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Namazi G, Chauhan N, Handler S. Myofascial pelvic pain: the forgotten player in chronic pelvic pain. Curr Opin Obstet Gynecol 2024; 36:273-281. [PMID: 38837702 DOI: 10.1097/gco.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW In this review article, we discuss myofascial-related chronic pelvic pain, pathophysiology, symptomology, and management options. RECENT FINDINGS Despite high prevalence of myofascial pelvic pain, screening is not routinely performed by providers. Treatment modalities include pelvic floor physical therapy, pelvic floor trigger point injections with anesthetics or botulinum toxin A and cryotherapy. Other adjunct modalities, such as muscle relaxants and intravaginal benzodiazepines, are used, but data regarding their effectiveness is sparse. SUMMARY Myofascial pelvic pain is an important, though overlooked component of chronic pelvic pain. Multimodal, multidisciplinary approach including patient education, pelvic floor physical therapy, and trigger point injections is the mainstay of the management of myofascial pelvic pain.
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Affiliation(s)
- Golnaz Namazi
- Minimally Invasive Gynecologic Surgery, University of California Riverside
| | - Navya Chauhan
- University of California Riverside School of Medicine
| | - Stephanie Handler
- Female Pelvic Medicine and Reconstructive Surgery, University of California Riverside, Riverside, California, USA
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Webb K, de Rijk MM, Gajewski JB, Kanai AJ, Perrouin-Verbe MA, van Koeveringe G, Wyndaele JJ, Drake MJ. Developing new ways to assess neural control of pelvic organ function in spinal conditions: ICI-RS 2023. Neurourol Urodyn 2024; 43:1431-1438. [PMID: 38048095 DOI: 10.1002/nau.25347] [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: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Several central nervous system (CNS) centers affect muscle groups of the lower urinary tract (LUT) and anorectal tract (ART) via autonomic and somatic pathways, working in different modes (storage or expulsion). Hence spinal cord dysfunction can affect the LUT and ART by several possible mechanisms. METHODS This review reports the discussions of a workshop at the 2023 meeting of the International Consultation on Incontinence Research Society, which reviewed uncertainties and research priorities of spinal dysfunction. RESULTS Discussion focussed on the levator ani nerve, mechanisms underpinning sensory function and sensation, functional imaging, dyssynergia, and experimental models. The following key research questions were identified. (1) Clinically, how can we evaluate the levator ani muscle to support assessment and identify prognosis for effective treatment selection? (2) How can we reliably measure levator ani tone? (3) How can we evaluate sensory information and sensation for the LUT and the ART? (4) What is the role of functional CNS imaging in development of scientific insights and clinical evaluation? (5) What is the relationship of detrusor sphincter dyssynergia to renal failure? CONCLUSIONS Spinal cord dysfunction can fundamentally disrupt LUT and ART function, with considerable clinical impact. The evaluation needs to reflect the full scope of potential problems, and new clinical and diagnostic approaches are needed, for prognosis and treatment. The preclinical science evaluating spinal cord function in both LUT and ART storage and elimination remains a major priority, even though it is a challenging experimental context. Without this underpinning evidence, development of new clinical evidence may be held back.
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Affiliation(s)
- Katie Webb
- Physiotherapy Department, Imperial College Healthcare Trust, St Mary's Hospital, London, UK
| | - Mathijs M de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony J Kanai
- Departments of Medicine-Renal-Electrolyte Division, and Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Gommert van Koeveringe
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK
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Torosis M, Carey E, Christensen K, Kaufman MR, Kenton K, Kotarinos R, Lai HH, Lee U, Lowder JL, Meister M, Spitznagle T, Wright K, Ackerman AL. A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction. Obstet Gynecol 2024; 143:595-602. [PMID: 38387036 PMCID: PMC10953682 DOI: 10.1097/aog.0000000000005536] [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: 09/26/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.
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Affiliation(s)
- Michele Torosis
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Erin Carey
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Kristin Christensen
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Melissa R. Kaufman
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Kimberly Kenton
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Rhonda Kotarinos
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - H. Henry Lai
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Una Lee
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Jerry L. Lowder
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Melanie Meister
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Theresa Spitznagle
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - Kelly Wright
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - A. Lenore Ackerman
- Department of Obstetrics and Gynecology and the Department of Urology, UCLA, and Cedars-Sinai Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, UNC, Chapel Hill, North Carolina; the Department of Urology, Vanderbilt, Nashville, Tennessee; the Department of Obstetrics and Gynecology, University of Chicago, Chicago, and Kotarinos Physical Therapy, Lake Zurich, Illinois; Washington University in St. Louis, the Division of Urologic Surgery, Departments of Surgery and Anesthesiology, and the Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri; the Department of Urology, Virginia Mason, Seattle, Washington; and Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
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Shetty A, Delanerolle G, Cavalini H, Deng C, Yang X, Boyd A, Fernandez T, Phiri P, Bhaskar A, Shi JQ. A systematic review and network meta-analysis of pharmaceutical interventions used to manage chronic pain. Sci Rep 2024; 14:1621. [PMID: 38238384 PMCID: PMC10796361 DOI: 10.1038/s41598-023-49761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
It is estimated 1.5 billion of the global population suffer from chronic pain with prevalence increasing with demographics including age. It is suggested long-term exposure to chronic could cause further health challenges reducing people's quality of life. Therefore, it is imperative to use effective treatment options. We explored the current pharmaceutical treatments available for chronic pain management to better understand drug efficacy and pain reduction. A systematic methodology was developed and published in PROSPERO (CRD42021235384). Keywords of opioids, acute pain, pain management, chronic pain, opiods, NSAIDs, and analgesics were used across PubMed, Science direct, ProQuest, Web of science, Ovid Psych INFO, PROSPERO, EBSCOhost, MEDLINE, ClinicalTrials.gov and EMBASE. All randomised controlled clinical trials (RCTs), epidemiology and mixed-methods studies published in English between the 1st of January 1990 and 30th of April 2022 were included. A total of 119 studies were included. The data was synthesised using a tri-partied statistical methodology of a meta-analysis (24), pairwise meta-analysis (24) and network meta-analysis (34). Mean, median, standard deviation and confidence intervals for various pain assessments were used as the main outcomes for pre-treatment pain scores at baseline, post-treatment pain scores and pain score changes of each group. Our meta-analysis revealed the significant reduction in chronic pain scores of patients taking NSAID versus non-steroidal opioid drugs was comparative to patients given placebo under a random effects model. Pooled evidence also indicated significant drug efficiency with Botulinum Toxin Type-A (BTX-A) and Ketamine. Chronic pain is a public health problem that requires far more effective pharmaceutical interventions with minimal better side-effect profiles which will aid to develop better clinical guidelines. The importance of understanding ubiquity of pain by clinicians, policy makers, researchers and academic scholars is vital to prevent social determinant which aggravates issue.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, UK.
- University College London, 235, Euston Road, London, NW1 2BU, UK.
- Pain Medicine, Cleveland Clinic London, London, United Kingdom.
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX3 7JX, UK
| | - Heitor Cavalini
- Southern Health NHS Foundation Trust, Southampton, SO40 2RZ, UK
| | - Chunli Deng
- Southern University of Science and Technology, Shenzhen, 518055, China
| | - Xiaojie Yang
- School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming, China
- National Centre for Applied Mathematics Shenzhen, Shenzhen, China
| | - Amy Boyd
- University of Oxford, Oxford, UK
| | - Tacson Fernandez
- University College London, 235, Euston Road, London, NW1 2BU, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, SO40 2RZ, UK
- Psychology Department, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Arun Bhaskar
- Imperial College Healthcare NHS Trust, London, UK
| | - Jian Qing Shi
- Southern Health NHS Foundation Trust, Southampton, SO40 2RZ, UK
- Southern University of Science and Technology, Shenzhen, 518055, China
- School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming, China
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Knapman BL, Li FG, Deans R, Nesbitt-Hawes E, Maheux-Lacroix S, Abbott J. Botulinum Toxin for the Management of Pelvic Floor Tension Myalgia and Persistent Pelvic Pain: A Systematic Review and Meta-analysis. Obstet Gynecol 2024; 143:e7-e17. [PMID: 37797336 DOI: 10.1097/aog.0000000000005388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/29/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To systematically review the literature on use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. DATA SOURCES The ClinicalTrials.gov , PubMed, EMBASE, and Scopus databases were searched from inception to November 2022 by two independent assessors (B.L.K. and F.G.L.). Identified studies were screened by title and abstract and included after full-text review. Data extraction was subsequently performed and recorded in Microsoft Excel. METHODS This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration in PROSPERO (CRD42022289132). All randomized studies, prospective studies with more than five participants, and retrospective studies with more than 10 participants published in English or French and assessing the use of botulinum toxin for the treatment of pelvic floor tension myalgia and persistent pelvic pain in women were included. Meta-analyses were performed on randomized data. TABULATION, INTEGRATION, AND RESULTS Of 4,722 articles identified, 24 satisfied inclusion criteria. A meta-analysis of five randomized controlled trials totaling 329 participants demonstrated no differences in patient- and clinician-reported outcome measures, including pain, dyspareunia, sexual function, and vaginal manometry. Mean duration of follow-up was 6 months. A qualitative analysis of 14 prospective and four retrospective studies including 804 participants is supportive of botulinum toxin; however, the quality of data is low, and there is marked heterogeneity between studies. CONCLUSION Meta-analyses of randomized data do not support the use of botulinum toxin to treat pelvic floor tension myalgia and persistent pelvic pain. Failure of these data to confirm the findings of nonrandomized prospective studies that suggest a treatment benefit may be attributable to the absence of placebo control and confounding outcomes obtained from an active comparator group. Further randomized controlled trials with true placebo are strongly recommended. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022289132.
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Affiliation(s)
- Blake Lawson Knapman
- University of New South Wales, Sydney, New South Wales, Australia; and Université Laval, Québec City, Québec, Canada
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Morsy H, Meister M, Spitznagle T, Scott C, Zhang T, Ghetti C, Chu C, Sutcliffe S, Lowder JL. A Pilot Randomized Controlled Trial of Vaginal Cryotherapy for the Treatment of Pelvic Floor Myofascial Pain. Int Urogynecol J 2024; 35:215-225. [PMID: 38133837 PMCID: PMC11232877 DOI: 10.1007/s00192-023-05692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor myofascial pain (PFMP) is a common but underrecognized component of chronic pelvic pain and pelvic floor disorders symptoms with limited, well-studied treatment modalities. Our objective was to determine the effect of vaginal cryotherapy on PFMP with palpation. METHODS Following a standardized PFMP screening examination, individuals with a pain score ≥4/10 in ≥1 of four muscle groups were invited to participate in a randomized controlled trial comparing patients undergoing vaginal cryotherapy with controls. Participants in both arms could choose to participate in a single in-office treatment; a 2-week, at-home daily treatment; or both. RESULTS Between March 2019 and September 2021, a total of 163 participants were enrolled and randomized: 80 to cryotherapy, and 83 to the control group. Sixty-three (28 cryotherapy; 35 controls) completed in-office treatment and 56 (32 cryotherapy; 24 controls) completed at-home therapy. In the in-office comparison, mean pain scores decreased significantly in both arms: cryotherapy (5.13 vs 4.10; p=0.02) and controls (5.60 vs 4.72; p<0.01), with a similar magnitude of reduction between arms (p=0.75). In the at-home comparison, mean pain scores decreased significantly in the cryotherapy arm (6.34 vs 4.75; p<0.01), and nonsignificantly in the control arm (5.41 vs 4.66; p=0.07), resulting in a nonsignificant difference between arms (p=0.14). CONCLUSIONS Pelvic floor myofascial pain with palpation improved following both a single cryotherapy session and 2 weeks of daily cryotherapy. Interestingly, pain scores also improved with room temperature therapy. Whether these findings reflect a therapeutic effect of both cold and room temperature intravaginal therapy or a placebo effect is unclear but should be explored in larger studies.
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Affiliation(s)
- Haidy Morsy
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA
- Geisinger, Wilkes Barre, PA, USA
| | - Melanie Meister
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Carter Scott
- Oregon Health Sciences University, Portland, OR, USA
| | - Tianyi Zhang
- Brown School, Washington University, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, MO, USA
| | - Chiara Ghetti
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA
| | - Christine Chu
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Siobhan Sutcliffe
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, MO, USA
| | - Jerry L Lowder
- Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, MSC 8064-37-1005, 4901 Forest Park Avenue, COH, 10th Floor, St. Louis, MO, 63108, USA.
- Department of Surgery, Division of Public Health Sciences, Washington University, St. Louis, MO, USA.
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Etrusco A, Geru M, Laganà AS, Chiantera V, Giannini A, Buzzaccarini G. Use of botulinum toxin in aesthetic medicine and gynaecology: current approaches, controversies, and future directions. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2023; 22:155-160. [PMID: 37829261 PMCID: PMC10566329 DOI: 10.5114/pm.2023.131457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/06/2023] [Indexed: 10/14/2023]
Abstract
This review looks at the use of botulinum toxin in the gynaecological field with the aim of determining what needs to be further investigated to achieve a standardized application. Numerous studies have been conducted to explore how botulinum toxins (BoNT) can be applied, and it is becoming popular for treating various disorders such as chronic pelvic pain, vestibulodynia, and vaginism. However, the exact dosage and ideal location for injections still need to be clarified. The objective of this study is to point out which aspects need to be more carefully studied to ensure a consistent use of BoNT in gynaecology.
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Affiliation(s)
- Andrea Etrusco
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Maurina Geru
- Department of Women’s and Children’s Health, Gynaecology and Obstetrics Clinic, University of Padua, Padua, Italy
| | - Antonio Simone Laganà
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, Rome, Italy
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Villa-Muñoz P, Albaladejo-Belmonte M, Nohales-Alfonso FJ, Alberola-Rubio J, Garcia-Casado J. Treatment of Vestibulodynia with Submucosal Injections of IncobotulinumtoxinA into Targeted Painful Points: An Open-Label Exploratory Study. Toxins (Basel) 2023; 15:476. [PMID: 37624233 PMCID: PMC10467121 DOI: 10.3390/toxins15080476] [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: 05/30/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
The studies carried out to date on vulvodynia treatment with botulinum neurotoxin type A (BoNT/A) have followed generic injection protocols and reported contradictory outcomes on its effects. The aim of the present study was thus to propose a protocol for injecting BoNT/A into targeted painful points, to comprehensively assess the clinical effect of BoNT/A treatment and identify the risk/protective factors for successful treatment. Thirty-five vestibulodynia patients were treated with submucosal injections of incobotulinumtoxinA and assessed 8, 12 and 24 weeks after their treatment. Their clinical and pelvic statuses were assessed from self-reported questionnaires (Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI), Marinoff's Dyspareunia Scale (MDS), Hospital Anxiety and Depression Scale (HADS), Catastrophizing Scale (CS)), physical examinations and surface electromyography (sEMG). The patients reported a reduction in provoked vestibulodynia ( FSFI, p < 0.01;
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Affiliation(s)
- Paula Villa-Muñoz
- Servicio De Ginecología Y Obstetricia, Hospital Universitari I Politècnic La Fe, 46026 Valencia, Spain; (P.V.-M.); (F.J.N.-A.)
| | - Monica Albaladejo-Belmonte
- Centro De Investigación E Innovación En Bioingeniería (CI2B), Universitat Politècnica De València, 46022 Valencia, Spain;
| | - Francisco J. Nohales-Alfonso
- Servicio De Ginecología Y Obstetricia, Hospital Universitari I Politècnic La Fe, 46026 Valencia, Spain; (P.V.-M.); (F.J.N.-A.)
| | | | - Javier Garcia-Casado
- Centro De Investigación E Innovación En Bioingeniería (CI2B), Universitat Politècnica De València, 46022 Valencia, Spain;
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9
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Lewis GK, Chen AH, Craver EC, Crook JE, Carrubba AR. Trigger point injections followed by immediate myofascial release in the treatment of pelvic floor tension myalgia. Arch Gynecol Obstet 2023; 307:1027-1035. [PMID: 36513896 DOI: 10.1007/s00404-022-06880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Pelvic floor physical therapy (PFPT) is first-line therapy for treatment of pelvic floor tension myalgia (PFTM). Pelvic floor trigger point injections (PFTPI) are added if symptoms are refractive to conservative therapy or if patients experience a flare. The primary objective was to determine if a session of physical therapy with myofascial release immediately following PFTPI provides improved pain relief compared to trigger point injection alone. METHODS This was a retrospective cohort analysis of 87 female patients with PFTM who underwent PFTPI alone or PFTPI immediately followed by PFPT. Visual analog scale (VAS) pain scores were recorded pre-treatment and 2 weeks post-treatment. The primary outcome was the change in VAS between patients who received PFTPI alone and those who received PFTPI followed by myofascial release. RESULTS Of the 87 patients in this study, 22 received PFTPI alone and 65 patients received PFTPI followed by PFPT. The median pre-treatment VAS score was 8 for both groups. The median post-treatment score was 6 for the PFTPI only group and 4 for the PFTPI followed by PFPT group, showing a median change in VAS score of 2 and 4, respectively (p = 0.042). Seventy-seven percent of patients in the PFTPI followed by PFPT group had a VAS score improvement of 3 or more, while 45% of patients in the PFTPI only group had a VAS score improvement greater than 3 (p = 0.008). CONCLUSION PFTPI immediately followed by PFPT offered more improvement in pain for patients with PFTM. This may be due to greater tolerance of myofascial release immediately following injections.
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Affiliation(s)
- Gregory K Lewis
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA.
| | - Anita H Chen
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA
| | - Emily C Craver
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Julia E Crook
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Aakriti R Carrubba
- Department of Medical and Surgical Gynecology, Mayo Clinic, 4500 San Pablo South Road, Jacksonville, FL, 32224, USA
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10
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Myofascial Pelvic Pain: Best Orientation and Clinical Practice. Position of the European Association of Urology Guidelines Panel on Chronic Pelvic Pain. Eur Urol Focus 2023; 9:172-177. [PMID: 35945131 DOI: 10.1016/j.euf.2022.07.007] [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: 03/15/2022] [Revised: 06/20/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT Despite the high prevalence of a myofascial pain component in chronic pelvic pain (CPP) syndromes, awareness and management of this component are lacking among health care providers. OBJECTIVE To summarize the current state of the art for the management of myofascial pain in chronic primary pelvic pain syndromes (CPPPS) according to scientific research and input from experts from the European Association of Urology (EAU) guidelines panel on CPP. EVIDENCE ACQUISITION A narrative review was undertaken using three sources: (1) information in the EAU guidelines on CPP; (2) information retrieved from the literature on research published in the past 3 yr on myofascial pelvic pain; and (3) expert opinion from panel members. EVIDENCE SYNTHESIS Studies confirm a high prevalence of a myofascial pain component in CPPPS. Examination of the pelvic floor muscles should follow published recommendations to standardize findings and disseminate the procedure. Treatment of pelvic floor muscle dysfunction and pain in the context of CPP was found to contribute to CPP control and is feasible via different physiotherapy techniques. A multidisciplinary approach is the most effective. CONCLUSIONS Despite its high prevalence, the myofascial component of CPP has been underevaluated and undertreated to date. Myofascial pain must be assessed in all patients with CPPPS. Treatment of the myofascial pain component is relevant for global treatment success. Further studies are imperative to reinforce and better define the role of each physiotherapy technique in CPPPS. PATIENT SUMMARY Pain and inflammation of the body's muscle and soft tissues (myofascial pain) frequently occurs in pelvic pain syndromes. Its presence must be evaluated to optimize management for each patient. If diagnosed, myofascial pain should be treated.
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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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12
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Spruijt MA, Klerkx WM, Kelder JC, Kluivers KB, Kerkhof MH. The efficacy of botulinum toxin a injections in pelvic floor muscles in chronic pelvic pain patients: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:2951-2961. [PMID: 35362767 PMCID: PMC9569307 DOI: 10.1007/s00192-022-05115-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022]
Abstract
Introduction and hypothesis Chronic pelvic pain (CPP) is a common multifactorial condition affecting 6 to 27% of women aged 18–50 years worldwide. This study was conducted to review and meta-analyse the current literature on the reduction of chronic pelvic pain after botulinum toxin A (BTA) injection. Method In July 2021 we performed a systematic search in PubMed and EMBASE to assess the benefits of BTA injection in pelvic floor muscles in women with chronic pelvic pain. Primary outcome was reduction in visual analogue scale (VAS) after treatment. Secondary outcomes evaluated were: reduction of dyspareunia, pelvic floor resting pressure and quality of life. Identified reports were assessed on quality of reporting and risk of bias. Standardized mean difference (SMD) was used to combine and analyse outcomes of the included studies. Results Eight studies with 289 participants were considered eligible to be included in this systematic review and meta-analysis. After recalculating SMD into VAS scores (0–100), long-term follow-up (24–26 weeks) showed a significant 15-point improvement in VAS scores (95% CI: 8.8–21.5) for non-menstrual pelvic pain and a 13-point improvement (95% CI: 2.1–24.0) for dyspareunia. BTA injection had a significant effect on pelvic floor resting pressure and quality of life. Conclusion There is limited scientific evidence on the effectiveness of BTA injections in pelvic floor muscles in women with chronic pelvic pain. The available studies show that BTA injections significantly reduce pain levels and improve quality of life at 6 months follow-up. Prospero ID CRD42018105204.
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Affiliation(s)
- Melle A Spruijt
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands. .,Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Wenche M Klerkx
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands
| | - Johannes C Kelder
- Department of Epidemiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Manon H Kerkhof
- Department of Gynaecology and Reconstructive pelvic surgery, Curilion Women's Health Clinic, Haarlem, The Netherlands
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13
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Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy. J Pers Med 2022; 12:jpm12010101. [PMID: 35055416 PMCID: PMC8779548 DOI: 10.3390/jpm12010101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Although several treatments are currently available for chronic pelvic pain, 30–60% of patients do not respond to them. Therefore, these therapeutic options require a better understanding of the mechanisms underlying endometriosis-induced pain. This study focuses on pain management after failure of conventional therapy. Methods: We reviewed clinical data from 46 patients with endometriosis and chronic pelvic pain unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain from 2018 to 2021. Demographic data, clinical and exploratory findings, treatment received, and outcomes were collected. Results: Median age was 41.5 years, and median pain intensity was VAS: 7.8/10. Nociceptive pain and neuropathic pain were identified in 98% and 70% of patients, respectively. The most common symptom was abdominal pain (78.2%) followed by pain with sexual intercourse (65.2%), rectal pain (52.1%), and urologic pain (36.9%). A total of 43% of patients responded to treatment with neuromodulators. Combined therapies for myofascial pain syndrome, as well as treatment of visceral pain with inferior or superior hypogastric plexus blocks, proved to be very beneficial. S3 pulsed radiofrequency (PRF) plus inferior hypogastric plexus block or botulinum toxin enabled us to prolong response time by more than 3.5 months. Conclusion: Treatment of the unresponsive patient should be interdisciplinary. Depending on the history and exploratory findings, therapy should preferably be combined with neuromodulators, myofascial pain therapies, and S3 PRF plus inferior hypogastric plexus blockade.
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14
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Kapurubandara SC, Lowes B, Sansom-Daly UM, Deans R, Abbott JA. A systematic review of diagnostic tests to detect pelvic floor myofascial pain. Int Urogynecol J 2022; 33:2379-2389. [PMID: 35796787 PMCID: PMC9427874 DOI: 10.1007/s00192-022-05258-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Myofascial pain arising from pelvic floor muscles occurs in women with vaginismus, interstitial cystitis and endometriosis but is often overlooked. The aim is to examine alternative diagnostic tests to detect pelvic floor myofascial pain compared with standardized vaginal palpation of pelvic floor muscles as the reference test. METHODS A systematic review was prospectively conducted (PROSPERO-CRD42020183092) according to PRISMA guidelines. Databases searched included Ovid Medline 1946-, Embase 1957-, Scopus 1960-, Cochrane Combined, Clinical trials, Google Scholar (top 200 articles), Web of Science, TRIP, BIOSIS, DARE, CINHAL, EmCare, PEDro, ProQuest and EBSCOhost up to July 2020. Articles were independently screened by two authors and assessed for bias using QUASDAS-2 tool. RESULTS A total of 26,778 articles were screened and 177 were selected for full text review, of which 5 were selected for final analysis. Five studies included 9694 participants of which 1628 had pelvic floor myofascial pain. Only one study reported data to calculate sensitivities and specificities of the index test, which utilized a score of > 40 on the Central Sensitization Inventory to detect women with pelvic floor myofascial pain and revealed a sensitivity of 34.8% and a specificity of 84.9% compared to the reference test. CONCLUSIONS This systematic review did not reveal any diagnostic test superior to the pre-defined reference test. There is a lack of consensus on the definition of pelvic floor myofascial pain and a lack of a validated diagnostic criteria which must be addressed to progress with meaningful research in this field.
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Affiliation(s)
- Supuni C. Kapurubandara
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Obstetrics and Gynaecology, Level 1, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW 2031 Australia ,Department of O&G, Westmead Hospital, Sydney, Australia ,Sydney West Advanced Pelvic Surgical Unit, SWAPS, Sydney, Australia
| | - Basia Lowes
- Sydney West Advanced Pelvic Surgical Unit, SWAPS, Sydney, Australia ,Western Sydney University, Sydney, Australia ,Department of O&G, Blacktown Hospital, Sydney, Australia
| | - Ursula M. Sansom-Daly
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Obstetrics and Gynaecology, Level 1, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW 2031 Australia ,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Sydney, Australia ,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Obstetrics and Gynaecology, Level 1, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW 2031 Australia ,GRACE Unit, Royal Hospital for Women, Sydney, Australia
| | - Jason A. Abbott
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Obstetrics and Gynaecology, Level 1, Royal Hospital for Women, Barker Street, Randwick, Sydney, NSW 2031 Australia ,GRACE Unit, Royal Hospital for Women, Sydney, Australia
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Tarazona-Motes M, Albaladejo-Belmonte M, Nohales-Alfonso FJ, De-Arriba M, Garcia-Casado J, Alberola-Rubio J. Treatment of Dyspareunia with Botulinum Neurotoxin Type A: Clinical Improvement and Influence of Patients' Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8783. [PMID: 34444532 PMCID: PMC8393724 DOI: 10.3390/ijerph18168783] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022]
Abstract
The treatment of chronic pelvic pain (CPP) with botulinum neurotoxin type A (BoNT/A) has increased lately, but more studies assessing its effect are needed. This study aimed to evaluate the evolution of patients after BoNT/A infiltration and identify potential responders to treatment. Twenty-four women with CPP associated with dyspareunia were treated with 90 units of BoNT/A injected into their pelvic floor muscle (PFM). Clinical status and PFM activity were monitored in a previous visit (PV) and 12 and 24 weeks after the infiltration (W12, W24) by validated clinical questionnaires and surface electromyography (sEMG). The influence of patients' characteristics on the reduction in pain at W12 and W24 was also assessed. After treatment, pain scores and the impact of symptoms on quality of life dropped significantly, sexual function improved and sEMG signal amplitude decreased on both sides of the PFM with no adverse events. Headaches and bilateral pelvic pain were risk factors for a smaller pain improvement at W24, while lower back pain was a protective factor. Apart from reporting a significant clinical improvement of patients with CPP associated with dyspareunia after BoNT/A infiltration, this study shows that clinical characteristics should be analyzed in detail to identify potential responders to treatment.
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Affiliation(s)
- Marta Tarazona-Motes
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe de Valencia, 46026 Valencia, Spain; (M.T.-M.); (F.J.N.-A.); (M.D.-A.)
| | - Monica Albaladejo-Belmonte
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Edif. 8B, Camino de Vera SN, 46022 Valencia, Spain; (M.A.-B.); (J.G.-C.)
| | - Francisco J. Nohales-Alfonso
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe de Valencia, 46026 Valencia, Spain; (M.T.-M.); (F.J.N.-A.); (M.D.-A.)
| | - Maria De-Arriba
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe de Valencia, 46026 Valencia, Spain; (M.T.-M.); (F.J.N.-A.); (M.D.-A.)
| | - Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Edif. 8B, Camino de Vera SN, 46022 Valencia, Spain; (M.A.-B.); (J.G.-C.)
| | - Jose Alberola-Rubio
- Unidad de Bioelectrónica, Procesamiento de señales y Algoritmia, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
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