Vínculo parental, saúde mental e catastrofização em mulheres com dor pélvica crônica
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2022-10-26
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Universidade Federal de Goiás
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Introduction: The experience of pain and its coping strategies, mental disorders such as anxiety and depression, and maladaptive personality traits such as catastrophizing have been associated with parenting styles in childhood. In turn, catastrophizing has been considered an important predictor of outcomes for different types of pain, including chronic pelvic pain (CPP) in women, which is a common and difficult-to-treat health condition. Aims: To perform a narrative review of the available literature on CPP in women. To evaluate the association between parenting style and CPP in women, and to investigate the association between catastrophizing, pain intensity, anxiety, depression, and parenting style in women with CPP. Methods: A search was conducted of the Medline, Embase and SciELO (Scientific Electronic Library Online) databases up to the cut-off date of October 15, 2021. The following terms were used: chronic pelvic pain, central sensitization, hyperalgesia, chronic pain, neuromodulation, women, somatic pain, visceral pain, nociplastic pain and neuropathic pain. An observational case-control study was also conducted between May 2018 and August 2021 with 123 women with CPP and 123 pain-free controls. Sociodemographic, clinical, and behavioral data were investigated. Parental Bonding Instrument was used to assess parenting styles. Generalized Anxiety Disorder-7 e 9-item Patient Health Questionnaire were used to evaluate anxiety and depression, respectively. Pain intensity and catastrophizing were investigated in the CPP group using, respectively, a 10-cm numerical pain rating scale and the Pain Catastrophizing Scale. Yates’s chi-square test and the Mann-Whitney test were used to compare characteristics between the groups. Multiple logistic regression analyses were conducted to determine possible associations between each parenting style and CPP in women, and the odds ratios (OR) and their respective 95% confidence intervals (95%CI) were calculated. Spearman’s correlation coefficient (r) was used to verify possible correlations between catastrophizing, pain intensity, the duration of pain, anxiety, depression, and parental bonding style (maternal and paternal care and overprotection) in the group of women with CPP. Results: A higher frequency of low maternal care (60.7% versus 45.2%; p=0.026), anxiety (79.7% versus 56.9%; p<0.001), depression (73.2% versus 56.1%; p=0.008), physical violence (31.7% versus 14.6%; p=0.003), relationship difficulties (39.8% versus 19.5%; p=0.001), and abdominal/pelvic surgery (78.0% versus 63.4%; p=0.017) were found in the CPP group compared to the control group. The domains of parental bonding were not independently associated with CPP in women. Catastrophizing was identified in 77.2% of women in the CPP group. Catastrophizing women were found to use significantly more pain medication compared to non-catastrophizing women (94.7% vs 78.6%; p=0.024). A positive correlation was found between catastrophizing and pain intensity (r=0.342; p<0.001), anxiety (r=0.271; p=0.002), depression (r=0.272; p=0.002), and maternal overprotection (r=0.185; p=0.046). A negative correlation was found between anxiety and maternal (r=-0.184; p=0.047) and paternal (r=-0.286; p=0.006) care and between depression and maternal (r=-0.219; p=0.018) and paternal (r=-0.234; p=0.026) care in the CPP group. Conclusions: CPP is an challenger condition that may not be associated with an obvious cause. A timely scheme of investigation and treatment of associated comorbidities is recommended. The clinical identification of a central sensitization phenotype can guide the management of women with CPP, which must be interdisciplinary and involve biopsychosocial aspects. Low maternal care was more common in women with CPP compared to the pain-free controls, with no independent association between parental bonding and CPP. Catastrophizing was very common and positively, but weakly, correlated with the intensity of pain, anxiety, depression, and maternal overprotection in the CPP group. Maternal and paternal care was negatively and weakly correlated with anxiety and depression in women with CPP. Our findings suggest further studies on the role of families, particularly fathers and mothers, in the emotional development and pain coping strategies of women with CPP. They also indicate the need for a personalized approach to women with CPP, seeking better therapeutic outcomes.
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CAMPOS, V. M. S. Vínculo parental, saúde mental e catastrofização em mulheres com dor pélvica crônica. 2022. 192 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2022.