A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: A blinded study of examination findings

Neville, Cynthia E.; Fitzgerald, Colleen M.; Mallinson, Trudy; Badillo, Suzanne; Hynes, Christina; Tu, Frank F.

doi:10.1016/j.jbmt.2011.06.002

Cited by 38 publications

(55 citation statements)

References 30 publications

(25 reference statements)

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“…Rate of endometriosis was 6% or the same as in the general population (3%‐6%) but found that endometriosis may be overdiagnosed because of pain complaints, leading to inappropriate treatment and surgical procedures . Literature also supports an association between symptoms of dysmenorrhea and dyspareunia with myofascial pelvic pain . This may suggest a potential explanation for previously noted strong associations and higher rates of dysmenorrhea and dyspareunia in hEDS/JHS groups …”

Section: Introductionmentioning

confidence: 71%

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Hastings

Forster

Witzeman

2019

PM&R

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Background Female chronic pelvic pain is estimated to affect up to 24% of adult women, many of whom have a component of myofascial pelvic pain. Although an association of joint hypermobility and pelvic pain has been hypothesized, limited data are available that estimate the prevalence of joint hypermobility in this population. Objective To estimate the prevalence of generalized hypermobility spectrum disorder (G‐HSD) among female patients with chronic myofascial pelvic pain and examine the association between G‐HSD and other frequent pelvic pain‐associated complaints. Study Design Retrospective case control. Setting Tertiary referral center within a university‐affiliated public health system. Patients Adult women who were diagnosed with myofascial pelvic pain during a 1‐year period (n = 77 with G‐HSD and n = 241 without G‐HSD). Methods Data were abstracted via chart review of patients meeting inclusion criteria. Outcomes The primary outcome of this study was the prevalence of G‐HSD among patients with persistent myofascial pelvic pain. Secondary outcomes included the prevalence of dyspareunia, provoked vestibulodynia, stress urinary incontinence, irritable bowel syndrome, hip pain, low back pain, and fibromyalgia in patients with persistent myofascial pelvic pain with and without G‐HSD. Results Twenty‐four percent (N = 77; 95% CI: 19.6, 29.4) of myofascial pelvic pain patients also met criteria for G‐HSD. After adjusting for confounders, the odds in favor of having G‐HSD was 3.55 higher (95% CI: 1.50, 8.40) (P = .004) in females with dyspareunia; 7.46 higher (95% CI: 2.41, 23.1) (P < .001) with low back pain; 3.76 higher (95% CI: 1.35, 10.5) (P = .02) with stress urinary incontinence; 4.72 higher (95% CI: 2.00, 11.2) (P < .001) with irritable bowel syndrome; and 3.12 higher (95% CI: 1.36, 7.13) (P = .007) with hip pain. There was no significant association identified between provoked vestibulodynia or fibromyalgia and G‐HSD. Conclusion The estimated prevalence of G‐HSD is higher in chronic myofascial pelvic pain patients than in the general population with statistically significant associations with several comorbid conditions. Characterizing these associations is the first step in developing effective, evidence‐based screening recommendations. Level of Evidence III

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Section: Introductionmentioning

confidence: 71%

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Hastings

Forster

Witzeman

2019

PM&R

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“…8,9,14,17,18,20,26,74 CONCLUSION A high percentage (36%) of patients referred to outpatient physical therapy for pelvic pain also presented with scoliosis. However, previously published research studies describing musculoskeletal characteristics of patients with pelvic pain have had similar or fewer subjects.…”

Section: Limitationsmentioning

confidence: 96%

“…1 , 3 There are a variety of causes of pelvic pain. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The temporal association between the musculoskeletal dysfunction and pelvic pain is not clear and may differ with other associated etiologies. A recent review noted that 93% of studies did not include the location of pelvic pain.…”

Section: Prevalence Of Scoliosis In a Pelvic Pain Cohortmentioning

confidence: 99%

“…Studies attempting to identify prevalence, causes, and natural course associated with development of pelvic pain have been challenging because of ill-defi ned defi nitions of pelvic pain. 26 Tight or high-tone pelvic fl oor muscles, or pelvic fl oor muscles that are tender to palpation, have been found to be highly correlated with pelvic pain in many studies. 6 A 2006 review, which excluded pain confi ned to the vulvar region, identifi ed general, gynecologic/ obstetric, and psychosocial factors as predictors of pelvic pain excluding cyclical pain and dyspareunia.…”

Section: Prevalence Of Scoliosis In a Pelvic Pain Cohortmentioning

confidence: 99%

“…A recent review noted that 93% of studies did not include the location of pelvic pain. 8,9,11,21,26 High-tone pelvic fl oor dysfunction has been correlated with painful bladder syndrome and interstitial cystitis 16 and was originally identifi ed in the colorectal literature. This review did not identify causative musculoskeletal factors other than adhesions.…”

Section: Prevalence Of Scoliosis In a Pelvic Pain Cohortmentioning

confidence: 99%

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Prevalence of Scoliosis in a Pelvic Pain Cohort

Tate¹

2015

Journal of Women's Health Physical Therapy

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Objective: Adolescent idiopathic scoliosis has a reported prevalence of 0.16% to 3.26% overall, is higher in females than in males, and higher with age. The relationship between pelvic pain and musculoskeletal dysfunction has been reported. However, the presence of scoliosis in patients with pelvic pain has not been reported in the literature to date. The purpose of this pilot study is to determine the prevalence of scoliosis in a cohort of patients who were referred to physical therapy for musculoskeletal pelvic pain. Study Design: This was a retrospective cross-sectional study. Methods: A retrospective chart review was performed to identify patients referred with a diagnosis of pelvic pain. Scoliosis was defi ned by the presence of an observable spinal deformity in the transverse, frontal, and sagittal planes, including a positive Adam's forward bend test, and/or a positive history of adolescent idiopathic scoliosis. Data about age and number of therapy sessions were calculated for this cohort. Results: Sixty-one patients, mean age 41.3 (15.4) years, were referred for pelvic pain. Of this cohort, 22 (36%) were diagnosed with scoliosis. In this cohort, no signifi cant differences were observed between those with and without scoliosis for age and number of intervention visits. Conclusion: The prevalence of scoliosis in this cohort of patients with pelvic pain was higher than expected. It is possible that scoliosis contributes to pelvic pain by infl uencing pelvic joints and muscles. Standard screening during evaluation for pelvic pain may be warranted. Further research is needed to identify optimal treatment interventions and to establish the association between scoliosis and pelvic pain.

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Chronic Pelvic Pain in Women

Lamvu

Carrillo

Ouyang

et al. 2021

JAMA

153

139

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ImportanceChronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world’s female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions.ObservationsChronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process.Conclusions and RelevanceChronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.

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A preliminary report of musculoskeletal dysfunction in female chronic pelvic pain: A blinded study of examination findings

Cited by 38 publications

References 30 publications

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Prevalence of Scoliosis in a Pelvic Pain Cohort

Chronic Pelvic Pain in Women

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