The Suffering Scale: A Novel Way of Assessing Pain
Chronic Pelvic Pain (CPP) affects 10-15% of females and a smaller proportion of males. It is a heterogeneous disorder with multiple causes that results in a substantial loss of function and a heavy economic toll. There is often no clear relationship between the severity of pelvic pain and observed pathology in the pelvis. This includes the reproductive tract–the ovaries and uterus in the female and prostate and testes in the male–in addition to the urinary bladder and colon in both sexes. Studies of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system in individuals with CPP, in particular interstitial cystitis and irritable bowel syndrome, suggest a model in which alteration in the central pain circuits of predisposed individuals may be trigger patho-physiological changes in the viscera. (ref for IC and IBS).
CPP patients may have significantly more depression, psychological and somatic complaints. There is sometimes a history of physical, sexual or emotional abuse or trauma in CPP patients who do not respond to targeted therapy. Chronic pain adversely affects mood, social, and professional life and general overall well being. These quality of life impacts can affect the severity of pain and the degree of impairment resulting from constant painful suffering.
Assessing the impact of the pain on various domains of a patient’s existence has become an important focus in the clinical management of pain. Evaluation and treatment of chronic pain now incorporates a pain scale (0-10) for the assessment of pain severity. In addition, there are many questionnaires that help assess quality of life, depression and anxiety; and some of these have been used in the multidisciplinary assessment of patients with CPP.