Negative Illness Perceptions are Associated With a Pronociceptive Modulation Profile and Augmented Pelvic Pain

A patient's personal interpretations of a health threat or "illness perceptions" (IPs) are associated with their clinical outcomes. This study explored whether IPs are associated with pain severity and ability to modulate pain in women with chronic pelvic pain syndrome (CPPS), as well as the predictive value of IPs on myofascial manual therapy (MMT) success.

Illness Perceptions Questionnaire-Revised (IPQ-R), mechanical and heat pain thresholds, mechanical temporal summation, and conditioned pain modulation (CPM) were evaluated in CPPS patients (n=39) before, and 3 months after MMT. CPPS severity was obtained by the Brief Pain Inventory (BPI).

Stronger perceptions of illness chronicity were correlated with less efficient CPM (r=0.488, P=0.002) and increased mechanical pain intensity (r=0.405, P=0.02). Lower perceptions of control over illness were associated with enhanced mechanical temporal summation (r=0.399, P=0.01). Higher BPI scores were correlated with emotional representations (negative emotional representations) and severe consequences due to CPPS. Regression analyses revealed that negative IPs predict less efficient MMT.

Cognitive representations play a unique role in CPPS expression and MMT outcomes. The interplay between negative IPs and a pronociceptive modulation profile, mediated by enhanced facilitatory and reduced inhibitory processes, may be involved in the manifestation of CPPS.