Musculoskeletal Causes of Chronic Pelvic Pain

Abstract

Ten percent of all gynecologic consultations are for chronic pelvic pain, and 20% of patients require a laparoscopy. Chronic pelvic pain affects 15% of all women annually in the United States, with medical costs and loss of productivity estimated at $2.8 billion and $15 billion per year, respectively. Chronic pelvic pain in women may have multifactorial etiology, but 22% have pain associated with musculoskeletal causes. Unfortunately, pelvic musculoskeletal dysfunction is not routinely evaluated as a cause of pelvic pain by gynecologists. A pelvic musculoskeletal examination is simple to perform, is not time-consuming, and is one of the most important components to investigate in all chronic pelvic pain patients. This article describes common musculoskeletal causes of chronic pelvic pain and explains how to perform a simple musculoskeletal examination that can be easily incorporated into the gynecologist physical examination.

Indications and Alternatives to Hysterectomy

“…In the last decade, gynecologists have become more informed about the relationship between musculoskeletal disorders and pelvic pain, yet they infrequently look to this common etiology during the initial evaluation. 104 In women with pelvic pain, up to 22% will be found to have MSK dysfunction, 105 but other studies have referenced rates of myofascial pain between 37% and 70% in chronic pain cohorts. 106,107 Myofascial pain is 1 subgroup of MSK-related pain and is distinguished by the key feature of trigger points within muscle and fascial planes.…”

Obstetrics-Gynecology Resident Attitudes and Perceptions About Chronic Pelvic Pain: A Targeted Needs Assessment to Aid Curriculum Development

“…Understanding the complex nature of this syndrome, which results from dysfunction and complex interactions between neurologic, musculoskeletal, and endocrine systems that are further influenced by behavioral and psychological factors, requires significant effort and study. [9][10][11] Curriculum development is needed to improve training on the care of CPP patients, and it should address the areas discussed in this study. As chronic pain is more prevalent in our society than all forms of cancer, diabetes, and heart disease combined, 1 more emphasis should be placed on improving obstetricsgynecology residents' knowledge and understanding of chronic pain disorders.…”

“…[4][5][6][7][8] Current literature also supports the complex nature of diagnosis and potential clinical approaches required to address the needs of women afflicted with CPP. [9][10][11][12] Resident attitudes and perceptions may create barriers to interest in learning and compassionate treatment of these patients, and improvements in resident education in this area are needed. No studies to date specifically evaluate obstetrics-gynecology residents' attitudes and perceptions about CPP.…”

Update in Diagnosis and Treatment of Chronic Pelvic Pain Syndromes

“…Trigger points are defined as a tender locus within a taut band of muscle, which restricts full range of motion and refers pain centrifugally when stimulated [59]. Patients who suffer with MPPS may have pain in the pelvis, vagina, vulva, rectum, bladder, or in more distant referred sites such as the groin, thighs, hips, sacrum, buttock, low back, or abdomen [60]. Symptoms may range from pressure, aching, and heaviness to overactive bladder, evacuation dysfunction, and dyspareunia [61].…”