Fatores associados à funcionalidade de mulheres com dor pélvica crônica

Abstract

Introduction: Chronic pelvic pain (CPP) is characterized by the presence of localized pain in the pelvis, persisting for 6 months or more, and may involve the pelvis and adjacent regions. Its origin may be related to multiple factors or conditions, which often overlap and can coexist in a single individual. Thus, the impacts generated in the lives of women with CPP are not limited to the occurrence of prolonged physical pain, but extend to psychosocial factors, triggering functional impairment that leads to disability. Therefore, it is important to investigate functioning, based on the International Classification of Functioning, Disability and Health (ICF), and its factors in women associated with CPP. The current literature addresses several aspects, such as sexual function, pain, physical activity, and depressive symptoms in women with CPP, however, studies are still needed to explore which factors are associated with functioning in this population. Objective: Exploring the factors associated with functioning in women with chronic pelvic pain (CPP). Methods: Cross-sectional study, carried out with women with CPP, between 18 and 45 years old, assisted at the chronic pelvic pain, endometriosis, and pelvic physiotherapy clinics at Maternidade Escola Assis Chateaubriand (MEAC), Fortaleza. Data collection was carried out between December 2020 and October 2022, through interviews, using a structured form with sociodemographic and clinical data, anthropometric measurements, urogynecological and obstetric history, and self-report of physical activity practice. After the form, the participants answered the instruments: World Health Disability Assessment Schedule 2.0 (WHODAS 2.0), Pain Catastrophizing Scale (PCS), Female Sexual Function Index (FSFI), Tampa Scale for Kinesiophobia (TSK) and Patient Health Quality – 9 ( PHQ-9); and performed the sit-to-stand test. For data analysis we used means and standard deviations, Pearson's correlation tests, Student's t-test, and multiple linear regression, considering a significance level of 5%. Results: 168 women with a mean age of 34.2 (± 6.9) years were evaluated. Those with greater pain intensity and catastrophizing, sexual dysfunction, kinesiophobia, depressive symptoms, who do not practice regular physical activity and with worse performance in the sit and stand test, had worse levels of functioning. In the multiple linear regression model, we observed that women with catastrophic thoughts related to pain (β = 6.40; 95%CI 0.44;12.36) and with depressive symptoms (β = 12.03; 95%CI 6.61; 17,45) showed greater impairments in functionality. Conclusion: This study suggests that the occurrence of CPP is related to psychological factors (pain catastrophizing and depressive symptoms), and not only biophysical, which can lead to disability. We reinforce the need for a comprehensive look at women with CPP, emphasizing the importance of a multidisciplinary approach and an adequate line of care, covering the components of functioning.