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Si M, Chen J, Zhang X, Zhu L, Jiang Y. Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing. PLoS One 2024; 19:e0301095. [PMID: 38739604 PMCID: PMC11090321 DOI: 10.1371/journal.pone.0301095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident. AIM The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population. METHODS This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling. RESULTS Pain not only had a direct positive impact (B = 0.575; SE = 0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE = 0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE = 0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE = 0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data. CONCLUSION The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.
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Affiliation(s)
- Mingyu Si
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Chen
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xue Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Zhu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Einig S, Ruess E, Schoetzau A, Ayllon Bartet K, Heinzelmann-Schwarz V, Vigo F, Kavvadias T. Pelvic Pain of Myofascial Origin in Women: Correlation with Lower Urinary Tract Symptoms. Adv Urol 2024; 2024:5568010. [PMID: 38524733 PMCID: PMC10959583 DOI: 10.1155/2024/5568010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Women with lower urinary tract symptoms (LUTS) and high-tone pelvic floor often experience pain and have positive trigger points upon pelvic floor examination. However, the correlation of these findings has not yet been systematically examined and sufficiently understood. The aim of this cross-sectional study is to examine the correlation of pelvic myofascial pain with LUTS and pelvic floor tone. Materials and Methods All participants filled a standardized pelvic floor questionnaire to assess LUTS, which consists of a total of 43 questions regarding bladder, bowel, and sexual function as well as prolapse symptoms. Myofascial trigger points in different muscle groups including pubococcygeus, iliococcygeus, and obturator as well as pelvic floor muscle tone were assessed using a standardized digital examination technique. Results 110 women were included in the study. There was a significant correlation between pain in various muscle groups and LUTS as well as high-tone pelvic floor muscle. A significant correlation could also be found between high pelvic floor muscle tone and the overall questionnaire score (p < 0.001) as well as the bladder function score (p < 0.001) and various pain scores of the different groups. Individuals with high-tone pelvic floor were more likely to have more LUTS and higher pain scores. Conclusions The existence of myofascial pelvic floor trigger points and high pelvic floor muscle tone seem to be reflective of pelvic floor symptoms, as assessed with a standardized pelvic floor questionnaire.
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Affiliation(s)
| | - Esther Ruess
- University Hospital of Basel, Basel, Switzerland
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Mijatovic V, Vercellini P. Towards comprehensive management of symptomatic endometriosis: beyond the dichotomy of medical versus surgical treatment. Hum Reprod 2024; 39:464-477. [PMID: 38199787 DOI: 10.1093/humrep/dead262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
Except when surgery is the only option because of organ damage, the presence of suspicious lesions, or the desire to conceive, women with endometriosis-associated pain often face a choice between medical and surgical treatment. In theory, the description of the potential benefits and potential harms of the two alternatives should be standardized, unbiased, and based on strong evidence, enabling the patient to make an informed decision. However, doctor's opinion, intellectual competing interests, local availability of specific services and (mis)information obtained from social media, and online support groups can influence the type of advice given and affect patients' choices. This is compounded by the paucity of robust data from randomized controlled trials, and the anxiety of distressed women who are eager to do anything to alleviate their disabling symptoms. Vulnerable patients are more likely to accept the suggestions of their healthcare provider, which can lead to unbalanced and physician-centred decisions, whether in favour of either medical or surgical treatment. In general, treatments should be symptom-orientated rather than lesion-orientated. Medical and surgical modalities appear to be similarly effective in reducing pain symptoms, with medications generally more successful for severe dysmenorrhoea and surgery more successful for severe deep dyspareunia caused by fibrotic lesions infiltrating the posterior compartment. Oestrogen-progestogen combinations and progestogen monotherapies are generally safe and well tolerated, provided there are no major contraindications. About three-quarters of patients with superficial peritoneal and ovarian endometriosis and two-thirds of those with infiltrating fibrotic lesions are ultimately satisfied with their medical treatment although the remainder may experience side effects, which may result in non-compliance. Surgery for superficial and ovarian endometriosis is usually safe. When fibrotic infiltrating lesions are present, morbidity varies greatly depending on the skill of the individual surgeon, the need for advanced procedures, such as bowel resection and ureteral reimplantation, and the availability of expert colorectal surgeons and urologists working together in a multidisciplinary approach. The generalizability of published results is adequate for medical treatment but very limited for surgery. Moreover, on the one hand, hormonal drugs induce disease remission but do not cure endometriosis, and symptom relapse is expected when the drugs are discontinued; on the other hand, the same drugs should be used after lesion excision, which also does not cure endometriosis, to prevent an overall cumulative symptom and lesion recurrence rate of 10% per postoperative year. Therefore, the real choice may not be between medical treatment and surgery, but between medical treatment alone and surgery plus postoperative medical treatment. The experience of pain in women with endometriosis is a complex phenomenon that is not exclusively based on nociception, although the role of peripheral and central sensitization is not fully understood. In addition, trauma, and especially sexual trauma, and pelvic floor disorders can cause or contribute to symptoms in many individuals with chronic pelvic pain, and healthcare providers should never take for granted that diagnosed or suspected endometriosis is always the real, or the sole, origin of the referred complaints. Alternative treatment modalities are available that can help address most of the additional causes contributing to symptoms. Pain management in women with endometriosis may be more than a choice between medical and surgical treatment and may require comprehensive care by a multidisciplinary team including psychologists, sexologists, physiotherapists, dieticians, and pain therapists. An often missing factor in successful treatment is empathy on the part of healthcare providers. Being heard and understood, receiving simple and clear explanations and honest communication about uncertainties, being invited to share medical decisions after receiving detailed and impartial information, and being reassured that a team member will be available should a major problem arise, can greatly increase trust in doctors and transform a lonely and frustrating experience into a guided and supported journey, during which coping with this chronic disease is gradually learned and eventually accepted. Within this broader scenario, patient-centred medicine is the priority, and whether or when to resort to surgery or choose the medical option remains the prerogative of each individual woman.
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Affiliation(s)
- Velja Mijatovic
- Department of Gynaecology & Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Diaz-Mohedo E, Hita-Contreras F, Castro-Martin E, Pilat A, Perez-Dominguez B, Valenza-Peña G. Using Myofascial Therapy to Improve Psychological Outcomes, Quality of Life, and Sexual Function in Women with Chronic Pelvic Pain-A Case Series. Healthcare (Basel) 2024; 12:304. [PMID: 38338190 PMCID: PMC10855135 DOI: 10.3390/healthcare12030304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Chronic pelvic pain represents a prevalent condition afflicting women. Research has highlighted the presence of psychological distress and sexual dysfunction in these individuals. Regrettably, myofascial pelvic pain often goes unnoticed and untreated despite its integral role in chronic pelvic pain. (2) Methods: By employing a longitudinal case series design, we studied eighteen women afflicted with chronic pelvic pain. Over a 12-week period, these participants underwent 15 sessions of myofascial therapy. Data encompassing sociodemographic particulars, the Hospital Anxiety and Depression Scale, the Medical Outcomes Study Short Form 12 questionnaire, and the Female Sexual Function Index were collected at baseline, 12 weeks post-intervention, and again at the 24-week mark. (3) Results: After a span of 12 weeks subsequent to the intervention, the participants demonstrated noteworthy enhancements (p < 0.001) in their depression and anxiety scores, their overall Mental Component scores in the Medical Outcomes Study Short Form 12, as well as sexual function. Importantly, these gains were sustained at the 24-week juncture post-therapy. (4) Conclusions: The findings stemming from our prospective case study underscore the potential utility of myofascial therapy for women grappling with chronic pelvic pain. This form of intervention yields significant advancements in alleviating anxiety, depression, health-related quality of life, and sexual function.
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Affiliation(s)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaen, 23071 Jaen, Spain;
| | - Eduardo Castro-Martin
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (E.C.-M.); (G.V.-P.)
| | - Andrzej Pilat
- Myofascial Therapy School “Tupimek”, Physiotherapy School ONCE, Universidad Autonoma, 28049 Madrid, Spain;
| | | | - Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (E.C.-M.); (G.V.-P.)
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Kadah S, Soh SE, Morin M, Schneider M, Ang WC, McPhate L, Frawley H. Are pelvic pain and increased pelvic floor muscle tone associated in women with persistent noncancer pelvic pain? A systematic review and meta-analysis. J Sex Med 2023; 20:1206-1221. [PMID: 37507352 DOI: 10.1093/jsxmed/qdad089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The association between pelvic pain and pelvic floor muscle (PFM) tone in women with persistent noncancer pelvic pain (PNCPP) is unclear. AIM To synthesize the evidence of the association between pelvic pain and PFM tone in women with PNCPP. METHODS A systematic review was conducted via MEDLINE, Emcare, Embase, CINAHL, PsycINFO, and Scopus to identify relevant studies. Studies were eligible if pelvic pain and PFM tone outcome measures were reported among women aged >18 years. The National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess study quality. Studies were pooled by assessment of PFM tone via a random effects model. Associations between the presence of pelvic pain and PFM tone were assessed with odds ratio (OR), while linear associations were assessed with Pearson or Spearman correlation. OUTCOMES Pelvic pain measures (intensity, threshold, and frequency) and resting PFM tone in women with PNCPP, as evaluated by any clinical assessment method or tool. RESULTS Twenty-four studies were included in this review. The presence of pelvic pain was significantly associated with increased PFM tone as assessed by digital palpation (OR, 2.85; 95% CI, 1.66-4.89). Pelvic pain intensity was inversely but weakly associated with PFM flexibility when evaluated through dynamometry (r = -0.29; 95% CI, -0.42 to -0.17). However, no significant associations were found between pelvic pain and PFM tone when measured with other objective assessment methods. CLINICAL IMPLICATIONS Pelvic pain and increased PFM tone may not be directly associated; alternatively, a nonlinear association may exist. A range of biopsychosocial factors may mediate or moderate the association, and clinicians may need to consider these factors when assessing women with PNCPP. STRENGTHS AND LIMITATIONS This review was reported according to the PRISMA guidelines. All possible findings from relevant theses and conference abstracts were considered in our search. However, nonlinear associations between pelvic pain and increased PFM tone were not assessed as part of this review. CONCLUSION Pelvic pain may be linearly associated with increased PFM tone and decreased PFM flexibility when measured with digital palpation or dynamometry; however, this association was not observed when other aspects of PFM tone were assessed through objective methods. Future studies are required using robust assessment methods to measure PFM tone and analyses that account for other biopsychosocial factors that may influence the association.
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Affiliation(s)
- Shaza Kadah
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia
- Department of Physical Therapy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia
| | - Melanie Morin
- School of Rehabilitation Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec J1K2R1, Canada
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - W Catarina Ang
- Women's Health Services, Royal Women's Hospital, Melbourne, Victoria 3052 Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Lucy McPhate
- Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Helena Frawley
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
- Allied Health Research, The Royal Women's Hospital, Melbourne, Victoria 3052 Australia
- Allied Health Research, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
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da Silva JP, de Almeida BM, Ferreira RS, de Paiva Oliveira Lima CR, Barbosa LMÁ, Ferreira CWS. Sensory and muscular functions of the pelvic floor in women with endometriosis - cross-sectional study. Arch Gynecol Obstet 2023; 308:163-170. [PMID: 37042996 DOI: 10.1007/s00404-023-07037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/01/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis. METHODS Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov-Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%. RESULTS Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s. CONCLUSIONS The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments.
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Affiliation(s)
- Joyce Pereira da Silva
- Department of Physiotherapy, Federal University of Pernambuco-UFPE, Av Prof. Moraes Rego, 1235. Cidade Universitária, Recife, Pernambuco, CEP: 50670-901, Brazil
| | - Bianca Maciel de Almeida
- Department of Physiotherapy, Federal University of Pernambuco-UFPE, Av Prof. Moraes Rego, 1235. Cidade Universitária, Recife, Pernambuco, CEP: 50670-901, Brazil
| | - Renata Santos Ferreira
- Department of Physiotherapy, Federal University of Pernambuco-UFPE, Av Prof. Moraes Rego, 1235. Cidade Universitária, Recife, Pernambuco, CEP: 50670-901, Brazil
| | | | - Leila Maria Álvares Barbosa
- Department of Physiotherapy, Federal University of Pernambuco-UFPE, Av Prof. Moraes Rego, 1235. Cidade Universitária, Recife, Pernambuco, CEP: 50670-901, Brazil
| | - Caroline Wanderley Souto Ferreira
- Department of Physiotherapy, Federal University of Pernambuco-UFPE, Av Prof. Moraes Rego, 1235. Cidade Universitária, Recife, Pernambuco, CEP: 50670-901, Brazil.
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Yang EC, Koenig NA, Gong M, Brotto LA, Barr AM, Lee T, Yong PJ, Geoffrion R. Cannabis use preferences in women with myofascial pelvic pain: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol X 2023; 18:100192. [PMID: 37095765 PMCID: PMC10121619 DOI: 10.1016/j.eurox.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 03/02/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
Objective Myofascial tenderness is present in most chronic pelvic pain conditions and causes significant distress to patients. Treatment is challenging and often not curative. Cannabis is often used for self-management of chronic pelvic pain. However, we do not know which concentrations and routes of administration are most acceptable to users. We aimed to investigate patterns and willingness of cannabis product use among both habitual users and non-users with myofascial pelvic pain (MPP), to inform therapeutic development. Study design We conducted a cross-sectional study of questionnaire responses from female patients with MPP from two tertiary pelvic pain centers. We aimed for a convenience sample of 100 responses with representation from both centers. Inclusion criteria were age over 18 with pelvic floor muscle tenderness on standard gynecologic examination. We collected information on demographics, pelvic pain history, cannabis use status, cannabis use preferences, validated opioid misuse risk assessment, and interest in using gynecologic cannabis products and used descriptive analyses. Results 77/135 (57 %) questionnaire respondents were cannabis users and 58 (43 %) were non-users. Most users consume cannabis daily, (48.1 %) orally (66.2 %) or by smoking (60.7 %), and rated cannabis as effective at relieving pelvic pain. 37/58 (63.8 %) non-cannabis users responded that they would be willing to use cannabis for pelvic pain. Lack of information and potential adverse effects were the most common reasons for unwillingness to use. Approximately 3 of 4 respondents were willing to try vaginal or vulvar application of cannabis products for pelvic pain. Conclusions This cross-sectional study describes cannabis use patterns in MPP patients. Topical vulvar and vaginal cannabis products are of strong interest to both cannabis users and non-users and warrant further research.
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Affiliation(s)
- Emily C. Yang
- University of British Columbia, Vancouver, BC, Canada
- Correspondence to: St. Paul’s Hospital, Department of Obstetrics and Gynecology, Suite 930, 1125 Howe Street, Vancouver, BC, Canada V6Z 2K8.
| | | | - Merry Gong
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Terry Lee
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC, Canada
| | - Paul J. Yong
- University of British Columbia, Vancouver, BC, Canada
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Baltazar MCDV, Russo JADO, De Lucca V, Mitidieri AMDS, da Silva APM, Gurian MBF, Poli-Neto OB, Rosa-e-Silva JC. Therapeutic ultrasound versus injection of local anesthetic in the treatment of women with chronic pelvic pain secondary to abdominal myofascial syndrome: a randomized clinical trial. BMC Womens Health 2022; 22:325. [PMID: 35918696 PMCID: PMC9343571 DOI: 10.1186/s12905-022-01910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chronic pelvic pain (CPP) is defined as recurrent or continuous pain in the lower abdomen or pelvis, either non-menstrual or noncyclical, lasting for at least 6 months. There is strong evidence that up to 85% of patients with CPP have serious dysfunctions of the musculoskeletal system, including abdominal myofascial pain syndrome (AMPS). AMPS is characterized by intense and deep abdominal pain, originating from hyperirritable trigger points, usually located within a musculoskeletal band or its lining fascia. In the literature, there are few studies that address AMPS. Objectives To evaluate and compare the efficacy of therapeutic ultrasound (TUS) and injection of local anesthetic (IA) to improve pain in women with abdominal myofascial syndrome secondary to CPP. Study design Randomized controlled clinical trial.
Setting Tertiary University Hospital. Materials and methods A randomized clinical trial was conducted, patients were allocated to two types of treatment: group TUS (n = 18), and group IA (n = 20). The instruments used for evaluation and reassessment were the Visual Analog Scale, Numerical Categorical Scale, McGill Pain Questionnaire, and SF-36 quality of life assessment questionnaire. They were evaluated before starting treatment, 1 week after the end of treatment, and at 1, 3, and 6 months. Results TUS and IA were effective in reducing clinical pain and improving quality of life through the variables analyzed among study participants. There was no significant difference between groups. Limitations: absence of blinding; exclusion of women with comorbidities and other causes of CPP, the absence of a placebo group, the difference between the number of sessions used for each technique, and the COVID-19.
Conclusion Treatment with TUS and IA were effective in reducing clinical pain and improving quality of life in women with AMPS secondary to CPP. Trail registration We declare that this clinical trial has been registered under the number [(ReBEC) no. RBR-39czsv] on 07/18/2018 in the Brazilian Registry of Clinical Trials.
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Tracey A. Pelvic Floor Physical Therapy and Its Merit in the Treatment of Female Urogenital Pain. Curr Pain Headache Rep 2022; 26:775-782. [DOI: 10.1007/s11916-022-01076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
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Khalife T, Hagen AM, Alm JEC. Retroperitoneal Causes of Genitourinary Pain Syndromes: Systematic Approach to Evaluation and Management. Sex Med Rev 2022; 10:529-542. [PMID: 37051972 DOI: 10.1016/j.sxmr.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/13/2022] [Accepted: 06/24/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Women with pelvic pain commonly report pain in their ovaries, vagina, uterus, or bladder. These symptoms may be caused by visceral genitourinary pain syndromes but also may be caused by musculoskeletal disorders of the abdomen and pelvis. Understanding neuroanatomical and musculoskeletal factors that may contribute to genitourinary pain is important for evaluation and management. OBJECTIVES This review aims to (i) highlight the importance of clinical knowledge of pelvic neuroanatomy and sensory dermatomal distribution of the lower abdomen, pelvis, and lower extremities, exemplified in a clinical case; (ii) review common neuropathic and musculoskeletal causes of acute and chronic pelvic pain that may be challenging to diagnose and manage; and (iii) discuss female genitourinary pain syndromes with a focus on retroperitoneal causes and treatment options. METHODS A comprehensive review of the literature was performed by searching the PubMed, Ovid Embase, MEDLINE, and Scopus databases using the keywords "chronic pelvic pain," "neuropathy," "neuropathic pain," "retroperitoneal schwannoma," "pudendal neuralgia," and "entrapment syndromes." RESULTS Retroperitoneal causes of genitourinary pain syndromes have substantial overlap with common conditions treated in a primary care setting. Thus, a comprehensive and systematic history and physical examination, with focused attention to the pelvic neuroanatomy, is key to establishing the correct diagnosis. In the clinical case, such a comprehensive approach led to the unexpected finding of a large retroperitoneal schwannoma. This case highlights the intricacy of pelvic pain syndromes and the complex nature of their possible overlapping causes, which ultimately affects treatment planning. CONCLUSION Knowledge of the neuroanatomy and neurodermatomes of the abdomen and pelvis, in addition to understanding pain pathophysiology, is critical when evaluating patients with pelvic pain. Failure to apply proper evaluation and implement proper multidisciplinary management strategies contributes to unnecessary patient distress, decreased quality of life, and increased use of health care services. Khalife T, Hagen AM, Alm JEC. Retroperitoneal Causes of Genitourinary Pain Syndromes: Systematic Approach to Evaluation and Management. Sex Med Rev 2022;XX:XXX-XXX.
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Affiliation(s)
- Tarek Khalife
- Obstetrics and Gynecology, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA.
| | - Amy M Hagen
- Obstetrics and Gynecology, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA
| | - Jessica E C Alm
- Physical Medicine and Rehabilitation, Mayo Clinic Health System - Southwest Minnesota region, Mankato, MN, USA
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Shi JY, Paredes Mogica JA, De EJB. Non-Surgical Management of Chronic Pelvic Pain in Females. Curr Urol Rep 2022; 23:245-254. [PMID: 36066815 DOI: 10.1007/s11934-022-01110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the most recent literature on non-surgical therapeutic options for chronic pelvic pain in females. RECENT FINDINGS Chronic pelvic pain can arise from virtually any organ system in the human body. If a precise etiology is identified, the management of chronic pelvic pain can be tailored accordingly. In some cases, patients with chronic pelvic pain can remain without a specific diagnosis. In these circumstances, adequate symptom control can still be achieved even if no underlying disorder is found. Although chronic pelvic pain is often a difficult disorder to manage, several non-surgical management options exist. Employing a multidisciplinary approach, most patients can achieve adequate symptom relief, usually without the need for surgical intervention.
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12
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Fischer G, Bradford J. Interactions between vulvovaginal disorders and urinary disorders: The case for an integrated view of the pelvis. Int J Womens Dermatol 2022; 7:600-605. [PMID: 35005179 PMCID: PMC8721064 DOI: 10.1016/j.ijwd.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022] Open
Abstract
Lower urinary tract symptomatology is often difficult to categorize if history and investigation focus only on the urinary tract. Disease and dysfunction in organs more posteriorly can often cause or influence such bladder and urethral symptoms. Vulvovaginal skin diseases are an important but often missed influence on lower urinary tract symptomatology.
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Affiliation(s)
- Gayle Fischer
- Department of Dermatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Bradford
- Department of Obstetrics and Gynaecology, Blacktown Hospital, Sydney, New South Wales, Australia
- Corresponding Author:
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Puleo RM, Barreveld A, Rice S, Althausen Plante AM, Kotler DH. Unique Concerns of the Woman Cyclist. Phys Med Rehabil Clin N Am 2021; 33:61-79. [PMID: 34799003 DOI: 10.1016/j.pmr.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previously a male-dominated activity, female cyclists now make up nearly half of all cyclists in the United States. Although cycling provides a significant number of health benefits, it is an activity that carries risk of injury, both traumatic and nontraumatic. Sex differences are seen in chest trauma and breast injury, as well as pelvic, given the inherent differences in anatomy. Understanding the relationship of the bicycle to the anatomy of the rider can help mitigate risks for injury.
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Affiliation(s)
- Rozanne M Puleo
- Sports Medicine, Lynn Community Health Center, 269 Union Street, Lynn, MA 01902, USA.
| | - Antje Barreveld
- Anesthesiology, Tufts University School of Medicine, Pain Management Services, Newton-Wellesley Hospital, 2014 Washington St, Newton, MA 02462, USA
| | - Sarah Rice
- Athletico Physical Therapy, 2143 W Division St, Chicago IL 60622-3006, USA
| | - Anne M Althausen Plante
- Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| | - Dana H Kotler
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Outpatient Center - Wellesley, 65 Walnut Street, Wellesley, Boston, MA 02481, USA
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Factors Associated With Myofascial Dysfunction of the Pelvic Floor Muscles in Women With Urinary Incontinence: A Cross-Sectional Study. Female Pelvic Med Reconstr Surg 2021; 27:691-696. [PMID: 33787564 DOI: 10.1097/spv.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to evaluate the prevalence and associated factors of pelvic floor myofascial dysfunction (PFMD) in women with urinary incontinence (UI). METHODS A cross-sectional study was performed. Pelvic floor myofascial dysfunction was defined by pain of any intensity during palpation of the pelvic floor muscles and strength assessed by the modified Oxford scale, and was classified in grade I (mild pain), grade II (moderate), and grade III (severe). Univariate and multivariate analyses were calculated (5% significance level) to seek for the associated factors of PFMD. RESULTS A total of 234 women with UI were included, 121 women in the PFMD group and 113 in the control group. The mean ages were 52.1 ± 10.2 and 53 ± 8.1 years, respectively. Pelvic floor myofascial dysfunction was more frequent among non-White women, and women with PFMD presented more dyspareunia and recurrent urinary tract infection. There was a higher frequency of mixed UI (MUI; 89.2%) in the PFMD group and stress UI (31.9%) in the control group. The prevalence of PFMD was 51.7%, with 10.6% of patients categorized into grade I, 18.8% in grade II, and 22.2% in grade III. In women with PFMD, there is an inverse relation between pain and muscle strength, with the highest strength values (3, 4, and 5) being in grade I (P = 0.028). The multivariate analysis has shown that women with MUI had a risk 4.9 times greater (adjusted odds ratio, 4.93 [2.34-10.42]; P < 0.001) of having PFMD, and non-White women had a 2.1-fold increased risk (adjusted odds ratio, 2.07 [1.10-3.91]; P = 0.024) of presenting with PFMD. CONCLUSIONS A high prevalence of PFMD was found among women with UI. Mixed UI and non-White race were the associated factors of PFMD.
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No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain. Arthrosc Sports Med Rehabil 2021; 3:e1407-e1412. [PMID: 34712979 PMCID: PMC8527253 DOI: 10.1016/j.asmr.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the association between intrauterine device (IUD) use and hip pain, orthopaedic visits for hip pain, and arthroscopic hip surgery. Methods This was a retrospective cohort study of patients aged 18-44 years old using either IUDs or subdermal implants for contraception in a large commercial claims database (MarketScan) from 2012 to 2015. All patients had at least 12 months of continuous enrollment both before and after contraceptive placement. Patients with a history of hip pain or surgery were excluded. The primary outcome was new hip pain. Secondary outcomes included visiting an orthopaedic or sports medicine provider for a hip complaint, intra-articular hip injection, and arthroscopic hip surgery. Outcomes were analyzed with Cox proportional-hazard models. Results We identified a total of 242,383 patients, including 216,541 (89.3%) with IUDs and 25,842 (10.7%) with subdermal contraceptive implants. In time-to-event analysis, IUDs (vs implants) were not associated with increased risk of new hip pain diagnoses (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.87-1.03, P = .21). In contrast, both age (P < .001) and region (P < .001) were associated with increased risk of new hip pain. Similar results were seen for the secondary outcomes, including risk of orthopaedic visits for hip complaints (HR 1.06, 95% CI 0.83-1.35, P = .63), intra-articular injections of the hip (HR 0.94, 95% CI 0.63-1.41, P = .77), and hip arthroscopy procedures (HR 1.13, 95% CI 0.53-2.40, P = .75). Conclusions In this study, we found no evidence that IUDs were associated with hip pain or surgery. Level of Evidence Level III, retrospective cohort.
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Xu J, Chen K, Ding B, Zhu M, Yao S, Ren M, Shen Y. Effectiveness of self-myofascial release combined with biofeedback and electrical stimulation for the management of myofascial pelvic pain: A randomized controlled trial. Eur J Pain 2021; 26:405-416. [PMID: 34592023 DOI: 10.1002/ejp.1867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 09/18/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Myofascial pelvic pain (MFPP) caused by myofascial trigger points (MTrPs) is a major contributor to chronic pelvic pain in women. However, the effect of the patient's self-myofascial release (SMFR) is unclear. This study aimed to investigate the effect of SMFR combined with biofeedback and electrical stimulation (BES) therapy in comparison with BES alone in patients with MFPP. METHODS A prospective randomized controlled study was conducted. Sixty-eight patients were randomly allocated into BES-SMFR group (n = 34) and BES group (n = 34). Every patient received 4 weeks of treatment, evaluated at baseline (T0), 4 weeks post-intervention (T4) and 12-week follow-up (T12). The primary outcome was pain intensity. The secondary outcomes were degree of activation of MTrPs, surface electromyography (sEMG) levels and Patient Global Impression of Improvement (PGI-I). RESULTS Compared with the effect of BES, BES-SMFR treatment significantly decreased pain intensity and the degree of activation of MTrPs in the levator ani (p = 0.02) and obturator internus (p = 0.03), as well as the sEMG levels of the pre-test resting baseline and post-test resting baseline (all p < 0.01). The degree of activation of MTrPs in the piriformis and coccygeus (all p > 0.05) and the sEMG levels of the quick flicks and endurance contraction were not significantly different. The BES-SMFR treatment improved the PGI-I scale at T4 (p = 0.02) but not at T12 (p = 0.40). CONCLUSIONS This study confirmed that the addition of SMFR to BES treatment resulted in superior outcomes compared with those with BES alone in patients with MFPP. SIGNIFICANCE STATEMENT Myofascial pelvic pain (MFPP) is a major contributor of female chronic pelvic pain. Myofascial release has been used commonly for better pain release; however, poor therapeutic effect due to poor patient compliance is common in clinical practice. Therefore, in future research, there is a need to investigate the effect of patient's self-myofascial release (SMFR) technique, which can eliminate the need for frequent office visits and improve patient compliance to some extent, in patients with MFPP.
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Affiliation(s)
- Jingyun Xu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Kai Chen
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Howard University Hospital, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Bo Ding
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Mingyue Zhu
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Shanshan Yao
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Mulan Ren
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
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Fraga MV, Oliveira Brito LG, Yela DA, de Mira TA, Benetti-Pinto CL. Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association. Int J Clin Pract 2021; 75:e14350. [PMID: 33973308 DOI: 10.1111/ijcp.14350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS Deep infiltrative endometriosis (DIE) may cause pelvic pain and thus negatively affect the function of different structures. We hypothesised that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs). METHODS This cross-sectional study included 160 women (80 with DIE under hormonal treatment and 80 women without DIE), who were assessed to determine the presence of pelvic symptoms (dysmenorrhea, chronic pelvic pain [CPP], deep/penetration dyspareunia, dysuria, dyschezia and vulvodynia), PFM function (PERFECT scheme, presence of hypertonia and trigger points, and muscle contraction and relaxation), abdominal muscle pain (Carnett's test) and muscle shortening in LLM (Thomas, Pace and Ober tests). RESULTS Women with DIE presented more CPP (30% vs 5%; P < .001), dysuria (12.5% vs 3.75%; P = .043) and dyschezia (47.5% vs 2.5%; P < .001) than the control group. Moreover, they had higher PFM hypertonia (28.75% vs 13.75%; P = .02), weaker PFM contraction (36.35% vs 2.5%; P < .001), and incomplete PFM relaxation (45% vs 13.75%; P < .001). Women with DIE had a higher rate of positive results in the Carnett's test (21.25% vs 2.5%; P < .001) than the control group. Moreover, they had a higher frequency of shortening of the anterior thigh (30% vs 10% in both LLM; P < .001), piriformis (16.25% vs 6.25%; P < .001) and iliotibial band muscles (bilateral; P < .001). Multivariate analysis revealed that the presence of pain increased the risk of PFM hypertonia (OR = 3.73 [1.26-11.07]; P = .018) and caused difficulty in PFM relaxation (OR = 2.98 [1.01-9.37]; P = .049). CONCLUSION Women with DIE exhibited a greater number of pelvic symptoms and greater PFM/LLM dysfunction than those in the control group. Pain was associated with PFM hypertonia and difficulty in PFM relaxation.
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Affiliation(s)
- Mirian Vieira Fraga
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Daniela Angerame Yela
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Ticiana Alves de Mira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Shafrir AL, Martel E, Missmer SA, Clauw DJ, Harte SE, As-Sanie S, Sieberg CB. Pelvic floor, abdominal and uterine tenderness in relation to pressure pain sensitivity among women with endometriosis and chronic pelvic pain. Eur J Obstet Gynecol Reprod Biol 2021; 264:247-253. [PMID: 34340095 DOI: 10.1016/j.ejogrb.2021.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/29/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Pelvic floor pain, abdominal wall pain, and central nervous system pain amplification can be contributing factors in chronic pelvic pain (CPP), however; limited research has investigated the association of pelvic floor, abdominal, and uterine tenderness with central nervous system pain amplification. We assessed whether pressure pain thresholds on the non-dominant thumbnail, a marker of central nervous system pain amplification, were associated with pelvic floor, abdominal, and uterine tenderness among women with endometriosis or CPP. STUDY DESIGN We conducted a cross-sectional study among 88 females with endometriosis and/or CPP. Abdominal (6 locations), pelvic floor (6 locations) and uterine (1 location) tenderness were assessed via a standardized physical exam. Participants reported their pain levels (0-10 scale) with application of 2 kg of pressure at each area, with a pain rating of ≥4 on the 0-10 scale considered moderate to severe pain. Pain sensitivity was measured on the non-dominant thumbnail by applying discrete pressure stimuli using a previously validated protocol. RESULTS Overall, 50% (44/88), 42% (37/88), and 58% (51/88) of participants reported high pelvic floor, abdominal, and uterine tenderness, respectively. Pressure intensities needed to elicit 'faint' and 'mild' pain were lower for participants with high vs. low pelvic floor tenderness (median intensity for 'faint' pain = 0.50 kgf/cm2(min-max:0.25-3.25) vs. 1.06(0.25-3.00), p-value = 0.006; median intensity for 'mild' pain = 2.00(0.63-4.88) vs. 2.63(0.75-6.00), p-value = 0.03). No association was observed between pressure pain sensitivity and abdominal or uterine tenderness (p > 0.11). Participants with endometriosis without pain were less likely to have high pelvic floor (22.2%), abdominal (11.1%), and uterine (25.9%) tenderness compared to participants with endometriosis with pain (63.0%, 50%, 65.2%, respectively) and participants with chronic pelvic pain (60%, 73.3%, 93.3%, respectively). CONCLUSIONS These results suggest that high pelvic floor tenderness among women with endometriosis/CPP may be a marker of heightened pain sensitivity suggestive of central nervous system pain amplification and may impact treatment response. Future research should examine whether this clinical phenotype predicts response to medical and behavioral treatments (e.g, anti-convulsants, behavioral therapy, Physical Therapy).
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Affiliation(s)
- Amy L Shafrir
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA
| | - Elena Martel
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Stacey A Missmer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Christine B Sieberg
- Departments of Anesthesiology, Critical Care, & Pain Medicine and Psychiatry, Boston Children's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, MA, USA.
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Abstract
IMPORTANCE Chronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world's female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions. OBSERVATIONS Chronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process. CONCLUSIONS AND RELEVANCE Chronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.
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Affiliation(s)
- Georgine Lamvu
- Division of Surgery, Gynecology Section, Veterans Affairs Medical Center, Orlando VA Healthcare System, Orlando, Florida
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando
| | - Jorge Carrillo
- Division of Surgery, Gynecology Section, Veterans Affairs Medical Center, Orlando VA Healthcare System, Orlando, Florida
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando
| | - Chensi Ouyang
- Division of Surgery, Gynecology Section, Veterans Affairs Medical Center, Orlando VA Healthcare System, Orlando, Florida
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando
| | - Andrea Rapkin
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles
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Hughes C, May S. A directional preference approach for chronic pelvic pain, bladder dysfunction and concurrent musculoskeletal symptoms: a case series. J Man Manip Ther 2020; 28:170-180. [PMID: 31702976 PMCID: PMC7480605 DOI: 10.1080/10669817.2019.1668994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) with concurrent musculoskeletal and bladder symptoms is a complex and challenging problem. However, clinically the co-existence of these symptoms is not routinely questioned, and their musculoskeletal source is not investigated thoroughly. The purpose of this case series is to present the use of Mechanical Diagnosis and Therapy (MDT) principles in seven patients with concurrent chronic pelvic pain, bladder dysfunction and musculoskeletal symptoms. CASE DESCRIPTIONS Seven patients with coexisting pelvic health and musculoskeletal signs and symptoms were retrospectively reviewed. Most common symptoms were urinary frequency, incontinence, pelvic pain, nocturia, dyspareunia, bladder dyssynergia, and lumbar, pelvic or hip pain. All patients failed to recognize the possible interconnectedness of the two sets of symptoms. Each exhibited a directional preference (DP) and subsequent MDT provisional classification of derangement was established; the use of DP forces abolished or dramatically improved both symptoms and mobility impairments. In all cases DP was for sustained sagittal forces initially, but ultimately lateral forces and mobilization were indicated. OUTCOMES Changes in Pelvic Floor Impact Questionnaire, Care Connections Pelvic Floor and Lumbar spine were all clinically significant and exceeded minimally Clinical Important Differences several times. Average of 5.8 sessions per patient was noted. Follow-up at an average of 3.3 years revealed ongoing satisfaction and confidence in independent self-management. DISCUSSION These case studies highlight the importance of ensuring expansion of intake questions for possible co-existence of symptoms in both pelvic and musculoskeletal patients, possibly suggesting a mechanical intervention is indicated. Provisional subclassification into 'Mechanical Pelvic Syndrome' is proposed. Level of Evidence: 4.
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Affiliation(s)
| | - Stephen May
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
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Moulder JK, Carrillo J, Carey ET. Pelvic Pain in the Transgender Man. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-020-00293-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Grinberg K, Sela Y, Nissanholtz-Gannot R. New Insights about Chronic Pelvic Pain Syndrome (CPPS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3005. [PMID: 32357440 PMCID: PMC7246747 DOI: 10.3390/ijerph17093005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. The aim of this article was to present new insight about CPPS in order to raise awareness of nursing and medical staff in the identification and diagnosis of the syndrome and to promote an appropriate treatment for each woman who suffers from CPPS. METHODS A literature review about the factors associated with CPPS and therapeutic interventions for CPPS was conducted. RESULTS CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. CONCLUSIONS The therapeutic interventions in CPPS cases should, consequently, follow a multidisciplinary approach.
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Affiliation(s)
- Keren Grinberg
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
| | - Yael Sela
- Department of Nursing, Faculty of Social and Community Science, Ruppin Academic Center, 40250 Emek-Hefer, Israel
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Aguirre F, Heft J, Yunker A. Factors Associated With Nonadherence to Pelvic Floor Physical Therapy Referral for the Treatment of Pelvic Pain in Women. Phys Ther 2019; 99:946-952. [PMID: 30916754 PMCID: PMC6602154 DOI: 10.1093/ptj/pzz050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 09/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with pelvic pain due to pelvic floor myofascial pain syndrome are often referred for pelvic floor physical therapy, the primary treatment option. However, many patients do not adhere to the treatment. OBJECTIVE The purpose of this study was to examine the adherence rate and outcomes of patients referred for physical therapy for pelvic floor myofascial pain syndrome and identify risk factors associated with nonadherence. DESIGN This was a retrospective cohort study. METHODS ICD-9 codes were used to identify a cohort of patients with pelvic floor myofascial pain syndrome during a 2-year time period within a single provider's clinical practice. Medical records were abstracted to obtain information on referral to physical therapy, associated comorbidities and demographics, and clinical outcomes. "Primary outcomes" was defined as attendance of at least 1 visit. Secondary outcomes included attendance of at least 6 physical therapist visits and overall improvement in pain. Statistical analysis was performed using chi-square, Fisher exact, and independent t tests. Nonparametric comparisons were performed using Wilcoxon signed rank test. Multivariate analysis was completed to adjust for confounders. RESULTS Of the 205 patients, 140 (68%) attended at least 1 session with physical therapy. At least 6 visits were attended by 68 (33%) patients. Factors associated with poor adherence included parity and a preexisting psychiatric diagnosis. The odds of attending at least 1 visit were 0.75 (95% confidence interval = 0.62-0.90) and 0.44 (95% confidence interval = 0.21-0.90), respectively. Patients who attended ≥ 6 visits were more likely to have private insurance (78%) and travel shorter distances to a therapist (mean = 16 miles vs 22). Patients with an improvement in pain (compared with those who were unchanged) attended an average of 3 extra physical therapist visits (mean = 6.9 vs 3.1). LIMITATIONS Limitations include reliance on medical records for data integrity; a patient population derived from a single clinic, reducing the generalizability of the results; the age of the data (2010-2012); and the likely interrelatedness of many of the variables. It is possible that maternal parity and psychiatric diagnoses are partial surrogates for social, logistic, or economic constraints and patient confidence. CONCLUSIONS Initial adherence to pelvic floor physical therapy was less likely for multiparous women and women with a history of psychiatric diagnosis. Persistent adherence was more likely with private insurance or if the physical therapist location was closer. Pain improvement correlated with increased number of physical therapist sessions.
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Affiliation(s)
- Frank Aguirre
- Department of Obstetrics and Gynecology, University of South Carolina Medical School, Columbia, South Carolina
| | - Jessica Heft
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amanda Yunker
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, 1161 21st Ave, MCN B-1100, Nashville, TN 37232 (USA),Address all correspondence to Dr Yunker at:
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Cameron B, Sabourin J, Sanaee MS, Koenig NA, Lee T, Geoffrion R. Pelvic floor hypertonicity in women with pelvic floor disorders: A case control and risk prediction study. Neurourol Urodyn 2018; 38:696-702. [DOI: 10.1002/nau.23896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/27/2018] [Accepted: 10/24/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Brianna Cameron
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Johanne Sabourin
- Providence Health Care/St Paul's Hospital Physiotherapy DepartmentVancouverBritish ColumbiaCanada
| | - May S Sanaee
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Nicole A Koenig
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Terry Lee
- Centre for Health Evaluation and Outcome SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Roxana Geoffrion
- Department of Obstetrics and GynecologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Evans SF, Brooks TA, Esterman AJ, Hull ML, Rolan PE. The comorbidities of dysmenorrhea: a clinical survey comparing symptom profile in women with and without endometriosis. J Pain Res 2018; 11:3181-3194. [PMID: 30588070 PMCID: PMC6300370 DOI: 10.2147/jpr.s179409] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Dysmenorrhea is a common disorder that substantially disrupts the lives of young women. The frequency of 14 associated symptoms both within and outside the pelvis was determined. Patients and methods Symptom questionnaires were completed by 168 women with dysmenorrhea, allocated to three groups based on their diagnostic status for endometriosis confirmed (Endo+), endometriosis excluded (Endo-), or endometriosis diagnosis unknown (No Lap). Those with endometriosis confirmed were further divided into current users (Endo+ Hx+) and non-users of hormonal treatments (Endo+ Hx-). Users of hormonal treatments were further divided into users (Endo+ Hx+ LIUCD+) and non-users (Endo+ Hx+ LIUCD-) of a levonorgestrel-releasing intra-uterine contraceptive device (LIUCD). The frequency and number of symptoms within groups and the effect of previous distressing sexual events were sought. Results Women with and without endometriosis lesions had similar symptom profiles, with a mean of 8.5 symptoms per woman. Only 0.6% of women reported dysmenorrhea alone. The presence of stabbing pelvic pains was associated with more severe dysmenorrhea (P=0.006), more days per month of dysmenorrhea (P=0.003), more days per month of pelvic pain (P=0.016), and a diagnosis of migraine (P=0.054). The symptom profiles of the Endo+ Hx+ and Endo+ Hx- groups were similar. A history of distressing sexual events was associated with an increased number of pain symptoms (P=0.003). Conclusion Additional symptoms are common in women with dysmenorrhea, and do not correlate with the presence or absence of endometriosis lesions. Our study supports the role of central sensitization in the pain of dysmenorrhea. The presence of stabbing pelvic pains was associated with increased severity of dysmenorrhea, days per month of dysmenorrhea, days per month of pelvic pain, and a diagnosis of migraine headache. A past history of distressing sexual events is associated with an increased number of pain symptoms.
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Affiliation(s)
- Susan F Evans
- School of Medicine, University of Adelaide, Adelaide, SA, Australia,
| | - Tiffany A Brooks
- School of Psychology, University of South Australia, Adelaide, SA, Australia
| | - Adrian J Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia.,James Cook University, Cairns, QLS, Australia
| | - M Louise Hull
- Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - Paul E Rolan
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
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Negative Illness Perceptions are Associated With a Pronociceptive Modulation Profile and Augmented Pelvic Pain. Clin J Pain 2018; 34:1141-1148. [DOI: 10.1097/ajp.0000000000000633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Meister MR, Shivakumar N, Sutcliffe S, Spitznagle T, Lowder JL. Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review. Am J Obstet Gynecol 2018; 219:497.e1-497.e13. [PMID: 29959930 DOI: 10.1016/j.ajog.2018.06.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myofascial pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor myofascial pain in the absence of local or referred pain has also been observed in patients with lower urinary tract symptoms, and we have found that many patients report an improvement in these symptoms after receiving myofascial-targeted pelvic floor physical therapy. OBJECTIVE We sought to systematically review the literature for examination techniques used to assess pelvic floor myofascial pain in women. STUDY DESIGN We performed a systematic literature search using strategies for the concepts of pelvic floor disorders, myofascial pain, and diagnosis in Ovid MEDLINE 1946-, Embase 1947-, Scopus 1960-, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, and Cochrane Database of Systematic Reviews. Articles were screened by 3 authors and included if they contained a description of a pelvic myofascial physical examination. RESULTS In all, 55 studies met our inclusion criteria. Overall, examination components varied significantly among the included studies and were frequently undefined. A consensus examination guideline was developed based on the available data and includes use of a single digit (62%, 34/55) to perform transvaginal palpation (75%, 41/55) of the levator ani (87%, 48/55) and obturator internus (45%, 25/55) muscles with a patient-reported scale to assess the level of pain to palpation (51%, 28/55). CONCLUSION Physical examination methods to evaluate pelvic musculature for presence of myofascial pain varied significantly and were often undefined. Given the known role of pelvic floor myofascial pain in chronic pelvic pain and link between pelvic floor myofascial pain and lower urinary tract symptoms, physicians should be trained to evaluate for pelvic floor myofascial pain as part of their physical examination in patients presenting with these symptoms. Therefore, the development and standardization of a reliable and reproducible examination is needed.
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Yuan X, Bevelaqua AC. Buttock Pain in the Athlete: the Role of Pelvic Floor Dysfunction. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Myofascial pelvic pain refers to pain in the pelvic floor muscles, the pelvic floor connective tissue, and the surrounding fascia. The cause is often multifactorial and requires treatment that encompasses multiple modalities. This type of pain is often associated with other abdominopelvic disorders, so providers in these specialties need to be aware of these connections. A comprehensive musculoskeletal examination, including evaluation of the pelvic floor muscles, and history are key to diagnosing myofascial pelvic pain. Treatments include physical therapy, muscle relaxers, oral neuromodulators, cognitive-behavioral therapy, and pelvic floor muscle injections.
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Prendergast SA. Pelvic Floor Physical Therapy for Vulvodynia: A Clinician's Guide. Obstet Gynecol Clin North Am 2018; 44:509-522. [PMID: 28778646 DOI: 10.1016/j.ogc.2017.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vulvar pain affects up to 20% of women at some point in their lives, and most women with vulvar pain have associated pelvic floor impairments. Pelvic floor dysfunction is associated with significant functional limitations in women by causing painful intercourse and urinary, bowel, and sexual dysfunction. A quick screening of the pelvic floor muscles can be performed in the gynecology office and should be used when patients report symptoms of pelvic pain. It is now known the vulvar pain syndromes are heterogeneous in origin; therefore, successful treatment plans are multimodal and include physical therapy.
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Affiliation(s)
- Stephanie A Prendergast
- Pelvic Health and Rehabilitation Center, 11500 West Olympic Boulevard, Suite 440, Los Angeles, CA 90064, USA.
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Sorensen J, Bautista KE, Lamvu G, Feranec J. Evaluation and Treatment of Female Sexual Pain: A Clinical Review. Cureus 2018; 10:e2379. [PMID: 29805948 PMCID: PMC5969816 DOI: 10.7759/cureus.2379] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022] Open
Abstract
Dyspareunia and vulvodynia are genital pain disorders that have devastating effects on women's quality of life. These disorders occur with high prevalence and place a significant financial burden on women and the health care system. Many women do not report genital pain, and most providers do not inquire about this type of pain. As a result, women also experience social isolation. Numerous treatments are thought to improve quality of life and decrease pain; however, more studies are needed. This review aims to provide an overview of clinical evaluation methods and to summarize treatment options for women suffering from dyspareunia and vulvodynia.
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Affiliation(s)
- James Sorensen
- University of Central Florida Ucf Com/hca Gme Consortium Obstetrics and Gynecology Residency Program, UCF/ Orlando Va Medical Center
| | | | - Georgine Lamvu
- Division of Surgery, Gynecology Section Orlando Va Medical Center, University of Central Florida College of Medicine , Orlando, USA
| | - Jessica Feranec
- Division of Surgery, Gynecology Section Orlando Va Medical Center, University of Central Florida College of Medicine, Orlando, USA
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Torstensson T, Butler S, Lindgren A, Peterson M, Nilsson-Wikmar L, Eriksson M, Kristiansson P. Anatomical landmarks of the intra-pelvic side-wall as sources of pain in women with and without pregnancy-related chronic pelvic pain after childbirth: a descriptive study. BMC WOMENS HEALTH 2018; 18:54. [PMID: 29587728 PMCID: PMC5870072 DOI: 10.1186/s12905-018-0542-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
Background Chronic pelvic pain (CPP) affects 15–24% of women and can have a devastating impact on quality of life. Laparoscopy is often used in the investigation, although in one third of the examinations there is no visible pathology and the women may be dismissed without further investigation. Also, the contribution of skeletal, muscular, periosteal and ligamentous tissues to CPP remains to be further elucidated. The objective of the present study was to compare pain intensity provoked from anatomical landmarks of the intra-pelvic side-wall in women with pregnancy-related CPP after childbirth and women without such pain. Methods This is a descriptive study of 36 non-randomly selected parous women with CPP after childbirth and 29 likewise selected parous women after childbirth without CPP. Pain was determined by questionnaire and clinical examination. The primary outcome measure was reported pain intensity provoked on 13 anatomical landmarks of the intra-pelvic side-wall. All women reported their perceived pain intensity for each anatomical landmark on Likert scales and an individual sum score was calculated. Results Women with chronic pelvic pain were older than women without CPP. At several intra-pelvic landmarks high intensity pain was provoked in women with CPP compared with less intense pain provoked at fewer landmarks in women without low back or pelvic pain (p < 0.0001). The average sum of pain intensity scores was about 4 times higher in women with CPP (1.3) as compared with those without low back or pelvic pain (0.3), p < 0.0001. This association remained when adjusting for the age difference between the pain groups in linear regression analysis. In addition, reported pain intensity at worst past week was independently associated with sum of pain intensity scores. The maximum individual sum of pain intensity scores among women without CPP was exceeded by that of 85% of the women with CPP. Conclusions Parous women with CPP after childbirth had a heightened pain intensity over 13 anatomical landmarks during pelvic examination compared with parous women without CPP. These results need to be confirmed in a larger cohort with different types of CPP.
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Affiliation(s)
- Thomas Torstensson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, SE, Sweden.,Departmemt of Physiotherapy, Sundsvall Hospital, 851 86, Sundsvall, SE, Sweden
| | - Stephen Butler
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, SE, Sweden.,Pain Center, Uppsala University Hospital, 751 85, Uppsala, SE, Sweden
| | - Anne Lindgren
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, SE, Sweden.,Departmemt of Physiotherapy, Sundsvall Hospital, 851 86, Sundsvall, SE, Sweden
| | - Magnus Peterson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, SE, Sweden.,Academic Primary Healthcare Centre, Stockholm County Council, 104 31, Stockholm, SE, Sweden
| | - Lena Nilsson-Wikmar
- Departmemt of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 141 83, Huddinge, SE, Sweden.,Academic Primary Healthcare Centre, Stockholm County Council, 104 31, Stockholm, SE, Sweden
| | - Margaretha Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, SE, Sweden
| | - Per Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, SE, Sweden.
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Abstract
The management of chronic pelvic pain poses a significant challenge to both physicians and patients. Patients should be evaluated for both gynecologic and nongynecologic conditions, and >1 source may be identified. Treatment involves medical as well as surgical options, and it is important to set realistic goals with patients. Treatment may not be curative, but should improve the patient's quality of life.
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35
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Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J Bodyw Mov Ther 2018; 22:92-96. [DOI: 10.1016/j.jbmt.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 01/13/2023]
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Abstract
OBJECTIVE To determine the feasibility of a detailed pain sensitivity assessment using body-wide musculoskeletal tender points (TPs) in women with different types of chronic pelvic pain (CPP) and compare phenotypic differences. MATERIALS AND METHODS Seventy women with CPP and 35 pain-free women underwent musculoskeletal evaluation of TPs in the pelvic floor, abdomen, groin, inner thigh, and all 18 fibromyalgia TPs. Patients scored elicited pain on a numeric rating scale. TP pain scores were used for intergroup comparison and intragroup correlation. RESULTS Women with CPP were grouped as having either bladder pain syndrome (BPS, n=24) or myofascial pelvic pain (MPP, n=11) singularly or both concomitantly (BPS+MPP, n=35). TP pain scores for all evaluations were higher in women with CPP compared with healthy women (P<0.001). Women with BPS+MPP had elevated TP pain for each evaluation compared with women with BPS alone. Pelvic floor and fibromyalgia TP scores correlated strongly in the MPP group, moderately in the BPS+MPP group, and weakly in the BPS alone group. Although some moderate and strong correlations between different body locations were present in all 3 groups, only the BPS+MPP group showed moderate to strong correlations between all body TPs. CONCLUSIONS Detailed musculoskeletal evaluation of women with CPP is feasible and well tolerated. Careful phenotyping differentiated BPS, MPP, and BPS+MPP groups. Attending to the differences between these groups clinically may lead to more effective treatment strategies and improved outcomes for patients with CPP.
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38
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Matikainen M, Hermunen H, Paajanen H. Athletic Pubalgia in Females: Predictive Value of MRI in Outcomes of Endoscopic Surgery. Orthop J Sports Med 2017; 5:2325967117720171. [PMID: 28840145 PMCID: PMC5546653 DOI: 10.1177/2325967117720171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Athletic pubalgia is typically associated with male athletes participating in contact sports and less frequently with females. Endoscopic surgery may fully treat the patient with athletic pubalgia. Purpose: To perform an outcomes analysis of magnetic resonance imaging (MRI) and endoscopic surgery in female patients with athletic pubalgia. Study Design: Cohort study; Level of evidence, 3. Methods: Fifteen physically active female patients (mean age, 37 years) with athletic pubalgia were treated surgically via placement of total extraperitoneal endoscopic polypropylene mesh behind the injured groin area. The presence of preoperative bone marrow edema (BME) at the pubic symphysis seen on MRI was graded from 0 to 3 and correlated with pain scores after surgery. The outcome measures were pre- and postoperative pain scores and recovery to daily activity between 1 and 12 months after surgery. Results were compared with previously published scores from male athletes (n = 30). Results: With the exception of lower body mass index, the females with (n = 8) and without (n = 7) pubic BME had similar patient characteristics to the corresponding males. Mean inguinal pain scores (0-10) before surgical treatment were greater in females than males (during exercise, 7.8 ± 1.1 vs 6.9 ± 1.1; P = .0131). One month after surgery, mean pain scores for females were still greater compared with males (2.9 ± 1.7 vs 1.3 ± 1.6; P = .0034). Compared with female athletes with normal MRI, pubic BME was related to increased mean preoperative pain scores (8.13 ± 0.99 vs 6.43 ± 1.2; P = .0122). After 1 year, surgical outcomes were excellent or good in 47% of women. Conclusion: Endoscopic surgery was helpful in half of the females with athletic pubalgia in this study. The presence of pubic BME may predict slightly prolonged recovery from surgery.
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Affiliation(s)
- Markku Matikainen
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - Heikki Hermunen
- Department of Radiology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Hannu Paajanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
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Alapati S, Wadhwa V, Komarraju A, Guidry C, Pandey T. Magnetic Resonance Imaging of Nonneoplastic Musculoskeletal Pathologies in the Pelvis. Semin Ultrasound CT MR 2017; 38:291-308. [PMID: 28705373 DOI: 10.1053/j.sult.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Musculoskeletal pathologies in the pelvis encompass a wide variety of lesions including femoroacetabular impingement, athletic pubalgia, ischiofemoral impingement, and apophyseal avulsion injuries. Magnetic resonance imaging is the noninvasive imaging modality of choice for the diagnosis and management of these lesions. In this article, the authors discuss the nonneoplastic musculoskeletal lesions in the pelvis, with illustrations and relevant case examples.
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Affiliation(s)
- Sindhura Alapati
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Aparna Komarraju
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Carey Guidry
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
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Harris V, Fischer G, Bradford JA. The aetiology of chronic vulval pain and entry dyspareunia: a retrospective review of 525 cases. Aust N Z J Obstet Gynaecol 2017; 57:446-451. [DOI: 10.1111/ajo.12613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 01/08/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Victoria Harris
- Department of Dermatology; Royal North Shore Hospital; Sydney New South Wales Australia
- Northern Clinical School; University of Sydney; Australia
| | - Gayle Fischer
- Discipline of Dermatology, Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
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Del Río FJ, Cabello-Santamaría F, Cabello-García MA, Aragón-Vela J. Sexual Pain Disorders in Spanish Women Drug Users. Subst Use Misuse 2017; 52:145-151. [PMID: 27759504 DOI: 10.1080/10826084.2016.1222625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The impact of pain in sexuality, couple relationships and the quality of life is very well known. OBJECTIVES The relationship between substance abuse and the presence of sexual pain disorder is assessed, together with anxiety and sexual attitudes . METHOD Two samples were selected. One sample for women with a history of substance abuse (n = 129), and another one of women nonconsumers (n = 129). The Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Sexual Opinion Survey (SOS) and the State Trait Anxiety Inventory (STAI) questionnaires were used. RESULTS The results indicate that women consumers obtained a higher mean scores in sexual pain disorder (4.88 > 2.89, that is 65.12%), plus higher mean scores on state anxiety (23.82 > 14.56) and trait anxiety (30.93 > 16.95), and lower average figure in erotophilia (84.93 < 95.81). It was also verified that the period of abstinence does not improve sexual response. CONCLUSIONS Substance consumption affects sexual response in women negatively. Sexual response does not improve with abstinence period.
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Affiliation(s)
- Francisco Javier Del Río
- a Instituto Andaluz de Sexología y Psicología , Málaga , Spain.,b Department of Psychology , University of Cádiz , Cádiz , Spain
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von Heymann W. Chronischer Beckenschmerz und sexuelle Gewalt. MANUELLE MEDIZIN 2016. [DOI: 10.1007/s00337-016-0196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lee DW, Lim CH, Han JY, Kim WM. Chronic pelvic pain arising from dysfunctional stabilizing muscles of the hip joint and pelvis. Korean J Pain 2016; 29:274-276. [PMID: 27738508 PMCID: PMC5061646 DOI: 10.3344/kjp.2016.29.4.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 11/06/2022] Open
Abstract
Chronic pelvic pain in women is a very annoying condition that is responsible for substantial suffering and medical expense. But dealing with this pain can be tough, because there are numerous possible causes for the pelvic pain such as urologic, gynecologic, gastrointestinal, neurologic, or musculoskeletal problems. Of these, musculoskeletal problem may be a primary cause of chronic pelvic pain in patients with a preceding trauma to the low back, pelvis, or lower extremities. Here, we report the case of a 54-year-old female patient with severe chronic pelvic pain after a transcutaneous electrical nerve stimulation (TENS) accident that was successfully managed with image-guided trigger point injections on several pelvic stabilizing muscles.
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Affiliation(s)
- Dae Wook Lee
- Department of Anesthesiology & Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Chang Hun Lim
- Department of Anesthesiology & Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae Young Han
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Woong Mo Kim
- Department of Anesthesiology & Pain Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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45
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Dynamic Ultrasonography of the Deep External Rotator Musculature of the Hip: A Descriptive Study. PM R 2016; 8:640-50. [DOI: 10.1016/j.pmrj.2015.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 11/18/2022]
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46
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Botulinum Toxin A Injections Into Pelvic Floor Muscles Under Electromyographic Guidance for Women With Refractory High-Tone Pelvic Floor Dysfunction: A 6-Month Prospective Pilot Study. Female Pelvic Med Reconstr Surg 2016; 21:277-82. [PMID: 25900057 DOI: 10.1097/spv.0000000000000177] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES High-tone pelvic floor dysfunction (HTPFD) is a debilitating chronic pain disorder for many women with significant impact on their quality of life (QoL). Our objective was to determine the efficacy of electromyography-guided onabotulinumtoxinA (Botox; Allergan, Irvine, Calif) injections in treating patient's perception of pelvic pain and improving QoL measurement scores. METHODS This is a prospective pilot open-label study of women with chronic pelvic pain and HTPFD who have failed conventional therapy between January 2011 and August 2013. Botox injections (up to 300 U) were done using needle electromyography guidance, from a transperineal approach, to localize spastic pelvic floor muscles (PFMs). Data were collected at baseline, 4, 8, 12, and 24 weeks after injections. This included demographics; Visual Analog Scale (VAS) scores for pain and dyspareunia; validated questionnaires for symptoms, QoL, and sexual function; Global Response Assessment scale for pelvic pain; digital examination of PFM for tone and tenderness; and vaginal manometry. Side effects were also recorded. RESULTS Out of 28 women who enrolled in the study, 21 completed the 6-month follow-up and qualified for analysis. The mean (SD) age was 35.1 (9.4) years (range, 22-50 years), and the mean (SD) body mass index was 25 (4.4). Comorbidities included interstitial cystitis/bladder pain syndrome (42.9%) and vulvodynia (66.7%). Overall, 61.9% of subjects reported improvement on Global Response Assessment at 4 weeks and 80.9% at 8, 12, and 24 weeks post injection, compared with baseline. Of the subjects who were sexually active at baseline, 58.8% (10/17), 68.8% (11/16), 80% (12/15), and 83.3% (15/18) reported less dyspareunia at 4, 8, 12, and 24 weeks, respectively. Dyspareunia Visual Analog Scale score significantly improved at weeks 12 (5.6, P = 0.011) and 24 (5.4, P = 0.004) compared with baseline (7.8). Two of the 4 patients who avoided sexual activity at baseline secondary to dyspareunia resumed and tolerated intercourse after Botox. Sexual dysfunction as measured by the Female Sexual Distress Scale significantly improved at 8 weeks (27.6, P = 0.005), 12 weeks (27.9, P = 0.006), and 24 weeks (22.6, P < 0.001) compared with baseline (34.5). The Short-Form 12 Health Survey (SF-12) showed improved QoL in the physical composite score at all post injections visits (42.9, 44, 43.1, and 45.5 vs 40 at baseline; P < 0.05), and in the mental composite score at both 12 and 24 weeks (44.3 and 47.8 vs 38.5, P = 0.012). Vaginal manometry demonstrated significant decrease in resting pressures and in maximum contraction pressures at all follow-up visits (P < 0.05). Digital assessment of PFM (on a scale from 0 to 4) showed decreased tenderness on all visits (mean of 1.9, 1.7, 1.8, 1.9; P < 0.001) compared with baseline (2.8). Reported postinjection adverse effects included worsening of the following preexisting conditions: constipation (28.6%), stress urinary incontinence (4.8%), fecal incontinence (4.8%), and new onset stress urinary incontinence (4.8%). CONCLUSIONS Electromyography-guided Botox injection into PFM could be beneficial for women with refractory HTPFD who have failed conservative therapy.
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Lindau ST, Abramsohn EM, Baron SR, Florendo J, Haefner HK, Jhingran A, Kennedy V, Krane MK, Kushner DM, McComb J, Merritt DF, Park JE, Siston A, Straub M, Streicher L. Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist. CA Cancer J Clin 2016; 66:241-63. [PMID: 26784536 PMCID: PMC4860140 DOI: 10.3322/caac.21337] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 12/15/2022] Open
Abstract
Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society.
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Affiliation(s)
- Stacy Tessler Lindau
- Director, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
- Associate Professor, Department of Medicine-Geriatrics, University of Chicago, Chicago, IL
- MacLean Center on Clinical Medical Ethics, University of Chicago, Chicago, IL
- Associate Professor, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Emily M Abramsohn
- Researcher and Project Manager, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Shirley R Baron
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Judith Florendo
- Doctor of Physical Therapy, Florendo Physical Therapy, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Hope K Haefner
- Professor, Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI
| | - Anuja Jhingran
- Professor, Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanessa Kennedy
- Assistant Professor, Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA
| | - Mukta K Krane
- Assistant Professor, Department of Surgery, University of Washington, Seattle, WA
| | - David M Kushner
- Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jennifer McComb
- Assistant Clinical Professor, The Family Institute at Northwestern University, Evanston, IL
| | - Diane F Merritt
- Professor, Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, WA University School of Medicine, St. Louis, MO
| | - Julie E Park
- Associate Professor, Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Amy Siston
- Clinical Associate, Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL
| | - Margaret Straub
- Physician's Assistant, Radiation Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Lauren Streicher
- Associate Professor, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL
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Abdominal Wall Pain in Women With Chronic Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:154-9. [DOI: 10.1016/j.jogc.2015.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review was to assess recent research (the last 18 months) and its impact on understanding sexual pain disorders relevant to daily clinical practice. RECENT FINDINGS It has been highlighted that sexual pain is related to the number of tender points, pressure pain threshold, more deliberate fear and less global positive affective associations with sexual stimuli, episiotomy, attachment styles, drug abuse and the influence of ambivalence over emotional expression in couples.The efficacy of a multidisciplinary vulvodynia programme of treatment, another type of therapy based on the fear-avoidance and pain self-efficacy model and a novel cognitive-behavioral couple therapy has been stated. SUMMARY There is a gradual advance in the knowledge of sexual pain disorder etiology. At the same time different therapeutics strategies have been increasing, but it is necessary to introduce guidelines on the basis of the evidence to approach with efficacy this severe disorder. VIDEO ABSTRACT http://links.lww.com/YCO/A31.
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Ayorinde AA, Macfarlane GJ, Saraswat L, Bhattacharya S. Chronic pelvic pain in women: an epidemiological perspective. ACTA ACUST UNITED AC 2015; 11:851-64. [PMID: 26450216 DOI: 10.2217/whe.15.30] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic pelvic pain (CPP) is common in women of reproductive age and has a significant impact on quality of life, work efficiency and healthcare utilization. CPP can be a manifestation of many different, often multifactorial conditions, and in the absence of an identified cause, the management can be particularly challenging. High quality epidemiological studies would improve the understanding of CPP and identify risk factors which may be targeted for the development of appropriate management strategies. This review focuses on what is known about the prevalence, risk factors, individual and societal burden of CPP and outlines important management strategies.
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Affiliation(s)
- Abimbola A Ayorinde
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Gary J Macfarlane
- Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Lucky Saraswat
- Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, Scotland, UK
| | - Siladitya Bhattacharya
- Institute of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
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