Musculoskeletal Considerations in Female Patients with Chronic Pelvic Pain

Lamvu, Georgine; Carrillo, Jorge Fernando García; Witzeman, Kathryn; Alappattu, Meryl

doi:10.1055/s-0038-1676085

Cited by 22 publications

(17 citation statements)

References 21 publications

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“…To calculate the sample size, dyspareunia was considered the primary outcome. The proportion comparison method between the two groups was used in a previous study, 6 with an 80% study power and 5% alpha, requiring the inclusion of at least 50 participants in each group. The SAS package (version 9.4, SAS Institute Inc, Carl, DC, USA) was used for statistical analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Musculoskeletal disorders can be identified in approximately 22% of women with CPP of varying etiology. 6 Visceral structures in the pelvis receive and send stimuli to the central nervous system. A harmful stimulus, such as those caused by endometriotic injuries, can affect the musculature, causing persistent contractions.…”

Section: Introductionmentioning

confidence: 99%

“…In theory, pain can negatively affect the function of different structures and cause dysfunction. Musculoskeletal disorders can be identified in approximately 22% of women with CPP of varying etiology 6 . Visceral structures in the pelvis receive and send stimuli to the central nervous system.…”

Section: Introductionmentioning

confidence: 99%

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Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association

et al. 2021

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Aims: Deep infiltrative endometriosis (DIE) may cause pelvic pain and thus negatively affect the function of different structures. We hypothesised that women with DIE may have dysfunctions of the pelvic floor muscles (PFMs) and lower limb muscles (LLMs). Methods: This cross-sectional study included 160 women (80 with DIE under hormonal treatment and 80 women without DIE), who were assessed to determine the presence of pelvic symptoms (dysmenorrhea, chronic pelvic pain [CPP], deep/penetration dyspareunia, dysuria, dyschezia and vulvodynia), PFM function (PERFECT scheme, presence of hypertonia and trigger points, and muscle contraction and relaxation), abdominal muscle pain (Carnett's test) and muscle shortening in LLM (Thomas, Pace and Ober tests).Results: Women with DIE presented more CPP (30% vs 5%; P < .001), dysuria (12.5% vs 3.75%; P = .043) and dyschezia (47.5% vs 2.5%; P < .001) than the control group. Moreover, they had higher PFM hypertonia (28.75% vs 13.75%; P = .02), weaker PFM contraction (36.35% vs 2.5%; P < .001), and incomplete PFM relaxation (45% vs 13.75%; P < .001). Women with DIE had a higher rate of positive results in the Carnett's test (21.25% vs 2.5%; P < .001) than the control group. Moreover, they had a higher frequency of shortening of the anterior thigh (30% vs 10% in both LLM;

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association

et al. 2021

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“…At specialized CPP centers with an evaluation that includes musculoskeletal examination, 50% to 90% of women have pain originating from musculoskeletal structures . A focus on the patient’s visceral or organic causes for pain, neglecting central sensitization and myofascial dysfunction, may lead to prolonged pain, delayed treatment, and the patient being subjected to unnecessary surgical interventions …”

Section: Pathophysiology and Clinical Presentationmentioning

confidence: 99%

Chronic Pelvic Pain in Women

Lamvu

Carrillo

Ouyang

et al. 2021

JAMA

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172

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ImportanceChronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world’s female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions.ObservationsChronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process.Conclusions and RelevanceChronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.

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“…For instance, ovarian cysts, pelvic inflammatory disease, pelvic adhesions, leiomyomata, adenomyosis, and endometriosis, among others, can all present similarly to musculoskeletal hip pathology in some patients. 8 , 9 , 19 , 20 , 21 In most cases, these symptoms arise secondary to the pelvic inflammation associated with these conditions. 12 , 19 , 22 , 23 , 24 To avoid unnecessary arthroscopic hip surgery, it is thus critical to identify and/or rule out all possible gynecologic causes of hip pain.…”

mentioning

confidence: 99%

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

Varady

Abraham

Kucharik

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To investigate the association between intrauterine device (IUD) use and hip pain, orthopaedic visits for hip pain, and arthroscopic hip surgery. Methods: This was a retrospective cohort study of patients aged 18-44 years old using either IUDs or subdermal implants for contraception in a large commercial claims database (MarketScan) from 2012 to 2015. All patients had at least 12 months of continuous enrollment both before and after contraceptive placement. Patients with a history of hip pain or surgery were excluded. The primary outcome was new hip pain. Secondary outcomes included visiting an orthopaedic or sports medicine provider for a hip complaint, intra-articular hip injection, and arthroscopic hip surgery. Outcomes were analyzed with Cox proportional-hazard models. Results: We identified a total of 242,383 patients, including 216,541 (89.3%) with IUDs and 25,842 (10.7%) with subdermal contraceptive implants. In time-to-event analysis, IUDs (vs implants) were not associated with increased risk of new hip pain diagnoses (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.87-1.03, P ¼ .21). In contrast, both age (P < .001) and region (P < .001) were associated with increased risk of new hip pain. Similar results were seen for the secondary outcomes, including risk of orthopaedic visits for hip complaints (

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Musculoskeletal Considerations in Female Patients with Chronic Pelvic Pain

Cited by 22 publications

References 21 publications

Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association

Pelvic floor muscle dysfunctions in women with deep infiltrative endometriosis: An underestimated association

Chronic Pelvic Pain in Women

No Association Between Intrauterine Contraceptive Devices and Musculoskeletal Hip Joint Pain

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