17-24 – Pain processing pathways in women with and without chronic pelvic pain, are they different?

Chronic pelvic pain (CPP) is pain in the lower abdomen or pelvis lasting longer than three months. CPP is a symptom, not a diagnosis, and can be attributed to various conditions therefore a single aetiology is difficult to elicit, making diagnosis challenging and often no pathology is found. Diagnosis, pain processing and the long-term sequelae of CPP is under-researched and poorly understood leaving many women in the cyclical process of no answers and repeated investigations. Functional magnetic resonance imaging (fMRI) uses a powerful magnetic field and radiofrequency pulses to produce images of brain structures, and measures brain activity through small changes in blood flow. Pain processing pathways can be examined by applying pain stimuli during fMRI. We aim to:1. Investigate differences in pain processing of women with and without CPP, when assessed at the same phase of their menstrual cycle. 2. Determine if women with and without CPP show differences in processing response to three types of pain stimulation. 3. See if we can identify biological markers that predict CPP pathology at diagnostic laparoscopy. 40 participants: (20 women with CPP and 20 healthy volunteers (HV)) will undergo fMRI. A short demographic and pain questionnaire will be completed before pain threshold testing and fMRI scan. Scan images will be analysed and pain processing and mechanisms for central sensitisation of pain in women with CPP and HV’s will be compared using a dedicated open access software, Statistical Parametric Mapping (SPM) and CONN (a functional connectivity toolbox) to analyse functional connectivity. These findings will provide useful information for counselling patients prior to undergoing diagnostic laparoscopy to ensure patient expectations are set and alternative treatment options can be implemented.