Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study.
Journal
European journal of pain (London, England)
ISSN: 1532-2149
Titre abrégé: Eur J Pain
Pays: England
ID NLM: 9801774
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
14
05
2020
accepted:
12
12
2020
pubmed:
17
12
2020
medline:
28
4
2021
entrez:
16
12
2020
Statut:
ppublish
Résumé
Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis-associated chronic pelvic pain. Cross-sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain-focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro-musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure-pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index. All women had a pelvic floor muscle spasm that they self-identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure-pain thresholds and trigger points in over two-thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure-pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009). Women with endometriosis-associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on-going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population. Clinicaltrials.gov identifier: NCT01553201. Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On-going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.
Sections du résumé
BACKGROUND
Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment.
OBJECTIVE
Characterize the presence and distribution of pain, myofascial dysfunction and sensitisation beyond the pelvis in women with endometriosis-associated chronic pelvic pain.
METHODS
Cross-sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain-focused abdominopelvic gynaecologic examination with the identification of pelvic floor muscle spasm. Neuro-musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger points in 13 paired muscles. Pressure-pain thresholds were measured over interspinous ligaments and trigger points. Women completed the body territories element of the Body Pain Index.
RESULTS
All women had a pelvic floor muscle spasm that they self-identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure-pain thresholds and trigger points in over two-thirds of 26 assessed regions. Widespread spinal segmental sensitisation was present in 17/30, thoracic in 21/30 and lumbosacral/pelvic in 18/30. Cervical sensitisation manifested as low pressure-pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p = .024) and lumbosacral/pelvic (p = .036) sensitisation and report over 10 painful body areas (p = .009).
CONCLUSIONS
Women with endometriosis-associated chronic pelvic pain often have myofascial dysfunction and sensitisation beyond the pelvic region that may be initiated or maintained by on-going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population. Clinicaltrials.gov identifier: NCT01553201.
SIGNIFICANCE
Women with endometriosis often have pelvic pain persisting after surgery despite hormonal therapies and these women have regional pelvic sensitisation and myofascial dysfunction. Pelvic floor muscle spasm is a major pain focus in this population. Sensitisation and myofascial dysfunction are widespread, beyond the pelvic region. On-going pelvic floor spasm may initiate or maintain sensitisation. Myofascial/sensitisation manifestations warrant consideration when managing pain in this population.
Identifiants
pubmed: 33326662
doi: 10.1002/ejp.1713
pmc: PMC7979491
mid: NIHMS1656175
doi:
Banques de données
ClinicalTrials.gov
['NCT01553201']
Types de publication
Journal Article
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
831-840Subventions
Organisme : Intramural NIH HHS
ID : ZIA NS003159
Pays : United States
Informations de copyright
© 2020 European Pain Federation - EFIC®.
Références
Pain. 1975 Sep;1(3):277-299
pubmed: 1235985
J Headache Pain. 2015;17:28
pubmed: 27002510
Trends Endocrinol Metab. 2015 Jan;26(1):1-10
pubmed: 25465987
Semin Reprod Med. 2017 Jan;35(1):88-97
pubmed: 28049214
Hum Reprod Update. 2005 Nov-Dec;11(6):595-606
pubmed: 16172113
Biol Reprod. 2018 Aug 1;99(2):349-359
pubmed: 29425272
Sex Med Rev. 2020 Jan;8(1):3-17
pubmed: 30928249
Hum Reprod. 2000 Aug;15(8):1744-50
pubmed: 10920097
J Pain. 2009 Jun;10(6):556-72
pubmed: 19380256
Eur J Pain. 2007 May;11(4):415-20
pubmed: 16815054
J Pain. 2009 Sep;10(9):895-926
pubmed: 19712899
Am J Obstet Gynecol. 2016 Dec;215(6):760.e1-760.e14
pubmed: 27443813
Hum Reprod. 2012 Mar;27(3):702-11
pubmed: 22252082
J Pain. 2003 Sep;4(7):372-80
pubmed: 14622679
Reg Anesth Pain Med. 2019 Jul 8;:
pubmed: 31289238
Hum Reprod Update. 2011 May-Jun;17(3):327-46
pubmed: 21106492
Reprod Sci. 2019 Mar;26(3):357-369
pubmed: 29730970
J Pain. 2016 Jan;17(1):1-13
pubmed: 26456676
J Pain. 2016 Sep;17(9 Suppl):T93-T107
pubmed: 27586833
Phys Med Rehabil Clin N Am. 2003 May;14(2):261-86
pubmed: 12795516
Arthritis Rheum. 2003 Oct;48(10):2916-22
pubmed: 14558098
Eur J Neurosci. 1999 Mar;11(3):837-46
pubmed: 10103077
Philos Trans R Soc Lond B Biol Sci. 1996 Mar 29;351(1338):441-8
pubmed: 8730783
Pain. 2011 Jan;152(1):14-27
pubmed: 20851519
Eur J Pain. 2018 Feb;22(2):216-241
pubmed: 29105941
Hum Reprod. 2015 Oct;30(10):2427-38
pubmed: 26269529
Pain. 2012 May;153(5):1006-1014
pubmed: 22387096
Mol Cell Endocrinol. 2012 Jul 25;358(2):208-15
pubmed: 22085558
Arthritis Rheum. 1990 Feb;33(2):160-72
pubmed: 2306288
Eur J Pain. 2005 Jun;9(3):267-75
pubmed: 15862476
Science. 2005 Jun 10;308(5728):1587-9
pubmed: 15947176
Acta Obstet Gynecol Scand. 2019 Mar;98(3):327-336
pubmed: 30472739
Eur J Pain. 2020 May;24(5):933-944
pubmed: 32034979
Arthritis Rheum. 1993 May;36(5):642-6
pubmed: 8489541
Hum Reprod Update. 2009 Mar-Apr;15(2):177-88
pubmed: 19136455
Obstet Gynecol. 2015 Mar;125(3):719-728
pubmed: 25730237
N Engl J Med. 2020 Mar 26;382(13):1244-1256
pubmed: 32212520
Pain. 2017 Oct;158(10):1925-1937
pubmed: 28683025
Pain Med. 2018 Jan 1;19(1):142-150
pubmed: 29025044
Pain. 2006 Aug;123(3):231-243
pubmed: 16697110
Obstet Gynecol. 2013 Nov;122(5):1047-1055
pubmed: 24104772
Am J Obstet Gynecol. 2018 Nov;219(5):497.e1-497.e13
pubmed: 29959930
J Obstet Gynaecol Can. 2013 Jun;35(6):531-535
pubmed: 23870777
Pain. 2011 Mar;152(3 Suppl):S2-S15
pubmed: 20961685
Hum Reprod. 2009 Apr;24(4):827-34
pubmed: 19151028
Neurourol Urodyn. 2007;26(1):59-62
pubmed: 17195176
Hum Reprod. 2019 Mar 1;34(3):469-478
pubmed: 30597044
Proc Natl Acad Sci U S A. 2004 Jul 27;101(30):11094-8
pubmed: 15256593
Curr Opin Obstet Gynecol. 2014 Aug;26(4):253-9
pubmed: 24921647
Front Cell Neurosci. 2018 Feb 13;12:35
pubmed: 29487504