Chronic Pelvic Pain Patients Demonstrate Higher Catastrophizing in Association with Pelvic Symptoms and Comorbid Pain Diagnoses.

OBJECTIVE

To elucidate the relationship between catastrophization and pelvic pain symptomatology in chronic pelvic pain (CPP) patients using standardized questionnaires.

METHODS

CPP patients completed standardized questionnaires which included: genitourinary pain index, patient health questionnaire for anxiety and depression, interstitial cystitis symptom index, and pelvic floor distress inventory. Scores and number of comorbidities were compared to Pain Catastrophizing Scale (PCS) by linear regression. Patients categorized as "extreme catastrophizing" (PCS score ≥30), traditionally associated with worse outcomes in the pain literature [10-11], were also analyzed separately.

RESULTS

184 patients were included (mean age 42 years, N = 23 male). Higher number of pain comorbidities was correlated to PCS (P < .001) as well as higher scores on all standardized questionnaires (P < .001). Forty-four percent of patients (81/184) were extreme catastrophizers and scored significantly worse on all standardized measures when compared to nonextreme catastrophizers. Mean scores for nonextreme vs extreme catastrophizers were: genitourinary pain index (25.7 ± 6.8 vs 32.7 ± 6.5, P < .001), interstitial cystitis symptom index (6.5 ± 4.7 vs 9.4 ± 5.8, P < .001), pelvic floor distress inventory (88.8 ± 52 vs 121.1 ± 62.8, P < .001), patient health questionnaire anxiety (1.7 ± 2.0 vs 3.6 ± 2.1, P < .001), and depression (1.4 ± 1.6 vs 3.3 ± 2.0, P < .001). Number of comorbidities was not significant predictor of extreme catastrophizing (3.5 vs 3.7 P = .22).

CONCLUSION

Higher scores on standardized questionnaires and more comorbidities was associated with more catastrophizing in CPP patients. This study highlights the significance of standardized questionnaires, including the PCS, to predict which patients may be extreme catastrophizers and thus subject to worse outcomes. Future studies are needed to look at catastrophization as a potentially modifiable and treatable risk factor.