Sociopsychological factors in chronic pelvic pain: a review.

Chronic pelvic pain is a common gynecological problem. There has long been an assumption that social and psychological factors play a part in its genesis in a significant subgroup, but their precise role remains unclear. More recently, childhood sexual abuse has been implicated as a specific risk factor. For this review, PSYCHLIT and MEDLINE searches for relevant publications were supplemented by tracing back through the latter's related reference lists. One hundred thirty-one references directly concerning pelvic pain were identified with varying emphasis on social and psychological aspects. A further 449 references were in related fields. Forty-three were considered to be helpful in directly exploring the link between chronic pelvic pain and sociopsychological factors and 22 of these reported specific studies directly relevant. In common with other research into chronic pain conditions, it appears unhelpful to separate this type of pain into "psychogenic" and "organic" categories. Clear case definition is essential. The specificity of childhood sexual abuse as a risk factor is unclear. It may be helpful to consider clearly defined subgroups with the condition in future studies. An example of such a subgroup with pelvic venous congestion is discussed.

Sociopsychological factors in women with chronic pelvic pain with and without pelvic venous congestion.

Social and psychological factors have long been proposed as being of importance in a sizeable subgroup of women complaining of unexplained chronic pelvic pain (CPP). The aim of this study was to examine this in two subgroups of CPP patients, thereby eliminating pain alone as the determining variable. Consecutive attenders at a clinic for CPP were assessed on a range of somatic, historical, social, and psychological variables using detailed interviews and questionnaires. They were subsequently allocated to one of two groups, based on the presence or absence of pelvic venous congestion (PVC). Significant associations emerged between some social arrangements, paternal parenting, and patterns of hostility in the group with pelvic venous congestion. The groups also differed in patterns of family illness, and the congested group tended to report more childhood sexual abuse (CSA). Clear case definition in CPP is important. In the subgroup with pelvic venous congestion early social experience may play an important role. Father-daughter relationships may be particularly relevant. Hostility patterns may influence the development of the condition. CSA does not appear to play a specific role in all unexplained CPP cases, but may have relevance for the subgroup with pelvic venous congestion.

Interviewing for sexual abuse: reliability and effect of interviewer gender.

An interview to detect histories of sexual abuse was administered to consecutive attenders at a gynecology clinic on two occasions, on one occasion by a male interviewer and on the other by a female interviewer. Fifty-six subjects were assessed, and at least partial agreement was found in 70% between the two interviews. Approximately one-third of incidents were reported at only one of the interviews, with gender of interviewer making little apparent difference to this. Contrary to expectation, subjects appeared more forthcoming at the first interview. Reasons for this are discussed. Interviews for sexual abuse must be carried out in an appropriate context, and simple routine screening questions may not be appropriate. Selection of interviewers on the basis of gender alone may not be helpful.

Hostility and doctor-patient interaction in chronic pelvic pain.

BACKGROUND: Interaction in medical consultations is of interest for many reasons and has long been thought an important variable in determining outcomes. Relatively few methods or instruments exist that attempt to access this phenomenon. The design, validation and possible application of a simple instrument to assess doctor-patient interaction are reported. Rapport and hostility may be related and we hypothesised that interaction between doctor and patient would be related in part to hostility. METHODS: A simple instrument to assess doctor-patient interaction was designed based on 4 areas related to interaction and perception of 'the other'. These were the areas of communication, rapport, trust and sense of ease. The instrument was compared with an external previously validated measure of hostility. Data were obtained from 74 women attending initial and follow-up consultations for chronic pelvic pain during the course of a larger study. RESULTS: The instrument had acceptable reliability and a single-factor structure. Patients' assessment of the initial consultation as unsatisfactory correlated with inwardly directed hostility (Spearman correlation coefficient, r = 0.30, p = 0.011). Patients' tendency to rate the consultation worse than the doctor was correlated with inwardly directed hostility (r = 0.42, p < 0.001). Pain outcomes were not directly related to the variables studied. CONCLUSIONS: This instrument offers a simple method of assessing some interactional aspects of a medical consultation.

Psychosocial aspects of chronic pelvic pain, with special reference to sexual abuse. A study of 164 women.

Patients with chronic pelvic pain attending a tertiary referral centre show certain social, developmental and psychological characteristics. Specifically, they appear to have fewer children and to report more paternal overprotection, and a trend towards low maternal care compared to normals. They also show more depression, free-floating anxiety and somatic anxiety than such populations. The levels are similar to those found in other outpatient populations presenting with migraine or irritable bowel syndrome. Hostility levels are greater than those in normal subjects. Overall the present patient population reports the same degree of childhood sexual abuse as do many other female clinic and community sample populations. Sexual abuse is unlikely to be a specific aetiological factor in the development of chronic pelvic pain though it may yet be found to be important in subsets of the population.

Patients' illness models in chronic pelvic pain.

A modification of Kleinman's approach to eliciting concepts that patients have about their illnesses was applied to 64 patients with chronic pelvic pain. The women involved did not have clear schemata about causes of the process, and displayed flexibility in the concepts they did have. A significant proportion had clear ideas about what they did not want in terms of treatment. Worries focussed on interminability and effects on sex and work. It appears that offering a simple explanatory model such as that based on venous congestion fulfils some of the treatment needs in this group. Kleinman's approach could be more widely employed.

The effect of chylomicron remnants on bile acid synthesis in cultured rat hepatocytes.

The effect of chylomicron remnants on bile acid synthesis in isolated rat hepatocytes in monolayer cultures was investigated. Production of bile acids by the cells in the presence of chylomicron remnants at a cholesterol concentration of 7.8-9 nmol/ml was increased by approx. 75% after 17 h and 25% after 24 h incubation. Similar concentrations of cholesterol added to the cells in the form of chylomicrons had no significant effect on bile acid synthesis. These results suggest that cholesterol taken up in chylomicron remnants may be an important source of substrate for bile acid synthesis.

Short tandem repeats shared by B- and C-hordein cDNAs suggest a common evolutionary origin for two groups of cereal storage protein genes.

We have identified cDNA clones coding for the major sulphur-rich and sulphur-poor groups of barley storage proteins (the B- and C-hordeins, respectively). Hybridization studies have revealed unexpected homologies between B- and C-hordein mRNAs. Using a deletion mutant (Risø 56), we have mapped some C-hordein-related sequences within, or closely associated with, B-hordein genes at the Hor 2 locus. Nucleotide sequencing has shown that the primary structure of B-hordein polypeptides can be divided into at least two domains: domain 1 (repetitive, proline-rich, sulphur-poor), which is homologous to C-hordein sequences, and domain 2 (non-repetitive, proline-poor, sulphur rich), which makes up two-thirds of the polypeptide and is partially homologous to a 2S globulin storage protein found in dicotyledons. The coding sequences that are homologous in B- and C-hordein mRNAs have an asymmetric base composition (>80% C-A) and are largely composed of a degenerate tandem repeat based on a 24 nucleotide consensus that encodes Pro-Gln-Gln-Pro-Phe-Pro-Gln-Gln. We discuss the evolutionary implications of the domain structure of the B-hordeins and the unusual relationship between the two groups of barley storage proteins.