Pain and functionality improved when underlying neuromuscular dysfunction addressed in chronic pelvic pain patients

Abstract

Aim: Examine the effects of treating underlying neuromuscular dysfunction in chronic pelvic pain (CPP) patients.Methods: A retrospective longitudinal study of 200 female and male patients with CPP was performed upon an Institutional Review Board (IRB) approval (IRB# 17-0761). The outpatient protocol consisted of ultrasound-guided trigger point injections to the pelvic floor musculature with peripheral nerve blocks once a week for 6 weeks in an outpatient setting. Pelvic pain and functionality were measured before and after treatment using the Visual Analogue Scale and the Functional Pelvic Pain Scale. Functionality categories assessed were intercourse, bladder, bowel, working, walking, running, lifting, and sleeping. Results: Pretreatment, mean VAS score was 6.44 (standard deviation [SD] = 2.50; p < 0.05, 95% confidence interval [CI] = 6.09-6.79). Posttreatment mean VAS score was 4.25 (SD = 2.63; p < 0.05, 95% CI = 3.88-4.61). The mean FPPS score before treatment was 10.77 (SD = 6.39; p < 0.05, 95% CI = 9.88-11.65). Posttreatment mean FPPS score was 7.42 (SD = 5.87; p < 0.05, 95% CI = 6.61-8.23). Analysis of subcategories within FPPS indicated statistically significant improvement in the categories of intercourse, working, and sleeping. Conclusion: Findings show the treatment was efficient at decreasing pain in CPP patients. Results show promise for improving overall pelvic functionality, particularly within the categories of intercourse, sleeping, and working. K E Y W O R D S chronic pelvic pain, chronic prostatitis, endometriosis, pelvic floor dysfunction, pelvic floor myalgia, pelvic pain 1 | INTRODUCTION Chronic Pelvic Pain (CPP) is characterized by noncyclical pain in the pelvis or abdomen present for 3-6 months, interfering with daily function. 1 CPP is also known as Urological Chronic Pelvic Pain (UCPPS) and Chronic Pelvic Pain Syndrome (CPPS), 2 for the purposes of this study, CPP will be the consistent nomenclature. Rather than being perceived as a single disorder, CPP should be viewed as a pattern of symptoms caused by overlapping

Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections

“…15 Given the cross innervation between these two nerves, it is important to downregulate and reverse the aberrant firing and neurogenic inflammation that occurs in both nerves. 16 BPS/IC is thought to have a major component of neurogenic inflammation and pelvic floor hypertonia that through the pelvic cross-sensitisation process and inter-neuronal connections, this causes injury/trauma to the bladder and results in symptoms commonly associated with BPS/IC. 8 treatment protocol addresses the pelvic cross-sensitisation, neurogenic inflammation and pelvic floor hypertonia associated with BPS/IC.…”

“…The pudendal nerve and the posterior femoral cutaneous nerves were treated as they are the two major sensory nerves that innervate the lower two‐thirds of the pelvis 15 . Given the cross innervation between these two nerves, it is important to downregulate and reverse the aberrant firing and neurogenic inflammation that occurs in both nerves 16 …”

“… 15 Given the cross innervation between these two nerves, it is important to downregulate and reverse the aberrant firing and neurogenic inflammation that occurs in both nerves. 16 …”

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

“…Pelvic floor physical therapy in concomitance to the injections is referred to “down training” to restore the peripheral nervous system and central nervous system to a relaxed state and release muscle spasms. The focus is on internal release of the hypertonic pelvic floor muscular structure, skin rolling along the lower abdomen and buttocks, scar tissue mobilization, visceral mobilization, nerve gliding along the pudendal and posterior femoral cutaneous nerves, and diaphragmatic breathing 5 . Home exercise program consists of restorative yoga poses involving stretches for thighs, buttocks, abdomen, and the back which can be repeated 1–3 times a day as needed.…”

“…1 This study's objective is to establish the efficacy of an outpatient, comprehensive, neuromuscular treatment protocol aimed at treating the myofascial pain and dysfunction, peripheral sensitization, and central sensitization seen in CPPS patients. This treatment's effects have been studied for 200 male and female CPPS patients 5 and the current analysis was completed for only women with CPPS.…”