A number of women who come to the clinic with a musculoskeletal complaint will describe other painful syndromes that involve other body systems (see Women and Pain blogs Part 1 & Part 2). These include irritable bowel syndrome (IBS), pelvic pain, dysmennorhoea, endometriosis, bladder dysfunction, jaw pain (TMJ), migraines and widespread musculoskeletal pain. Often hypermobility is also a feature (see blogs here and here) . These are termed functional pain syndromes and require a comprehensive approach to tackle the physical, cognitive and emotional dimensions of the pain and associated problems that impact upon quality of life.
This recent study looked at a cohort of women in Australia and showed that the presence of one condition is associated with the development of another. Certainly in functional pain syndromes we know about the underpinning central sensitisation that is a common theme that manifests in different end-organs or body systems to create the aforementioned conditions. Using strategies to cultivate health within the systems is important, but so is using therapies to target the central mechanisms and driving systems, i.e. the nervous system, the immune system and the endocrine system (including stress physiology).
Only through a detailed assessment and the creation of an environment that permits the patient’s narrative will this vital piece of the puzzle emerge (see Oliver Sack talk about narrative here).
The Relationship Between Incontinence, Breathing Disorders, Gastrointestinal Symptoms, and Back Pain in Women: A Longitudinal Cohort Study.
Smith MD, Russell A, Hodges PW.
OBJECTIVES:: Recent studies suggest a relationship between incontinence, respiratory disorders, gastrointestinal (GI) symptoms, and back pain (BP). However, causality is difficult to infer. This longitudinal study aimed to determine whether the presence or development of one disorder increases risk for the development of another. METHODS:: Women from the Australian Longitudinal Study on Women’s Health were divided into subgroups; those with no BP (n=7259), no incontinence (n=18,480), no breathing problems (including allergy) (n=15,096), and no GI symptoms (n=17,623). Each subgroup was analyzed to determine the relationship between the development of the absent condition and the presence or development of the other conditions. Factors with a previously identified relationship with BP were included in analysis.
RESULTS:: Women with pre-existing and/or newly developed incontinence [prevalence ratios (PR): 1.26 to 2.12] and breathing problems (PR: 1.38 to 2.11) had an increased risk for the development of BP, and women with pre-existing and newly developed BP were more likely to develop incontinence and breathing problems (PR: 1.18 to 2.44 and 1.53 to 2.62, respectively). The presence of GI symptoms was also identified as a risk factor for the development of these conditions.
DISCUSSION:: This study provides evidence of a relationship between BP, incontinence, respiratory problems, and GI symptoms in which the presence of one symptom is associated with the development of another. This suggests that common factors may contribute to the development of symptoms across this range of conditions.