Objectives: To explore the pain mechanism and the origin of the pain and to evaluate a short-term pain relief treatment in women suffering from CPP persisting after childbirth in order to enable physiotherapeutic intervention. Material and methods: Thirty-six parous women with chronic pelvic pain persisting after childbirth were recruited at the Department of Physiotherapy, SundsvallHospital and by advertisements in newspapers and 29 parous women without chronic pelvic pain were recruited from an organized gynaecological screening at a midwifery surgery. All women were provoked by intra-pelvic palpation of 13 predetermined intra-pelvic landmarks. The provoked pain distribution was expressed in pain drawings and the pain intensity verbally on a Likert scale.Also, in a randomised controlled trial the 36 women with chronic pelvic pain were allocated to bilateral injection treatment with either triamcinolone or saline solutions, given once on the ischial spine with follow-up after four weeks. Results: Referred pain provoked on intra-pelvic landmarks follows a specific pattern. In general, pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions. In women with chronic pelvic pain the provoked pain distribution area and pain intensity were magnified as compared to women without chronic pelvic pain. In the clinical trial decreased pain intensity, decreased distribution of pain and improved physical function was achieved among the triamcinolone treatment group as compared to the saline treatment group. Also, a positive correlation was shown between reduced pain intensity and improved function. Conclusions: Referred pain patterns provoked on intra-pelvic landmarks in women with chronic pelvic pain persisting after childbirth are consistent with sclerotomal sensory innervations and indicates allodynia and central sensitisation. This suggests that pain mapping can be used to evaluate and confirm the pain experience and contribute to diagnosis. Also, the pain intensity provoked by stimulation of the intra-pelvic landmarks is suggested to be useful to differentiate women with chronic pelvic pain from those without. Corticosteroid treatment to the ischial spine resulted in decreased pain and increased function.

The overall theme of this thesis is the study of sensory pain assessment and describes how digital pain mapping using standardized iconography can be used to help portray and understand the sensory pain experience. The research presented in this thesis is focused on the design, development, and use of a web-based sensory pain assessment tool for individuals with chronic pain called the Pain-QuILT. “QuILT” is an acronym describing the different parameters that are captured by the tool: pain quality, intensity, and location in a digital format that can be tracked over time. The central hypothesis guiding this work is that users of pain assessment tools will tend to favour a digital icon-based sensory pain mapping tool (‘PainQuILT’) over currently available sensory pain assessment tools. “Pain assessment tool” has been operationally defined as a standardized method for capturing information about an individual’s sensory pain experience. In this context, “users” include both individuals experiencing chronic pain and healthcare providers who seek to assess and understand pain. Research to date has focused on phased evaluation of the Pain-QuILT in the context of clinical sensory pain assessment for two distinct user groups: adolescents (aged 12 to 18 years) and adults (aged 19 years and older) with chronic pain. Each stage of research has generated and been informed by user feedback, leading to iterative improvements in tool functionality. Thus, as a whole, this body of work represents an evolving effort to improve the clinical assessment of sensory pain using the approach of icon-based pain mapping in a digital and visual format. Through the collective research presented in this thesis, we have affirmed that digital pain mapping using iconography is a viable solution to the clinical challenge of sensory pain assessment in adolescents and adults with chronic pain. / Dissertation / Doctor of Philosophy (PhD)