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

Grinberg, Keren, PhD*,†; Granot, Michal, PhD*,‡; Lowenstein, Lior, MD§; Abramov, Liora, MD; Weissman-Fogel, Irit, PhD*

doi: 10.1097/AJP.0000000000000633
Original Articles

Objectives: 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.

Materials and Methods: 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).

Results: 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.

Discussion: 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.

*Faculty of Social Welfare and Health Sciences, University of Haifa

The Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion

§The Department of Obstetrics and Gynecology, Rambam Medical Center and Faculty of Medicine, Technion, Haifa

The Department of Nursing, Ruppin Academic Center, Emek Hefer

Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, The Sex Therapy Clinic, Tel Aviv, Israel

This study was sponsored by the Israeli Ministry of Health Grant, Jerusalem, Israel (300000-7495) and the Israel Pain Association, Tel- Aviv, Israel. The authors declare no conflict of interest.

Reprints: Irit Weissman-Fogel, PhD, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushi Ave. Mount Carmel, Haifa, 3498838 Israel (e-mail:

Received May 16, 2017

Received in revised form April 20, 2018

Accepted May 17, 2018

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