Neuromuscular treatment approach for women with chronic pelvic pain syndrome improving pelvic pain and functionality

Abstract

Aims: Reporting the effects of treating underlying myofascial dysfunction and neuropathic pain in women with chronic pelvic pain syndrome (CPPS).Methods: Retrospective longitudinal study of 186 women with CPPS treated with ultrasound-guided peripheral nerve blocks and trigger point injections to pelvic floor muscles alongside pelvic floor physical therapy once weekly for 6 weeks in an outpatient setting. Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS) questionnaires quantified pain and function in the pelvis. Working, intercourse, sleeping, walking, running, lifting, bladder, and bowel were the function categories. Statistical significance was established by p value less than .05 in paired two-sample t-test.Results: VAS improved by 2.14 where average VAS before treatment was 6.61 (standard deviation [SD] 2.45; p < .05, 95% confidence interval [CI] = 6.26-6.96) and average VAS after treatment was 4.47 (SD 2.71; p < .05, 95% CI = 4.08-4.86).

Myofascial Trigger Points and Central Sensitization Signs, but No Anxiety, Are Shown in Women with Dysmenorrhea: A Case-Control Study

“…Further studies with accurate tools are needed to determinate the exact target points for minimally invasive treatment, enhancing the efficacy of these interventions. Patil et al [ 43 ] conducted a retrospective study, in 189 women with chronic pelvic pain, in which the authors reported the results of a myofascial intervention focused on the pelvic floor MTPs. The relation between pelvic floor muscles and abdominal wall muscles, acting as a synergic unit, is a common topic in scientific literature [ 44 ].…”

When and How to Utilize Pudendal Nerve Blocks for Treatment of Pudendal Neuralgia

“…17 In addition, the various combinations as well as the cross-over of neuronal types lead to the cross-stimulation that is often seen clinically in pelvic disease processes such as chronic pain from endometriosis, painful bladder syndrome, and irritable bowel syndrome. 1 This cross-over is also postulated to be the etiology for referred pain. 17 The parasympathetic and sympathetic inputs to the pelvic nervous system originate in the hypothalamus (anterior hypothalamus-parasympathetic and posterior hypothalamus-sympathetic), traveling through the spinal cord with axons extending via white rami communicans mostly laterally into the sympathetic trunk.…”

“…In total, the abdomen and pelvis are served by a pair of cranial nerves: 18 pairs of spinal nerves, each with 2 rami and 2 divisions forming 3 somatic plexuses and >22 named somatic nerves; as well as 12 autonomic plexuses with multiple subsidiary plexuses with 8 named autonomic nerves with 100 million ganglion cells and their associated nerve branches and fibers 17. In addition, the various combinations as well as the cross-over of neuronal types lead to the cross-stimulation that is often seen clinically in pelvic disease processes such as chronic pain from endometriosis, painful bladder syndrome, and irritable bowel syndrome 1. This cross-over is also postulated to be the etiology for referred pain 17…”

“…Some definitions of CPP have been proposed and are noted here1: Noncyclic pain persists for 6 or more months. Pain that localizes to the anatomic pelvis, to the anterior abdominal wall at or below the umbilicus, or the lumbosacral back or buttocks. Pain sufficiently severe to cause functional disability or lead to medical intervention. …”

“…Chronic pelvic pain (CPP) is a common gynecologic problem that has an estimated prevalence of 15% in reproductive age women and can affect a person's daily functioning, emotional state, and relationships. 1 The diagnosis and treatment of CPP is complex with no clear universal definition of the disease and no standard approach to treatment. Some definitions of CPP have been proposed and are noted here 1 :…”