Pelvic Girdle Pain (PGP) is reported by 50% of pregnant women and up to 11 years after pregnancy, 10% of women have persistent and per definition chronic PGP. Central (nervous system) sensitization that elicits pain hypersensitivity, may be one explanation. The overall aim of this study is to explore features of central sensitization in pregnant women and its predictive ability on physical activity, functioning and health in women with PGP. Measurements of central sensitization will be done on two study groups, pregnant women with PGP and healthy controls. To identify women at risk to develop chronic pain in relation to a common pain experience ie PGP in pregnancy, may help us understand if central sensitization early in life explains why women develop chronic pain.
Pelvic Girdle Pain (PGP) is reported by 50% (60000) of pregnant women yearly in Sweden. PGP is expected to disappear after delivery. However up to 11 years after pregnancy, 10% of women have persistent and per definition chronic PGP with large impact on their physical activity, functioning,and health. Central (nervous system) sensitization, defined as an amplification of neural signaling within the central nervous system that elicits pain hypersensitivity, may be one explanation why 10% of women develop postpartum chronic PGP and related physical inactivity. The overall aim of this study is to explore features of central sensitization in pregnant women and its predictive ability on physical activity, functioning and health in women with PGP. Two study groups, pregnant women with PGP and healthy controls (including non-native Swedish) will be included through maternity care units and a blog. Measurements of primary outcome central sensitization will be done. To identify women at risk to develop chronic pain in relation to a common pain experience ie PGP in pregnancy, may help us understand if central sensitization early in life explains why women develop chronic pain.
Study Type
OBSERVATIONAL
Enrollment
144
Närhälsan Gibraltargatan
Gothenburg, Sweden
RECRUITINGcentral sensitization measured by Patient Pain Drawing
spreading of pain
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
central sensitization measured by conditioned pain modulation using an algometer and a occlusion cuff
Malfunctioning of descending nociceptive inhibitory pathways resulting in dysfunctional endogenous analgesia, assessed by a conditioned pain modulation (CPM)= 1. PressurePainThresholds (PPT)is assed by a digital algometer at symtomatic (sacrum and lumbar paravertebral muscles and 2 remote locations)+at asymptomatic regions(web thumb-index, prox 1/3 calf ) 2. mechanism of CPM will be induced by inflating an occlusion cuff (conditioning stimulus) at the participant's left arm to a painful intensity. The occlusion cuff is inflated until 'the first sensation of pain' is reported. This cuff inflation is maintained for 30 sec. The participant is than asked to rate the pain intensity, as a result of cuff inflation at the left arm, on a NRS (0=no pain-10=worst pain). Next, the cuff inflation is increased or decreased until pain intensity at the left arm was rated as 3/10 on NRS. The PPT assessments are then repeated during maintenance of the cuff inflation and relaxation of the left arm.
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
Pregnancy Physical Activity Questionnaire
Physical activity and exercise are measured by this self-administered questionnaire which provides assessment of four domains of physical activity; ''Sports and Exercises', ''Household and Caregiving'', 'Transportation''and ''Occupation'. Since it measures the frequency and the duration of the activities, (an intensity value assigned to each activity), the minimum values are 0 but here are no maximum values. The activities can be analyzed by type, by intensity or for the total energy expenditure.
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
Pelvic Girdle Questionnaire
Functioning. Minimum score 0 maximum score 100 where high scores mean worse outcome.
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
Patients Specific Functioning Scale
Two by the participant, self-chosen activities rated on a numeric rating scale. Minimum score 0 maximum score 10 where high scores mean better outcome
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
EuroQol 5-dimension questionnaire (EQ5D)
Health-related quality of life. Minimum score -0,59 and 1 maximum score where high scores mean better outcome
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
Work Ability Index
Current work ability marked on a Numeric Rating Scale. Minimum score 0 maximum score 10 where high scores mean better outcome
Time frame: change from baseline (gestational week 20-30),at 12 months after delivery,
Numeric Rating Scale for pain
pain intensity. Minimum score 0 maximum score 10 where high scores mean worse outcome
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
Numeric Rating Scale for concern
Concern. Minimum score 0 maximum score 10 where high scores mean worse outcome
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
Edinburgh Postnatal Depression Scale
Symptoms of depression. Minimum score 0 maximum score 30 where high scores mean worse outcome
Time frame: change from baseline (gestational week 20-30) at 6 weeks, at 6 months and at 12 months after delivery
Sonia Coelho Cristovao, PhD-student
CONTACT
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