ROCHA, MG. Mediadores inflamatórios na dor pélvica crônica Identificação de possíveis marcadores séricos da doença. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2010. Introdução: Dor pélvica crônica é uma doença de elevada prevalência e fisiopatologia complexa. Os métodos diagnósticos muitas vezes são insuficientes e, em decorrência, o tratamento e seguimento das mulheres é difícil. Inúmeras doenças que se apresentam com dor crônica tem um perfil inflamatório, que ainda não foi investigado para o tema em questão. Objetivos: Quantificar os níveis de óxido nítrico (NO) e das metaloproteinases 2 (MMP-2) e 9 (MMP-9) no plasma de mulheres com dor pélvica crônica. Pacientes e métodos: Foram incluídas 64 mulheres, subdivididas em 02 grupos: dor pélvica crônica e grupo controle, com 37 pacientes no primeiro grupo e 27 pacientes no segundo grupo. As pacientes do grupo de estudo eram seguidas no Ambulatório de Dor Pélvica e Endoscopia e as pacientes do grupo controle eram seguidas no Ambulatório de Anticoncepção do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto USP. Foi realizada a mensuração clínica da dor através de uma escala unidimensional (VAS) e uma escala multidimensional (McGill). Também foram preenchidas as escalas de ansiedade e depressão (HAD). Indivíduos com qualquer evidência de processos inflamatórios, hipertensão, tabagismo ou uso de contraceptivos hormonais foram excluídos. Indivíduos tomando medicação para a dor, como analgésicos ou antiinflamatórios foram solicitados a pará-los 72 horas antes de participar do estudo. Foi coletada uma amostra sanguínea de 10 ml, no ato da consulta. Esse material foi armazenado em frasco próprio com anti-coagulante, processado imediatamente no local para separação do plasma e armazenado em freezer, a -70C para mensuração subseqüente. As concentrações de espécies relacionadas ao NO (nitrato) em líquidos foram medidas, sempre em triplicata, pelo método da quimioluminescência, que é um dos métodos mais simples, sensíveis e precisos disponíveis para medir NO. Foi utilizado um analisador de NO (Sievers Model 280 NO Analyzer - Boulder, CO, EUA), o qual permite medir NO em quantidades tão pequenas quanto 1 pmol. A atividade das MMP-2 e MMP-9 no plasma serão determinadas pelo método da zimografia, que consiste em uma eletroforese das amostras em um sistema SDS/PAGE que inclui o substrato da enzima (gelatina) no gel de separação, de modo a permitir a evidenciação e quantificação da atividade da enzima. Resultados: Os níveis plasmáticos de NO foram maiores nas pacientes com DPC quando comparadas às pacientes do grupo controle (16.8 ± 7.9 versus 12.2 ± 2.4, respectivamente (P = 0.0016). Especificamente, os níveis plasmáticos de NO foram maiores nas pacientes com DPC de origem visceral quando comparadas às pacientes com dor exclusivamente somática ou aos controles saudáveis (19.2 ± 8.9 versus 12.4 ± 1.8 versus 12.2 ± 2.4, respectivamente) (P=0.0001). Não observamos uma correlação entre os níveis plasmáticos de NO e a duração dos sintomas (em meses) (Spearman r = 0.04, 95%CI:-0.34 to 0.40, P = 0.84) ou com a intensidade dos sintomas dolorosos: EAV (Spearman r =:-0.18, 95%CI:-0.52 to 0.20, P=0.34), ou McGill (Spearman r = -0.06, 95%CI:-0.41 to 0.30, P =0.72). Com relação às MMP´s, não houve diferença estatística entre os dois grupos. Conclusões: Os níveis plasmáticos de NO encontram-se elevados em mulheres com DPC, especialmente naquelas com dor de origem visceral. Este fato pode ser considerado uma possibilidade no seguimento de pacientes com DPC, visto que pode ser usado como um marcador sérico para a doença. Já a dosagem das MMP-s não se mostrou útil como marcador plasmático para mulheres com DPC. / Background: Chronic pelvic pain is a disease of high prevalence and a complex pathophysiology. The diagnostic methods are often inadequate and, consequently, treatment and follow-up of women is quite difficult. Several diseases that present with chronic pain has an inflammatory profile, which has not yet been investigated for the topic. Aim: to quantify levels of nitric oxide (NO) and metalloproteinases 2 (MMP-2) and 9 (MMP-9) in plasma of women with chronic pelvic pain. Methods: 64 women were included in the sudy and divided into 02 groups: chronic pelvic pain and control group with 37 patients in the first group and 27 patients in the second group. Patients in the study group were followed at the Endoscopy and Pelvic Pain Unit and the control group patients were followed in the Contraception Unit of the Hospital of the Medical School of Ribeirão Preto University of São Paulo. We performed the measurement of clinical pain by a unidimensional scale (VAS) and a multidimensional scale (McGill). Anxiety and depression scales were also filled. Individuals with any evidence of inflammation, hypertension, smoking or use of hormonal contraceptives were excluded. Individuals taking medication for pain, such as painkillers or antiinflammatory drugs were asked to stop them 72 hours before entering the study. A blood sample was collected from 10 ml during the appointment. This material was stored in bottle itself with anti-coagulant (EDTA and / or heparin), processed immediately on site for plasma separation and stored in a -70 ºC freezer. The concentrations of species related to NO were measured in liquid, always in triplicate by the method of chemiluminescence, which is one of the most simple, sensitive and accurate available to measure NO. We used a NO analyzer (Sievers Model 280 NO Analyzer - Boulder, CO, USA), which allows the measurement of NO in quantities as small as 1 pmol. The activity of MMP-2 and MMP-9 in plasma was determined by the zymography method, which consists of an electrophoresis of the samples in an SDS / PAGE system, which includes the enzyme substrate (gelatin) in the gel separation, allowing the disclosure and quantification of enzyme activity. Results: Plasma NO levels were higher in CPP women than in controls (16.8 ± 7.9 versus 12.2 ± 2.4, respectively) (P=0.0016). Furthermore, plasma nitrate levels were higher in CPP women with evidence of pain of visceral origin than in CPP women with evidence of an exclusive somatic component or controls (19.2 ± 8.9 versus 12.4 ± 1.8 versus 12.2 ± 2.4, respectively) (P=0.0001). No correlation was detected between NO levels and duration of symptoms or intensity of pain. Regarding the MMP\'s, there was no statistical difference between the two groups. Conclusion: Plasma levels of NO are elevated in women with CPP, especially those with visceral pain. This fact can be considered an option in treating patients with CPP as it can be used as a serum marker for the disease. On the other hand, MMP´s did not turn out to be a good serum marker for women with CPP.

Bakgrund: Endometrios är en sjukdom som drabbar var tionde kvinna i fertil ålder. Sjukdomen kan ha en negativ inverkan på många livsdomäner och medföra ett stort lidande för dessa kvinnor. Tidigare forskning belyser smärta som en vanlig orsak till lidandet. För många kvinnor handlar det även om ett negativt påverkat sex och samliv till följd av endometrios. Många kvinnor lider av samlagssmärta som kan begränsa deras möjlighet till både sexuell tillfredsställelse och en god parrelation. Syfte: Att undersöka prevalensen av problem relaterade till sex och samliv hos kvinnor med endometrios. Metod: Litteraturstudie med 12 kvantitativa originalartiklar som granskades och sammanställdes genom en innehållsanalys. Resultat: I de granskade studierna kunde 19 olika problemområden relaterade till sex och samliv identifieras. Av dessa var dyspareuni, sexuell dysfunktion, kronisk bäckensmärta, minskad sexlust och minskad tillfredsställelse de mest förekommande problemen. I en av studierna led hälften av kvinnorna av dyspareuni. Bland kvinnor med dyspareuni fanns även en minskad frekvens av sex, reducerad orgasm och en minskad tillfredsställelse. Slutsats: Endometrios är en sjukdom som kan orsaka stort lidande. Merparten av kvinnor med endometrios upplever kronisk bäckensmärta, smärta vid samlag, en minskad lust till sex, minskad frekvens av sex och en minskad tillfredsställelse. Dessa problem kan i sin tur påverka kvinnornas parrelation negativt med en känsla av att vara en dålig partner, skuld och en rädsla för att bli lämnad. / Background: Endometriosis is a disease which affects every 10th woman of fertile age. The disease may have a negative impact on many aspects of life, and cause great suffering. Previous research highlights pain as a common cause for the suffering. Some women also experience a negative impact on their sex life and relationships due to endometriosis. Many women experience pain during intercourse, which can constrict their ability to experience sexual satisfaction and a good relationship with a partner. Aim: To examine the prevalence of problems related to sex and relations among women with endometriosis. Method: A literature review of 12 quantitative original articles which were examined and synthesized through a content analysis. Results: Among the studied articles, 19 different problem areas related to sex and relationships were identified. Out of these, dyspareunia, sexual dysfunction, chronic pelvic pain, reduced sexual desire and reduced sexual satisfaction were the most occurring problems. In one of the studies half of the women were suffering from dyspareunia. Among women with dyspareunia there were also a reduced frequency of sex, reduced orgasm and a reduced sexual satisfaction. Conclusion: Endometriosis is a disease which can cause great suffering. The majority of women with endometriosis experience chronic pelvic pain, pain during intercourse, a reduced sexual desire, a reduced frequency of sex and a reduced satisfaction. These problems can in turn negatively affect the relationships of the women, with a feeling of being a bad partner, guilt and a fear of being abandoned.

Abstract The principal aim of a population-based cross-sectional survey was to generate information on the lifetime occurrence of prostatitis in Finnish men and their exposure to the disease, and also on the influence of prostatitis-related fears and disturbances on their sexual life. A second aim was to develop and clinically validate a new diagnostic tool for differential diagnosis between the forms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), especially between patients belonging to categories IIIA and IIIB in the new NIH (National Institutes of Health) clinical classification. Altogether 1832 men out of 2500 aged 20–59 years chosen randomly from the two most northerly provinces of Finland (Oulu and Lapland) participated in the epidemiological study, a response rate of 75%. The overall lifetime prevalence of prostatitis was 14.2%. The risk of having had the disease increased with age, being 1.7 times greater in the men aged 40–49 years than in those aged 20–39 years, and 3.1 times greater in those aged 50–59 years. More than a quarter of the 261 men who had or had had prostatitis symptoms (27%) suffered from them at least once a year, while 16% suffered from chronic prostatitis symptoms throughout the year. 63% of the men with prostatitis had their worst symptoms during the wintertime (November–march). 17% of the men with chronic prostatitis reported a constant fear of undetected prostate cancer. Erectile dysfunction was reported by 43% of the symptomatic men and decreased libido by 24%. Self-assessment of personality showed that the men with prostatitis were more often busy and nervous and had a meticulous attitude to life and problems than were the non-symptomatic men. 197 patients with chronic prostatitis/chronic pelvic pain syndrome participated in three clinical case-control studies during the years 1995–2000, at Oulu University Hospital, the District Hospital of Oulainen and Seinäjoki Central Hospital. The first prostatic tissue pressure measurement (PTPM) study included 34 patients and 9 controls. A novel method was developed to measure intraprostatic tissue pressure with a Stryker® intracompartmental pressure monitor. The PTPM showed a clear increase (p < 0.001) in the patients with symptoms of prostatitis and benign prostatic enlargement (BPE) relative to the controls and the patients with BPE but without pain symptoms. The second PTPM study included 42 patients with chronic prostatitis symptoms without significant BPE and 12 new controls. Significantly higher pressure readings (p < 0.001) were recorded at all three measurement points in the patients than in the controls. 48 new patients and 12 new controls were enrolled for the third PTPM study, the purpose of which was to confirm the results of the previous ones and to compare the prostatic tissue pressures of two clinical groups (IIIA and IIIB). The prostatic tissue pressure was again significantly higher in the patients with chronic prostatitis symptoms than in the controls (p < 0.001). An interesting finding was that prostatitis patients belonging to clinical category IIIA had significantly higher tissue pressures (p < 0.01) than those in category IIIB, probably reflecting more severe inflammation in the prostatic tissue. This new PTPM method provides a more precise and/or exact tool for differential diagnosis between the forms of pelvic pain and CP/CPPS.

Kronisk underlivssmärta hos män är ett vanligt fenomen. Trots detta är ämnet relativtoutforskat, framförallt gällande yngre män. Studiens syfte var att undersöka upplevelser av attleva med denna smärta, hos män i åldrarna 18-40 år. Datainsamling skedde genomsemistrukturerade intervjuer (n = 5), utförda via Skype eller personligt möte. Dataanalyserades genom induktiv tematisk analys. Fem huvudteman utvecklades: “smärtan rubbardet dagliga livet”, “en klassisk man har inte problem där nere”, “smärtan blir något manmåste förhålla sig till”, “hjälpsamt att inte känna sig ensam” samt “vården kantas avosäkerhet”. Tillsammans ger de en bild av männens upplevelser. Resultatet visar att manligunderlivssmärta påverkar många områden i livet samt att det präglas av stigma ochstereotyper. Psykologiska och sociala mekanismer verkar avgörande för att förstå hur manhanterar smärtupplevelsen. Resultatet bekräftar tidigare fynd från studier på äldre män samtbidrar med nya rön från en yngre population. / Chronic pelvic pain is a common phenomena amongst men. Despite this, research on thesubject is still relatively scarce, especially amongst younger men. The aim of this study was toexamine the experience of living with pelvic pain. Data was collected through semi-structuredinterviews (n = 5), via Skype or face-to-face, from a Swedish sample. An inductive thematicanalysis was conducted. Five main themes were developed: “pain disturbs daily life”, “a real man has no problems down there”, “the pain is something you need to relate to”, “helpful tonot feel alone” and “the healthcare is riddled with insecurity”. Together these help summarizemen’s experiences. The results show that chronic pelvic pain affect many areas in everydaylife. It also shows that this pain is characterized by stigma and stereotypes. Psychological andsocial mechanisms seems vital for understanding how coping and pelvic pain relates. Theresults confirm parts from previous research and adds to existing knowledge, but from ayounger and less examined sample.

A dor pélvica crônica (DPC) é uma condição clínica comum, inclusive no Brasil. Estudos do nosso núcleo de pesquisa evidenciam uma prevalência em torno de 11%. Ela é, dentre outros agravos, causa recorrente de procura a serviços de saúde, falta ao trabalho e baixa produtividade. Com a inserção definitiva da mulher no mercado de trabalho a doença tem impactado negativamente no desempenho econômico desse grupo, afetando diretamente a atividade econômica domiciliar. Todavia, o diagnóstico da causa desta condição clínica não é trivial e erros podem ocorrer devido à falta de conhecimento sobre o assunto, portanto, a criação de um sistema que possa auxiliar no diagnóstico e na identificação das causas desta condição clínica é de grande importância para que os erros de diagnósticos sejam minimizados e para que esta condição seja tratada da melhor maneira possível. Contudo, o presente trabalho tem como objetivo o desenvolvimento de um sistema de inteligência artificial que auxilie no diagnóstico da DPC em seu estágio inicial, minimizando erros e tempo de tratamento por meio da mineração de dados em uma base médica previamente preenchida com casos já diagnosticados como auxilio a aprendizagem do sistema. / Chronic pelvic pain (CPP) is a common clinical condition, including in Brazil. Studies held by our research group shows evidences of a prevalence around 11%. It is, among other illness, a recurrent cause of lack of productivity, work miss and utilization of healthcare services. As the women is each time more inserted in the labor force this condition is impacting negatively the economic performance of this group, affecting directly the domestic economic activity. However, the diagnostic of the cause of this condition is not trivial, and mistakes can happen due to the lack of knowledge about the matter, therefore, the creation of a system that may help in the diagnosing and identification of the causes of this clinical condition is of great importance to the decrease of mistaken diagnoses leading to a better treatment of the condition. However, the current work has as objective the development of an artificial intelligence system that help in the CPP diagnose in its initial stage, decreasing mistakes and treatment time by using data mining in a medical database previously filled with already diagnosed cases as auxiliary to the learning of the system.

Chronic pelvic pain (CPP) is defined as constant or intermittent lower, cyclical or non-cyclical abdominal pain of at least six months’ duration. In the United Kingdom, over 1 million women suffer from CPP, with an estimated annual healthcare cost above £150 million. The aetiology of CPP is unknown in up to 50% of women, and in the remainder, the symptoms of CPP is associated with endometriosis, pelvic adhesions, irritable bowel syndrome or painful bladder syndrome. CPP is often accompanied by painful periods, pain during sexual intercourse and defaecation. Fatigue, sleep disturbances and depression are also common among this group of women. CPP asserts a heavy emotional, social and economic burden. Standard treatments such as hormonal and analgesic regimens are often associated with unacceptable side effects, even if helpful for the pain, underlining an urgent need for a satisfactory treatment. The meridian balanced method (BM) electro-acupuncture (EA) treatment (acupuncture needling + traditional Chinese medicine health consultation [TCM HC]) may be effective in managing CPP symptoms. Thus, I have completed a pilot study comprising of a three-armed randomised controlled trial (RCT), using a mixed methods research (MMR) approach, to assess the feasibility of a future large-scale RCT to determine the effectiveness of the meridian BMEA treatment on CPP in women. My hypothesis is that it is feasible to conduct such a large-scale RCT for CPP in women. The primary objectives were to determine recruitment and retention rates. The secondary objectives were to evaluate the, acceptability of the methods of recruitment, randomisation, interventions and assessment tools and any signals of effectiveness of the interventions. Thirty (30) women with CPP were randomised into three groups: BMEA treatment, TCM HC, or National Health Service standard care (NHS SC) group. The effects of my interventions were assessed by validated pain, physical and emotional functioning questionnaires, completed at weeks 0, 4, 8 and 12 of the study. Semi-structured telephone interviews and focus group discussions to explore participants’ experience of the study were conducted. Of the 59 women who were referred to the study, 30 women (51%) were randomised. There was a statistically significant difference in retention rates between the three groups. The retention rates were 80% (95% CI 74-96), in the BMEA treatment group, 53 % (95% CI 36- 70) in the TCM HC group and 87% (95% CI 63-90) in the NHS SC group. (Chi-square test, p=0.08) The attendance rates of the BMEA treatment group were 90% compared to 56% in the TCM HC group. There was a statistically significant difference (Mann-Whitney test, p=0.023) in attendance between the two intervention groups. Telephone interviews regarding the acceptability of the methods of recruitment, randomisation, assessment tools and interventions were positive. No adverse effects that were directly related to BMEA treatments were reported or observed. A higher proportion of the BMEA treatment group achieved clinical significance in the VAS-pain, BPI-pain severity, interference, and sleep scores, when compared to the other two groups. Due to small sample sizes, there was insufficient power to show statistically significant difference. (Fishers Exact Test, p=1.0) Analyses of the questionnaire data per group showed statistically significant differences in the following: the BMEA treatment group experienced less in pain at weeks 4 (p=0.01) and 8 (p=0.005); less helplessness (p=0.03) and their anxiety and depression scores declined at week 4 (p=0.04). The NHS SC group also reported less pain at week 4 (p=0.04). However, this group scored higher in anxiety and depression at weeks 8 and 12 (p=0.04). No statistically significant differences were achieved between the three groups at baseline, weeks 4, 8 and 12 in all scores. The therapeutic benefits gained by the TCM HC group were less compared to those of the BMEA treatment group, but better when compared to the NHS SC group. The BMEA treatment and TCM HC groups showed lower scores in anxiety and depression while the NHS SC group showed higher scores in anxiety and depression. The NHS SC group also tended to ruminate and magnify their problems as well as feeling more helpless than the other two groups. The three key themes that emerged from thematic analysis of focus group discussions were the “whole person effects” where participants reported an improvement in pain, sleep and a general sense of wellbeing in the two intervention groups; the “experience of standard care” and “impact of living with CPP”. In conclusion, the results of my pilot study are supportive of the feasibility of a future large-scale study. There were signals of effectiveness of interventions but the sample size was too small to make a definitive conclusion.

Introdução: A Dor Pélvica Crônica (DPC) é um problema social, com alta prevalência, acometendo mulheres na idade reprodutiva. Cada vez mais salientamos a importância de investigar instrumentos apropriados para avaliação da dor, facilitando na prática clínica a escolha do melhor método que torne mais completa a avaliação de aspectos da intensidade na mensuração da dor crônica. Portanto, o objetivo deste estudo é correlacionar diferentes instrumentos de avaliação da intensidade dolorosa, a escala numérica (EN), escala visual analógica (EVA) e a algometria de pressão, nas mulheres com DPC, a fim de identificar o instrumento que melhor expressa o quadro doloroso. Métodos: foram avaliadas pelo ginecologista oitenta mulheres encaminhadas ao ambulatório do serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre (HCPA), trinta e três mulheres apresentaram algum aspecto dos nossos critérios de não inclusão. Selecionamos para participar do estudo quarenta e sete pacientes com DPC, sendo que vinte pacientes apresentavam endometriose diagnosticada por videolaparoscopia e vinte e sete pacientes apresentavam outras causas ginecológicas. Utilizamos no estudo um roteiro para anamnese cujos dados relacionados com a DPC foram coletados, tais como diagnóstico, tratamento, sintomatologia e locais da dor. Escores de dor foram classificados de acordo com a intensidade, através das escalas de dor (EN e EVA), instrumentos baseados no autorrelato do indivíduo e algometria de pressão, para verificar o limiar de dor à pressão das pacientes. Na análise dos dados, a concordância entre as escalas foi avaliada pelo coeficiente de correlação intraclasse (ICC) e a associação entre as escalas com o algômetro foi avaliada pelo coeficiente de correlação de Spearman, o nível de significância adotado foi de 5% (P<0,05). Resultados: As participantes do estudo tinham idade média de 38,3 ± 7,6 anos. Utilizamos o ICC para análise da correlação entre os instrumentos de relato da percepção dolorosa, ou seja, entre as EN e EVA, em relação à dor (0,992), na dismenorreia (1,00) e na dispareunia (0,996), e encontramos excelente concordância entre as escalas, com P<0,01. As associações da algometria com as escalas foram moderadas e inversas, apresentando diferenças estatisticamente significativas, quanto maior a pontuação nas escalas EN e EVA em relação à dispareunia, menores os valores no algômetro, exceto nos pontos LA1 e LA2 em ambos os lados. Também houve associação inversa das escalas EN e EVA na dismenorréia, no ponto LAB2 lado direito e associação inversa no ponto PS lado direito com a escala EVA de dor, com diferenças estatisticamente significativas. Conclusão: As escalas são instrumentos eficientes para avaliação da dor, podendo ser utilizada tanto a EN quanto a EVA na avaliação da intensidade dolorosa. Na avaliação das mulheres com DPC devemos utilizar a algometria de pressão associada à EN ou EVA, instrumentos inversamente proporcionais, confiáveis e sensíveis, tornando menos subjetiva a avaliação da dor para melhor expressar o quadro doloroso. / Introduction: The Chronic Pelvic Pain (CPP) is a social problem, with high prevalence, affecting women in reproductive age. Increasingly, has been emphasised the importance of investigating appropriate instruments for evaluation of pain in clinical practice, by facilitating the choice of the best method to make more complete the evaluation in measuring intensity aspects of chronic pain. Therefore, the objective of this study is to correlate different painful intensity assessment tools, the numeric scale (NS), visual analogue scale (VAS) and algometry pressure, in women with CPP, in order to identify the instrument that best expresses the pain. Methods: were evaluated by the gynecologist eighty women referred to the Gynecology and Obstetrics service, Clinical Hospital of Porto Alegre (HCPA), thirty three women had some aspect of our criteria for not inclusion. The study included forty seven patients, twenty patients had endometriosis diagnosed by laparoscopy and twenty seven patients had other gynecological causes. For the analyses in this study we used a road map for anamnesis whose data related to the CPP was collected, such as diagnosis, treatment, symptoms and pain locations. In addition, pain scores were classified according to intensity, through the pain scales (NS and VAS), based on self-report instruments of individual and algometry, to verify the pressure pain threshold of the patients. Statistically, the agreement between scales was assessed by intraclass correlation coefficient (ICC) and the association between the scales with the algometer were evaluated by Spearman's rank correlation coefficient, the level of significance adopted was 5% (P<0,05). Results: Study participants had an average age of 38.3 ± 7.6 years old. In the statistical analysis, we used ICC reporting instruments of perception painful I mean, between NS and VAS regarding pain (0,992), in dysmenorrhoea (1.00) and Dyspareunia (0.996), and we found excellent correlation between scales, with P<0,01. The associations of algometria with the scales were moderate and inverses, showing differences statistically significant, the higher the score NS and VAS in relation to Dyspareunia smaller values in algometer, except in points LA1 and LA2 on both sides. Indeed, there were also inverse association of scales NS and VAS on dysmenorrhea, in point LAB2 in the right side and inverse association in point PS in the right side with scale VAS of pain, with statistically significant differences. Conclusion: the scales are effective instruments for evaluation of pain, and may be used both in NS and VAS at painful intensity evaluation. In the evaluation of women with CPP should be used the algometry pressure associated with NS or VAS, instruments inversely proportional, reliable and sensitive, making less subjective pain assessment to better express the pain.

Introdução: A Dor Pélvica Crônica (DPC) é um problema social, com alta prevalência, acometendo mulheres na idade reprodutiva. Cada vez mais salientamos a importância de investigar instrumentos apropriados para avaliação da dor, facilitando na prática clínica a escolha do melhor método que torne mais completa a avaliação de aspectos da intensidade na mensuração da dor crônica. Portanto, o objetivo deste estudo é correlacionar diferentes instrumentos de avaliação da intensidade dolorosa, a escala numérica (EN), escala visual analógica (EVA) e a algometria de pressão, nas mulheres com DPC, a fim de identificar o instrumento que melhor expressa o quadro doloroso. Métodos: foram avaliadas pelo ginecologista oitenta mulheres encaminhadas ao ambulatório do serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre (HCPA), trinta e três mulheres apresentaram algum aspecto dos nossos critérios de não inclusão. Selecionamos para participar do estudo quarenta e sete pacientes com DPC, sendo que vinte pacientes apresentavam endometriose diagnosticada por videolaparoscopia e vinte e sete pacientes apresentavam outras causas ginecológicas. Utilizamos no estudo um roteiro para anamnese cujos dados relacionados com a DPC foram coletados, tais como diagnóstico, tratamento, sintomatologia e locais da dor. Escores de dor foram classificados de acordo com a intensidade, através das escalas de dor (EN e EVA), instrumentos baseados no autorrelato do indivíduo e algometria de pressão, para verificar o limiar de dor à pressão das pacientes. Na análise dos dados, a concordância entre as escalas foi avaliada pelo coeficiente de correlação intraclasse (ICC) e a associação entre as escalas com o algômetro foi avaliada pelo coeficiente de correlação de Spearman, o nível de significância adotado foi de 5% (P<0,05). Resultados: As participantes do estudo tinham idade média de 38,3 ± 7,6 anos. Utilizamos o ICC para análise da correlação entre os instrumentos de relato da percepção dolorosa, ou seja, entre as EN e EVA, em relação à dor (0,992), na dismenorreia (1,00) e na dispareunia (0,996), e encontramos excelente concordância entre as escalas, com P<0,01. As associações da algometria com as escalas foram moderadas e inversas, apresentando diferenças estatisticamente significativas, quanto maior a pontuação nas escalas EN e EVA em relação à dispareunia, menores os valores no algômetro, exceto nos pontos LA1 e LA2 em ambos os lados. Também houve associação inversa das escalas EN e EVA na dismenorréia, no ponto LAB2 lado direito e associação inversa no ponto PS lado direito com a escala EVA de dor, com diferenças estatisticamente significativas. Conclusão: As escalas são instrumentos eficientes para avaliação da dor, podendo ser utilizada tanto a EN quanto a EVA na avaliação da intensidade dolorosa. Na avaliação das mulheres com DPC devemos utilizar a algometria de pressão associada à EN ou EVA, instrumentos inversamente proporcionais, confiáveis e sensíveis, tornando menos subjetiva a avaliação da dor para melhor expressar o quadro doloroso. / Introduction: The Chronic Pelvic Pain (CPP) is a social problem, with high prevalence, affecting women in reproductive age. Increasingly, has been emphasised the importance of investigating appropriate instruments for evaluation of pain in clinical practice, by facilitating the choice of the best method to make more complete the evaluation in measuring intensity aspects of chronic pain. Therefore, the objective of this study is to correlate different painful intensity assessment tools, the numeric scale (NS), visual analogue scale (VAS) and algometry pressure, in women with CPP, in order to identify the instrument that best expresses the pain. Methods: were evaluated by the gynecologist eighty women referred to the Gynecology and Obstetrics service, Clinical Hospital of Porto Alegre (HCPA), thirty three women had some aspect of our criteria for not inclusion. The study included forty seven patients, twenty patients had endometriosis diagnosed by laparoscopy and twenty seven patients had other gynecological causes. For the analyses in this study we used a road map for anamnesis whose data related to the CPP was collected, such as diagnosis, treatment, symptoms and pain locations. In addition, pain scores were classified according to intensity, through the pain scales (NS and VAS), based on self-report instruments of individual and algometry, to verify the pressure pain threshold of the patients. Statistically, the agreement between scales was assessed by intraclass correlation coefficient (ICC) and the association between the scales with the algometer were evaluated by Spearman's rank correlation coefficient, the level of significance adopted was 5% (P<0,05). Results: Study participants had an average age of 38.3 ± 7.6 years old. In the statistical analysis, we used ICC reporting instruments of perception painful I mean, between NS and VAS regarding pain (0,992), in dysmenorrhoea (1.00) and Dyspareunia (0.996), and we found excellent correlation between scales, with P<0,01. The associations of algometria with the scales were moderate and inverses, showing differences statistically significant, the higher the score NS and VAS in relation to Dyspareunia smaller values in algometer, except in points LA1 and LA2 on both sides. Indeed, there were also inverse association of scales NS and VAS on dysmenorrhea, in point LAB2 in the right side and inverse association in point PS in the right side with scale VAS of pain, with statistically significant differences. Conclusion: the scales are effective instruments for evaluation of pain, and may be used both in NS and VAS at painful intensity evaluation. In the evaluation of women with CPP should be used the algometry pressure associated with NS or VAS, instruments inversely proportional, reliable and sensitive, making less subjective pain assessment to better express the pain.

A dor pélvica crônica (DPC) é uma condição clínica comum, inclusive no Brasil. Estudos do nosso núcleo de pesquisa evidenciam uma prevalência em torno de 11%. Ela é, dentre outros agravos, causa recorrente de procura a serviços de saúde, falta ao trabalho e baixa produtividade. Com a inserção definitiva da mulher no mercado de trabalho a doença tem impactado negativamente no desempenho econômico desse grupo, afetando diretamente a atividade econômica domiciliar. Todavia, o diagnóstico da causa desta condição clínica não é trivial e erros podem ocorrer devido à falta de conhecimento sobre o assunto, portanto, a criação de um sistema que possa auxiliar no diagnóstico e na identificação das causas desta condição clínica é de grande importância para que os erros de diagnósticos sejam minimizados e para que esta condição seja tratada da melhor maneira possível. Contudo, o presente trabalho tem como objetivo o desenvolvimento de um sistema de inteligência artificial que auxilie no diagnóstico da DPC em seu estágio inicial, minimizando erros e tempo de tratamento por meio da mineração de dados em uma base médica previamente preenchida com casos já diagnosticados como auxilio a aprendizagem do sistema. / Chronic pelvic pain (CPP) is a common clinical condition, including in Brazil. Studies held by our research group shows evidences of a prevalence around 11%. It is, among other illness, a recurrent cause of lack of productivity, work miss and utilization of healthcare services. As the women is each time more inserted in the labor force this condition is impacting negatively the economic performance of this group, affecting directly the domestic economic activity. However, the diagnostic of the cause of this condition is not trivial, and mistakes can happen due to the lack of knowledge about the matter, therefore, the creation of a system that may help in the diagnosing and identification of the causes of this clinical condition is of great importance to the decrease of mistaken diagnoses leading to a better treatment of the condition. However, the current work has as objective the development of an artificial intelligence system that help in the CPP diagnose in its initial stage, decreasing mistakes and treatment time by using data mining in a medical database previously filled with already diagnosed cases as auxiliary to the learning of the system.

Introdução: A Dor Pélvica Crônica (DPC) é um problema social, com alta prevalência, acometendo mulheres na idade reprodutiva. Cada vez mais salientamos a importância de investigar instrumentos apropriados para avaliação da dor, facilitando na prática clínica a escolha do melhor método que torne mais completa a avaliação de aspectos da intensidade na mensuração da dor crônica. Portanto, o objetivo deste estudo é correlacionar diferentes instrumentos de avaliação da intensidade dolorosa, a escala numérica (EN), escala visual analógica (EVA) e a algometria de pressão, nas mulheres com DPC, a fim de identificar o instrumento que melhor expressa o quadro doloroso. Métodos: foram avaliadas pelo ginecologista oitenta mulheres encaminhadas ao ambulatório do serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre (HCPA), trinta e três mulheres apresentaram algum aspecto dos nossos critérios de não inclusão. Selecionamos para participar do estudo quarenta e sete pacientes com DPC, sendo que vinte pacientes apresentavam endometriose diagnosticada por videolaparoscopia e vinte e sete pacientes apresentavam outras causas ginecológicas. Utilizamos no estudo um roteiro para anamnese cujos dados relacionados com a DPC foram coletados, tais como diagnóstico, tratamento, sintomatologia e locais da dor. Escores de dor foram classificados de acordo com a intensidade, através das escalas de dor (EN e EVA), instrumentos baseados no autorrelato do indivíduo e algometria de pressão, para verificar o limiar de dor à pressão das pacientes. Na análise dos dados, a concordância entre as escalas foi avaliada pelo coeficiente de correlação intraclasse (ICC) e a associação entre as escalas com o algômetro foi avaliada pelo coeficiente de correlação de Spearman, o nível de significância adotado foi de 5% (P<0,05). Resultados: As participantes do estudo tinham idade média de 38,3 ± 7,6 anos. Utilizamos o ICC para análise da correlação entre os instrumentos de relato da percepção dolorosa, ou seja, entre as EN e EVA, em relação à dor (0,992), na dismenorreia (1,00) e na dispareunia (0,996), e encontramos excelente concordância entre as escalas, com P<0,01. As associações da algometria com as escalas foram moderadas e inversas, apresentando diferenças estatisticamente significativas, quanto maior a pontuação nas escalas EN e EVA em relação à dispareunia, menores os valores no algômetro, exceto nos pontos LA1 e LA2 em ambos os lados. Também houve associação inversa das escalas EN e EVA na dismenorréia, no ponto LAB2 lado direito e associação inversa no ponto PS lado direito com a escala EVA de dor, com diferenças estatisticamente significativas. Conclusão: As escalas são instrumentos eficientes para avaliação da dor, podendo ser utilizada tanto a EN quanto a EVA na avaliação da intensidade dolorosa. Na avaliação das mulheres com DPC devemos utilizar a algometria de pressão associada à EN ou EVA, instrumentos inversamente proporcionais, confiáveis e sensíveis, tornando menos subjetiva a avaliação da dor para melhor expressar o quadro doloroso. / Introduction: The Chronic Pelvic Pain (CPP) is a social problem, with high prevalence, affecting women in reproductive age. Increasingly, has been emphasised the importance of investigating appropriate instruments for evaluation of pain in clinical practice, by facilitating the choice of the best method to make more complete the evaluation in measuring intensity aspects of chronic pain. Therefore, the objective of this study is to correlate different painful intensity assessment tools, the numeric scale (NS), visual analogue scale (VAS) and algometry pressure, in women with CPP, in order to identify the instrument that best expresses the pain. Methods: were evaluated by the gynecologist eighty women referred to the Gynecology and Obstetrics service, Clinical Hospital of Porto Alegre (HCPA), thirty three women had some aspect of our criteria for not inclusion. The study included forty seven patients, twenty patients had endometriosis diagnosed by laparoscopy and twenty seven patients had other gynecological causes. For the analyses in this study we used a road map for anamnesis whose data related to the CPP was collected, such as diagnosis, treatment, symptoms and pain locations. In addition, pain scores were classified according to intensity, through the pain scales (NS and VAS), based on self-report instruments of individual and algometry, to verify the pressure pain threshold of the patients. Statistically, the agreement between scales was assessed by intraclass correlation coefficient (ICC) and the association between the scales with the algometer were evaluated by Spearman's rank correlation coefficient, the level of significance adopted was 5% (P<0,05). Results: Study participants had an average age of 38.3 ± 7.6 years old. In the statistical analysis, we used ICC reporting instruments of perception painful I mean, between NS and VAS regarding pain (0,992), in dysmenorrhoea (1.00) and Dyspareunia (0.996), and we found excellent correlation between scales, with P<0,01. The associations of algometria with the scales were moderate and inverses, showing differences statistically significant, the higher the score NS and VAS in relation to Dyspareunia smaller values in algometer, except in points LA1 and LA2 on both sides. Indeed, there were also inverse association of scales NS and VAS on dysmenorrhea, in point LAB2 in the right side and inverse association in point PS in the right side with scale VAS of pain, with statistically significant differences. Conclusion: the scales are effective instruments for evaluation of pain, and may be used both in NS and VAS at painful intensity evaluation. In the evaluation of women with CPP should be used the algometry pressure associated with NS or VAS, instruments inversely proportional, reliable and sensitive, making less subjective pain assessment to better express the pain.