mortality was increased. She presented research by Schrepf, et al, that concluded that women with chronic pelvic pain that had higher ACE severity were associated with greater depression, anxiety, perceived stress, pain catastrophizing, functional symptoms, widespreadness of pain, fatigue, poor sleep, worse perception of well-being, which all leads to less symptomatic improvement over time. Interestingly, the same was not true for their male counterparts. Another study by Gupta, et al presented data that suggests that early life trauma predisposes females, in particular, to increased perception of pain following subsequent trauma.
Dr. Christianson’s research utilized a mice model to further study the effect of early life trauma on pelvic pain. The study introduced two “stressors” to female baby mice. The first stressor was separating the pups from their mother for three hours per day for 21 days straight. The second stressor was causing neonatal vaginal irritation, or essentially diaper rash, in the pups. After these two stressors, they tested the pups pelvic organ sensitivity. After the vaginal irritation, they noted specific and widespread hypersensitivity. After the maternal separation, they noted urogenital-specific organ hypersensitivity. In the group that was separated from their mother, they further stressed them as adults with a water avoidance test. Essentially, they made it difficult for them to avoid falling in water. In this group, they found that their urogenital-specific organ hypersensitivity was exacerbated. Next they introduced a treatment intervention, which was exercise. They showed that when given the opportunity to exercise, the stressed mice didn’t exercise as much as the mice that did not undergo the stressors. They also found that the mice that did exercise showed a decrease in bladder sensitivity. The mice that didn’t exercise urinated more frequently when compared to the mice that did exercise. Upon further examination, they found that the mice that exercised had decreased cortisol levels and mast cell degranulation. They concluded that these early life stress or insult models provide clinically-relevant outcomes for testing pharmacological and/or lifestyle interventions for the treatment of chronic pelvic pain.
PHRC’s blog has tackled various lifestyle interventions that can play a crucial role in the treatment of chronic pelvic pain. In a previous blog, guest blogger, Lorraine Faehndrich, discusses negative thinking and how it affects pain. One of PHRC’s physical therapists, Maryssa Steffen, discusses the importance of sleep in this blog, and how it can positively affect pain.
I would like to thank Dr. Christianson and her team for their commitment to studying chronic pain and helping our medical community find more effective treatment interventions for this patient population.