A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain

Zoorob, Dani; South, Mary M.T.; Karram, Mickey M.; Sroga, Julie M.; Maxwell, Rose; Shah, Aparna D.; Whiteside, James L.

doi:10.1007/s00192-014-2606-4

Cited by 53 publications

(29 citation statements)

References 27 publications

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“…70 In a small study of 29 patients, greater than 50% improvement in pain scores was observed with physical therapy in 59% of patients and with levator-directed trigger-point injections in 58% of patients. 71 The high prevalence and severity of psychosocial issues in patients with urologic chronic pain syndromes 54 underscores the need for appropriate pharmacotherapy, counseling, and/or cognitive-behavioral therapy. These are often integrated in multidisciplinary programs that incorporate physical therapy, particularly for patients whose symptoms are refractory to other approaches.…”

Section: Methodsmentioning

confidence: 99%

Anorectal and Pelvic Pain

Bharucha

Lee

2016

Mayo Clinic Proceedings

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Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the three most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first two conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacologic, behavioral, and physical therapy. Opioids should not be avoided, and surgery has a limited role, primarily in refractory interstitial cystitis.

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Section: Methodsmentioning

confidence: 99%

Anorectal and Pelvic Pain

Bharucha

Lee

2016

Mayo Clinic Proceedings

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“…In a 2014 study by Zoorob et al, two groups of women reporting dyspareunia were treated with either pelvic floor PT or levator-directed trigger-point injections. Results from this study demonstrated improvement in both groups, however the group receiving PT demonstrated a greater overall improvement in sexual function based on sexual function scores [12]. In addition to decreasing pain with intercourse, some studies have shown that pelvic floor physical therapy intervention can actually help increase sexual pleasure [13,14].…”

Section: Management Of Types Of Sexual Dysfunction Through Pelvic Flomentioning

confidence: 82%

Pelvic Floor Physical Therapy and Women’s Health

Zoorob¹,

Anderson²

2020

Physical Therapy Effectiveness

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Personalized approaches for the management and maintenance of women's pelvic health are increasingly in demand. As pelvic floor dysfunction is multifactorial and origins vary, it is essential as a clinician, to be familiar with available interventions to address each of these dysfunctions and their causes. This chapter will discuss the role of physical therapy in the management of female patients presenting with pelvic floor dysfunction related to bowel, bladder and sexual health with focus on variations associated with age. Each section addresses a specific type of pelvic floor dysfunction, discusses the methodology for management, as well as the efficacy of the physical therapy intervention related to treatment of each diagnosis.

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“…A small study for women with pelvic floor myalgia showed reduction of pain with PFPT. 11 Another study showed that PFPT is beneficial in women with painful bladder syndrome and pelvic floor tenderness. 12 PFPT appears most beneficial for patients with pelvic floor dysfunction and/or myofascial pain components.…”

Section: Pelvic Floor Physical Therapymentioning

confidence: 99%

Opioids and Alternatives in Female Chronic Pelvic Pain

Valentine

Deimling

2018

Semin Reprod Med

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Chronic pelvic pain is a complex condition with peripheral and central mechanisms of pain. Successful nonsurgical management typically relies on a multimodal approach, with integration of both pharmacologic and nonpharmacologic interventions. This article reviews nonpharmacologic therapies including pelvic floor physical therapy, dietary modifications, psychotherapy, and acupuncture. These interventions are low risk and should be incorporated into treatment for chronic pelvic pain, as they show promise for successful symptom relief in many overlapping chronic pain conditions. Common nonopioid medications for pelvic are also reviewed, including analgesics, hormone modulating agents, antidepressants, and anticonvulsants. Guidelines for cautious and responsible opioid use are also summarized. While data specific to chronic pelvic pain management remain limited, evidence supporting treatment of other chronic pain conditions is reviewed to help guide management.

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A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain

Abstract: Vaginal myalgia and sex-related pain improved with pelvic floor PT and LTPI. Time-to-effect improvement and significance of therapy are dependent on treatment type.

Cited by 53 publications

References 27 publications

Anorectal and Pelvic Pain

Anorectal and Pelvic Pain

Pelvic Floor Physical Therapy and Women’s Health

Opioids and Alternatives in Female Chronic Pelvic Pain

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