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Sandrieser L, Heine J, Bekos C, Perricos-Hess A, Wenzl R, Husslein H, Kuessel L. Evaluating the Correlation between Myofascial Pelvic Pain and Female Sexual Function: A Prospective Pilot Study. J Clin Med 2024; 13:4604. [PMID: 39200746 PMCID: PMC11354640 DOI: 10.3390/jcm13164604] [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: 07/04/2024] [Revised: 07/25/2024] [Accepted: 08/04/2024] [Indexed: 09/02/2024] Open
Abstract
Introduction: Myofascial pelvic pain (MFPP) is a prevalent yet frequently overlooked condition characterized by myofascial trigger points located within the pelvic floor muscles. Women with MFPP often experience severely reduced quality of life due to impaired sexual health. Here, we examined the relationship between MFPP and sexual function. Materials and Methods: Eighty-three women with a benign gynecological condition were included in this pilot study. For each patient, we obtained a complete medical history, measured different types of subjective pain intensity using a visual analog scale, performed a validated standardized examination of the pelvic floor muscles for measuring MFPP, and used the German Female Sexual Function Index (FSFI-d) questionnaire. Results: Compared to women without MFPP (46 out of 83; 55.4%), the women with MFPP (37 out of 83; 44.6%) reported experiencing pain on more days per month (8 vs. 3 days/month; p = 0.002) and higher median VAS scores for dyspareunia (4 vs. 0; p < 0.001). We also found a significant inverse correlation between the severity of MFPP and overall FSFI-d scores (r = -0.35; p < 0.001), particularly in the FSFI-d subdomains of pain (r = -0.364; p < 0.001), lubrication (r = -0.230; p = 0.005), and arousal (r = -0.360; p < 0.001). Conclusions: Due to the higher prevalence of dyspareunia and pelvic pain, MFPP significantly impacts several aspects of female sexual health and function. This information, combined with increased awareness regarding MFPP, may provide a foundation for designing individualized therapies, thereby improving the quality of life of women affected by MFPP.
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Affiliation(s)
| | | | | | | | | | | | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (L.S.); (J.H.); (C.B.); (A.P.-H.); (R.W.); (H.H.)
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2
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Li D, Li M, Wu G, Wu L, Ma Y, Zhang X. Evaluating the Effectiveness of Radiofrequency Therapy and Manual Pelvic Fascial Release in Treating Myofascial Pelvic Pain. Int Urogynecol J 2024; 35:1219-1225. [PMID: 38722560 DOI: 10.1007/s00192-024-05763-x] [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: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Myofascial pelvic pain (MFPP), characterized by sensitive trigger points in the pelvic floor muscles, leads to chronic pain and affects various aspects of life. Despite the availability of different treatment modalities, there is limited comparative research on their effectiveness. This study compares radiofrequency (RF) therapy and myofascial manual therapy (MMT) in treating MFPP. We aimed to evaluate pelvic floor muscle strength changes, clinical symptoms, and patient comfort during treatment. METHODS The study involved 176 participants, divided equally into RF and MMT groups. We assessed pelvic floor pain using the Visual Analogue Scale (VAS), muscle strength using the Modified Oxford Scale (MOS) and surface electromyography (sEMG), clinical symptom improvement through questionnaires, and patient discomfort during treatment. RESULTS Both RF and MMT groups significantly reduced pelvic floor and paraurethral muscle pain (VAS scores, p < 0.001). RF treatment significantly decreased vaginal laxity in its group (p < 0.001), with no notable change in the MMT group (p = 0.818). RF therapy also resulted in greater patient comfort than MMT (p < 0.001). Although both treatments improved clinical symptoms, there was no significant difference between the two (p = 0.692). MOS scores and pelvic floor sEMG values showed no significant differences between the groups before and after treatment (p > 0.05). CONCLUSIONS Both RF and MMT effectively alleviate pelvic floor pain and improve clinical symptoms in MFPP patients. RF therapy, however, offers additional benefits in reducing vaginal laxity and enhancing treatment comfort.
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Affiliation(s)
- Dan Li
- Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, People's Republic of China
| | - Meng Li
- Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, People's Republic of China
| | - Guangping Wu
- Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Lan Wu
- Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, People's Republic of China
| | - Yuejuan Ma
- Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, People's Republic of China
| | - Xinwen Zhang
- Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, People's Republic of China.
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Zhu M, Huang F, Xu J, Zhou Q, Ding B, Shen Y. Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome. Open Med (Wars) 2024; 19:20240936. [PMID: 38841178 PMCID: PMC11151395 DOI: 10.1515/med-2024-0936] [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: 08/21/2023] [Revised: 02/06/2024] [Accepted: 02/25/2024] [Indexed: 06/07/2024] Open
Abstract
The objective of this study was to evaluate the efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome (CPPS). A total of 79 female patients diagnosed with CPPS from January 2021 to December 2022 were prospectively analyzed. Every patient received 3 weeks of treatment which included myofascial release therapy combined with electrical and magnetic stimulation. The visual analog score (VAS) of pelvic floor muscle (PFM) trigger points (TrPs) and the changes in pelvic floor surface electromyography before and after treatment were compared. Multiple linear regression was used to analyze the influencing factors of each outcome index. There were significant differences in VASs of muscle TrPs before and after treatment (P < 0.05). For the surface electromyography of PFMs, the differences in pre-baseline rest, post-baseline rest, isometric contractions for muscle endurance evaluation, and coefficient of variation were statistically significant (P < 0.05). Linear regression analysis showed that disease course (X 1), dyspareunia (X 5), and urinary incontinence (X 6) were influencing factors for the decline of pre-baseline rest (r5 = 1.067, R 2 = 0.089), post-baseline rest (r1 = 0.055, r5 = 0.99, R 2 = 0.119), VASs of ischial spine (r5 = 0.916, R 2 = 0.102), obturator internus (r5 = 0.796, r6 = -0.703, R 2 = 0.245), and pubococcygeus (r5 = 0.885, R 2 = 0.149) after treatment in the CPPS group. This study confirmed that individualized myofascial release therapy combined with electrical and magnetic stimulation has significant efficacy for patients with CPPS. At the same time, it is more effective for CPPS patients with longer course of disease, dyspareunia, and without urinary incontinence.
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Affiliation(s)
- Mingyue Zhu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing210009, Jiangsu, China
| | - Fei Huang
- Department of Rehabilitation Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing210009, Jiangsu, China
| | - Jingyun Xu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing210009, Jiangsu, China
| | - Qing Zhou
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing210009, Jiangsu, China
| | - Bo Ding
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing210009, Jiangsu, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing210009, Jiangsu, China
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Khasanah N, Peng CW, Fang JJ, Rahman MN, Sulistiawan D, Chin HY. Pain in the enthesis of levator ani muscle: A novel source of chronic pelvic pain. J Chin Med Assoc 2024; 87:505-510. [PMID: 38551348 DOI: 10.1097/jcma.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Managing chronic pelvic pain (CPP) remains a challenge due to its diverse range of causes. A newly identified anatomical entity known as the enthesis of the levator ani muscle (LAM) and its associated disorders might play a role. This paper describes a novel insight into CPP's origin, aiming to improve accurate diagnosis and treatment. METHODS Data were collected from medical records (paper or electronic) retrospectively. The study included 112 patients meeting the criteria, divided into CPP and non-CPP groups. Clinical symptoms, including location of LAM enthesis, referred pain from pain in LAM enthesis, and related lower urinary tract symptoms (LUTSs) were discussed. To identify differences in symptoms between the groups, a Chi-squared test and descriptive analyses were conducted. RESULTS Bimanual examination revealed tender sites in the attachment of the LAM to the pubic bone. LAM enthesis pain presumably caused referred pain in at least 10 areas, primarily in the lower abdominal quadrate (40.2%-47.3%) followed by the inguinal area (8.9%-15.1%). Multiple LUTSs were observed, including urinary frequency (72.3%), urgency (42.9%), nocturia (53.6%), residual urine sensation (64.3%), urinary incontinence (30.3%), painful bladder (34.8%), and weak urine stream (47.9%). Patients in the CPP groups experienced significant residual urine sensation (53.6%) and bearing-down sensation (42%) compared to the non-CPP group. CONCLUSION Pain in LAM enthesis is a novel cause of pelvic pain and LUTSs that warrants attention for the evaluation and management of CPP.
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Affiliation(s)
- Nurida Khasanah
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan, ROC
- Faculty of Medicine Public Health and Nursing, Department of Obstetrics and Gynecology, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Chih-Wei Peng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan, ROC
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan, ROC
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
- Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan, ROC
| | - Jessica Jay Fang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Muhammad Nurhadi Rahman
- Faculty of Medicine Public Health and Nursing, Department of Obstetrics and Gynecology, Universitas Gadjah Mada-Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | - Dedik Sulistiawan
- School of Public Health, Taipei Medical University, Taipei, Taiwan, ROC
- Departement of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Hung-Yen Chin
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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Ye J, Fei H, Du J, Liu Y, He J, Li M, He Y, Ren P, Li J, Xu Y, Li J, Wang P, Zhang X, Li T. Exploring transvaginal sonographic characteristics of the levator ani muscle in women with postpartum pelvic floor myofascial pain. BMC Womens Health 2024; 24:245. [PMID: 38637819 PMCID: PMC11025161 DOI: 10.1186/s12905-024-03052-9] [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: 01/20/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Pelvic floor myofascial pain is one of the pelvic floor dysfunction diseases disturbing women after delivery. There is a lack of objective standardization for the diagnosis of pelvic floor myofascial pain due to the various symptoms and the dependence on the palpating evaluation. Ultrasound imaging has the advantages of safety, simplicity, economy and high resolution, which makes it an ideal tool for the assistant diagnosis of pelvic floor myofascial pain and evaluation after treatment. METHODS This is a retrospective case-control study including women accepting evaluation of pelvic floor function at 6 weeks to 1 year postpartum. They were divided into pelvic floor myofascial pain group and normal control group. A BCL 10-5 biplane transducer was applied to observed their puborectalis. The length, minimum width, area, deficiency, deficiency length, deficiency width, deficiency area, rate of deficiency area, local thickening,angle between the tendinous arch of levator ani muscle and puborectalis of corresponding puborectalis in different groups were observed and measured. RESULTS A total of 220 postpartum women participated in the study, with 77 in the pelvic floor myofascial pain group and 143 in the normal control group. The Intraclass correlation coefficient value was over 0.750, and Kappa ranged from 0.600 to 0.800. puborectalis deficiency (adjusted odds ratio = 11.625, 95% confidence interval = 4.557-29.658) and focal thickening (adjusted odds ratio = 16.891, 95% confidence interval = 1.819-156.805) were significantly associated with higher odds of having postpartum pelvic floor myofascial pain. Grayscale or the angle between the arch tendineus levator ani and puborectalis measurements on the pain side tended to be smaller than on the non-pain side in patients with unilateral puborectalis or iliococcygeus pain (P < 0.05). CONCLUSIONS This study demonstrated that transvaginal ultrasound was a potentially efficient technique for evaluating postpartum pelvic floor myofascial pain due to its ability to assess various sonographic characteristics of the levator ani muscles.
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Affiliation(s)
- Juntong Ye
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Hui Fei
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Jingran Du
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yun Liu
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Juan He
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Mengxiong Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yunxia He
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Pinyu Ren
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Juanhua Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Yang Xu
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Jing Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China
| | - Pu Wang
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China.
| | - Xinling Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong Province, Guangzhou, China.
| | - Tian Li
- The Pelvic Floor Disorder Center, Obstetrics and Gynecology Department, The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Province, Shenzhen, China.
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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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Merli CEM, Cetera GE, Caia C, Facchin F, Vercellini P. "The sound of silence" Giving voice to endometriosis-related positional dyspareunia. Arch Gynecol Obstet 2024; 309:887-893. [PMID: 37689593 DOI: 10.1007/s00404-023-07205-3] [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: 05/10/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients' understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue.
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Affiliation(s)
- Camilla Erminia Maria Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy.
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Messelink B, Flink I, Dos Santos A, Adamse C. Chronic pelvic pain; more than just the bladder. Curr Opin Urol 2024; 34:69-76. [PMID: 37823725 DOI: 10.1097/mou.0000000000001134] [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: 10/13/2023]
Abstract
PURPOSE OF REVIEW Chronic pelvic pain is much of a burden to those who suffer from it. Additionally, in many patients medical doctors, such as urologists are unable to identify a cause or clear pathology that can explain the pain. Still numerous patients and doctors keep on searching for a cause, focussing particularly on the pelvic organs. Lots of diagnostics and treatment methods are used but often without success. In recent years, we have gained increased insight into the mechanisms of pain and adapted the terminology accordingly. RECENT FINDINGS Two aspects of chronic pelvic pain have gained more attention. First, the myofascial aspects, especially the role of the pelvic floor muscles in maintaining the pain and as a therapeutic option. Second, the role of the brain and the psychological aspects intertwine with the pain and its consequences also open up for alternative management options. In terminology chronic pain is now included in the ICD-11, a historical change. Introducing chronic primary pain (no cause found) helps us to look away from the organ and deal with the patient as a whole human being. SUMMARY The findings reported here are helpful for your daily practice. Looking from a broad perspective gives the patient the feeling of being seen and heard. Working together in a multidisciplinary team makes your work easier and gives more satisfaction. VIDEO ABSTRACT http://links.lww.com/COU/A44.
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Affiliation(s)
- Bert Messelink
- Medical Centre Leeuwarden, Department of Urology, Leeuwarden, The Netherlands
| | - Ida Flink
- Karlstad University, Karlstad, Sweden
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Bağcıer F, Yurdakul OV, Deniz G, Akbulut A, Çelik Y, Temel MH. Is Dry Needling Treatment an Extra Contribution to Conventional Treatment for Hemiplegic Shoulder Pain? A Prospective, Randomized Controlled Study. Med Acupunct 2023; 35:236-245. [PMID: 37900876 PMCID: PMC10606952 DOI: 10.1089/acu.2023.0060] [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: 10/31/2023] Open
Abstract
Objective This research was conducted to evaluate the effect of adding dry needling (DN) treatment to conventional rehabilitation for pain, range of motion (ROM), and functionality in patients with hemiplegic shoulder pain (HSP). Materials and Methods Patients with HSP (n = 38) were divided into 2 groups. A multimodal rehabilitation protocol, including physical therapy and exercise treatments, was given to both groups (5 sessions per week for 15 sessions). In addition to this rehabilitation, 3 sessions of DN therapy were given to one of the 2 groups. Measurements were a visual analogue scale; ROM; and 2 other scales (Quick Disability of the Arm, Shoulder, Hand; and the Fugl-Meyer Assessment Upper Extremity). Evaluations were made before, after, and at the third month after treatment. Results While a statistically significant improvement was seen in both groups in all parameters after their treatments, a statistical superiority was found in the conventional treatment+DN group (P < 0.05). However, the differences were not greater than the minimal clinically important difference values (MCID). At the 3rd month follow-up, there was no difference in pain and functionality parameters between the groups, while flexion and abduction measurements were higher in the conventional treatment+DN group (P < 0.05). Conclusions Adding DN treatment to conventional rehabilitation did not show any difference except in some joint ROM measurements in the subacute time. Although the changes found were statistically significant, they were not clinically significant as they did not reach MCID values.This study was registered prospectively at ClinicalTrials.gov (ref. no: NCT04790071).
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Affiliation(s)
- Fatih Bağcıer
- Clinic of Physical Medicine and Rehabilitation, Çam and Sakura City Hospital, İstanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bezmialem University İstanbul, Turkey
| | - Gamze Deniz
- Department of Physiotherapy and Rehabilitation, Biruni University Physiotherapy High School, Istanbul, Turkey
| | - Ahmet Akbulut
- Department of Physiotherapy and Rehabilitation, Biruni University Physiotherapy High School, Istanbul, Turkey
| | - Yusuf Çelik
- Department of Biostatistics, Biruni University, Faculty of Education, Istanbul, Turkey
| | - Mustafa Hüseyin Temel
- Clinic of Physical Medicine and Rehabilitation, Üsküdar State Hospital, İstanbul, Turkey
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Cetera GE, Merli CEM, Facchin F, Viganò P, Pesce E, Caprara F, Vercellini P. Non-response to first-line hormonal treatment for symptomatic endometriosis: overcoming tunnel vision. A narrative review. BMC Womens Health 2023; 23:347. [PMID: 37391793 PMCID: PMC10311799 DOI: 10.1186/s12905-023-02490-1] [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: 02/27/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
One-fourth to one-third of women with endometriosis receiving first-line hormonal treatment lacks an adequate response in terms of resolution of painful symptoms. This phenomenon has been ascribed to "progesterone resistance", an entity that was theorized to explain the gap between the ubiquity of retrograde menstruation and the 10% prevalence of endometriosis among women of reproductive age.Nevertheless, the hypothesis of progesterone resistance is not free of controversies. As our understanding of endometriosis is increasing, authors are starting to set aside the traditionally accepted tunnel vision of endometriosis as a strictly pelvic disease, opening to a more comprehensive perspective of the condition. The question is: are patients not responding to first-line treatment because they have an altered signaling pathway for such treatment, or have we been overlooking a series of other pain contributors which may not be resolved by hormonal therapy?Finding an answer to this question is evermore impelling, for two reasons mainly. Firstly, because not recognizing the presence of further pain contributors adds a delay in treatment to the already existing delay in diagnosis of endometriosis. This may lead to chronicity of the untreated pain contributors as well as causing adverse consequences on quality of life and psychological health. Secondly, misinterpreting the consequences of untreated pain contributors as a non-response to standard first-line treatment may imply the adoption of second-line medical therapies or of surgery, which may entail non-negligible side effects and may not be free of physical, psychological and socioeconomic repercussions.The current narrative review aims at providing an overview of all the possible pain contributors in endometriosis, ranging from those strictly organic to those with a greater neuro-psychological component. Including these aspects in a broader psychobiological approach may provide useful suggestions for treating those patients who report persistent pain symptoms despite receiving first-line hormonal medical treatment.
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Affiliation(s)
- Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Pesce
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesca Caprara
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Artacho-Cordón F, Lorenzo Hernando E, Pereira Sánchez A, Quintas-Marquès L. Conceptos actuales en dolor y endometriosis: diagnóstico y manejo del dolor pélvico crónico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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12
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Fernández-de-las-Peñas C, Nijs J, Cagnie B, Gerwin RD, Plaza-Manzano G, Valera-Calero JA, Arendt-Nielsen L. Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain. Life (Basel) 2023; 13:694. [PMID: 36983849 PMCID: PMC10059732 DOI: 10.3390/life13030694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Madrid, Spain
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Jette, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Robert D. Gerwin
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
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13
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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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Wójcik M, Szczepaniak R, Placek K. Physiotherapy Management in Endometriosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316148. [PMID: 36498220 PMCID: PMC9740037 DOI: 10.3390/ijerph192316148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 05/13/2023]
Abstract
Endometriosis is a disease whose underlying cause is the growth of the endometrium outside the uterine cavity. The disease is characterised by unpleasant pain in the pelvic region, irrespective of the phase of the woman's cycle. Physiotherapy in its various forms can be an excellent complement to the gynaecological treatment of endometriosis, by virtue of reducing inflammation, alleviating pain and thus significantly improving women's quality of life. Physiotherapy in endometriosis should include kinesiotherapy, manual therapy including visceral therapy, physical therapy, spa treatment including balneotherapy, and hydrotherapy. The aim of this study is to present the use of physiotherapy as an adjunct therapy in the treatment of endometriosis. A review of the available literature in the Medline, PubMed and Google Scholar databases was performed without being limited by the time frame of available publications on the forms of physiotherapy used in the treatment of endometriosis.
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Affiliation(s)
- Małgorzata Wójcik
- Department of Physiotherapy, Faculty of Physical Culture in Gorzow Wielkopolski, Poznan University of Physical Education, 61-871 Poznan, Poland
- Correspondence:
| | - Renata Szczepaniak
- Pabianice Medical Center, Department of Physiotherapy, WSB University, 41-300 Dabrowa Gornicza, Poland
| | - Katarzyna Placek
- Clinic and Department of Obstetrics, Women’s Diseases and Oncological Gynecology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, University Hospital No. 2 Jana Biziela in Bydgoszcz, 85-067 Bydgoszcz, Poland
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15
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Cain A, Carter K, Salazar C, Young A. When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia. Clin Obstet Gynecol 2022; 65:686-698. [PMID: 35703212 DOI: 10.1097/grf.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chronic pelvic pain is a common cause of pain in reproductive age women with debilitating consequences for affected women's health and quality of life. Treatment providers must be well versed in all treatment options for these patients, understanding the overlap in the management and treatment of chronic pelvic pain caused by pudendal neuralgia, myofascial pelvic pain, and vulvodynia. Pudendal blocks are a simple and quick procedure that can be performed in the office and often helps improve all the above conditions when used along with other treatment options. We review the anatomy and methodology on when and how to perform pudendal blocks in the office to better inform the general gynecologist on how to implement offering this treatment in the outpatient clinical setting.
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Affiliation(s)
- Abigail Cain
- The Dell Medical School at The University of Texas at Austin, Austin, Texas
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16
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Myofascial Trigger Points and Central Sensitization Signs, but No Anxiety, Are Shown in Women with Dysmenorrhea: A Case-Control Study. BIOLOGY 2022; 11:biology11111550. [PMID: 36358253 PMCID: PMC9688021 DOI: 10.3390/biology11111550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
Background primary dysmenorrhea (PD) is considered to be a cyclic chronic pelvic pain, with its onset in menstrual periods, often accompanied by the presence of myofascial trigger points (MTP). Most MTPs in subjects with chronic pelvic pain are in the inferior part of the abdomen, in the rectus abdominis (RA) area. Central sensitization is closely related to chronic pain processes. Previous studies in women with chronic pelvic pain reported central sensitization signs in their subjects, such as lower pain pressure threshold (PPT). Several authors agree that PPT in the tibialis anterior (TA) muscle, seems to be a reliable reference for signs of central sensitization. Amongst the factors that seem to accompany central sensitization, the presence of anxiety needs to be considered. The aim of the present study was to analyze the existence of hyperalgesic MTPs in RA, central sensitization signs and anxiety in women with PD, in comparison with a control group (CG). Methods: This study was designed following an observational, cross-sectional, case-control model. A total sample of 80 subjects was recruited trough social webs and advertising (PD n = 39) (CG n = 41). PPT in RA and AT was assessed bilaterally through algometry, and anxiety was evaluated through the State−Trait Anxiety Inventory. Results: Statistically significant differences (p < 0.001) were shown for NRS average and maximum increase, as well as lower bilaterally RA and TA PPT in favor of PD group compared to CG. State or trait STAI did not show any statistically significant differences (p > 0.05) between groups. Conclusions: In this study, women with PD reported symptoms of myofascial pain syndrome and central sensitization, when compared with healthy controls, without any sign of anxiety acting as a confounder for pain sensitivity.
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Leitch J, Webb A, Pudwell J, Chamberlain S, Henry R, Nitsch R. Magnesium-based trigger point infiltrations versus local anesthetic infiltrations in chronic pelvic myofascial pain: A randomized, double-blind control study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:877-885. [PMID: 35339694 DOI: 10.1016/j.jogc.2022.02.129] [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: 08/17/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine if a novel, magnesium-based trigger point infiltration formulation is more effective in treating chronic myofascial pelvic pain than lidocaine-only infiltration. METHODS This was a single-centre, double-blind, randomized controlled trial of women diagnosed with chronic pelvic myofascial pain associated with trigger points. We compared a novel magnesium-based infiltration formulation with lidocaine infiltration of trigger points and with a control group of participants who were waitlisted for a chronic pain clinic. Treatment groups completed a 12-week program that included 8 trigger point injection treatments and nine visits during which pain scores were recorded and questionnaires administered. The primary outcome measure was change in mean pain score between baseline and the final visit. Secondary outcomes included pain with function scores, scores on the World Health Organization Quality of Life questionnaire, procedural pain, concomitant medication use, and complications. RESULTS We assigned 44 women diagnosed with chronic myofascial pelvic pain associated with trigger points to either the magnesium-based infiltrate (n = 15), lidocaine infiltrate (n = 17), or waitlist (n = 12) group. In the intent-to-treat analysis, a clinically relevant decrease in mean pain score out of 10 was observed in the magnesium-based (-2.6 ± 3.2) and lidocaine (-2.9 ± 3.1) infiltration groups, but not in the waitlist group (-0.5 ± 2.3). The per protocol analysis post-hoc tests, adjusted for multiple comparisons, found a significant difference in the average change in pain score between the magnesium-based infiltrate and the waitlist groups (P = 0.045), while differences between the lidocaine infiltrate and waitlist groups approached statistical significance (P = 0.052). Both treatment groups saw improvements in pain with function and quality of life scores. CONCLUSION While this study is underpowered, it does not support the use of a magnesium-based trigger point infiltrate in the treatment of chronic myofascial pelvic pain over lidocaine-only infiltration. Nonetheless, these results are consistent with current management recommendations and suggest improvements in pain, pain with function, and quality of life scores with either magnesium-based or lidocaine-only infiltration. We outline an approach to assessment and treatment that can be adopted by general gynaecologists.
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Affiliation(s)
- Jordan Leitch
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Amanda Webb
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Jessica Pudwell
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Susan Chamberlain
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Richard Henry
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON
| | - Romy Nitsch
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON.
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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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