SERUM BETA-ENDORPHIN LEVELS IN CHRONIC PELVIC PAIN PATIENTS

Beta-endorphin is a 31 amino acid opioid peptide with several physiologic roles of which analgesia is one. Numerous reports relate stress in humans to an increase in beta-endorphin levels, suggesting a role for the peptide as a pain modulator. In chronic pain patients, elevated as well as reduced beta-endorphin levels have been reported. The pharmacopathology, if any, of chronic pelvic pain remains unclear. This study is to investigate the levels of serum beta-endorphin in chronic pelvic pain patients in relation to their perception of pain intensity. Twenty-three patients undergoing diagnostic laparoscopy for chronic pelvic pain were studied. Ten control patients were chosen from patients scheduled for elective laparoscopy sterilization who had no previous history of pelvic pain. Patients were asked to indicate their perception of pain intensity, using a visual analog scale, numbered one to ten. Laparoscopy was performed on all patients, with documentation of location, density of adhesions, and/or the presence of other pelvic pathology. All blood samples were drawn on the morning of surgery prior to laparoscopy. Results indicated a significantly (p < 0.01) higher serum beta-endorphin level in chronic pelvic pain patients compared to controls. The mean was 14.8 pg/ml +/- 13.2 SD for pain patients and 4.3 Pg/ml +/- 3.0 SD for controls. There were significantly more pelvic adhesions (p < 0.01) and pathologic abnormalities (p < 0.001) upon laparoscopic examination in the study group than controls. Of particular interest is an inverse correlation between subjective pain levels and serum beta-endorphin levels, i.e. the higher beta-endorphin level, the lower the perception of pain. Our data suggest a role for beta-endorphin in the modulation of chronic pelvic pain, i.e. of an opiate response to chronic pelvic pain. An elevation of beta-endorphin level appears to decrease the patient's perception of chronic pain. This response, providing the body with its own natural analgesic, would be in agreement with the well-documented role of this peptide in relieving acute pain in patients.