Women with CPP frequently present with psychological alterations and a life history that includes either one of the following alone or in combination: sexual abuse, family problems, divorce, or a history of violence.
10 Although the chronicity of pelvic pain becomes the focus of a gynecologic visit, some women manifest other physical signs of stress. Muscle weakness, spasm, and pain from disruption of muscle contraction and relaxation become complaints of fatigue, back pain, face pain, bruxism, headache, or fibromyalgia, or a combination of these complaints.
Because many women tend to internalize stress, repeated alternation of muscle tension and relaxation may lead to nerve entrapment or alteration of circulation to muscles or other body structures.
11 Weight changes also are modifying factors for posture, gait, and somatic complaints. Carrying extra pounds worsens spinal curves and stresses supportive structures of the pelvis, such as the extremities. When a woman loses weight as a result of stress, she increases her risk for the development of osteoporosis because of reduced calcium intake, altered estrogen production, and reduced bone mass.
While dealing with the psychosocial aspects of CPP, many women struggle with changing moods and altered sleep cycles. These fluctuations also compromise the immune system, and cause women to become fearful of other chronic diseases such as chronic fatigue syndrome, myofascial pain syndrome, and fibromyalgia.
12 Pain signals and other sensory inputs are amplified via central sensitization at the spinal cord level. Pain is not processed normally in the dorsal horn, which allows temporal summation of pressure sensations.
12 Descending modulation from the brain-stem is impaired and contributes to excess spinal fluid levels of substance P and other neurotransmitters involved in nocioception. Lower spinal fluid levels of serotonin, norepinephrine, and dopamine have also been associated with depressive syndromes.
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Sleep deprivation, depression, and pain may put a woman with CPP at risk for serious injury. For example, she may be running late for work, before which she must drop her children off at school. Because of muscle pain and stress, she may become distracted and become involved in a motor vehicle accident, sustaining injuries, which lead to more pain, depression, and tension. Additionally, she may be taking one or more medications for the foregoing problems, some of which may have side effects that may alter her judgment or alertness. These factors may perpetuate the cycle.