Widespread Pain Hypersensitivity and Lumbopelvic Impairments in Women Diagnosed with Endometriosis

Abstract

Objective To explore hypersensitivity to pain and musculoskeletal impairments in the lumbopelvic area in women with and without endometriosis. Methods This cross-sectional study included 66 women (41 women with endometriosis and 25 healthy women). Pain and related catastrophizing thoughts were assessed through a numeric rating scale, pressure pain thresholds (PPTs), the slump test, and the Pain Catastrophizing Scale. Lumbopelvic muscles were evaluated through ultrasound imaging, flexor/extensor resistance tests, and the lumbopelvic stability test. Results Women with endometriosis showed increased self-reported intensity of current pelvic pain (CuPP), reduced local PPTs (42.8–64.7% in the affected area, P-value <.001) and higher prevalence of lumbar nerve root impingement/irritation pain and catastrophizing thoughts (P-value ≤.002). Moreover, affected women showed decreased thickness of transversus abdominis, reduced resistance of flexor and extensor trunk muscles and lower lumbopelvic stability (P-values <.030). Endometriosis stage and severity of CuPP were related to worse results in these parameters. Conclusions The presence of pain sensitization signs and lumbopelvic impairments, more pronounced in patients with stage IV endometriosis and moderate/severe CuPP, warrants the development of rehabilitation interventions targeting pain and lumbopelvic impairments in women with endometriosis.

‘Physio-EndEA’ Study: A Randomized, Parallel-Group Controlled Trial to Evaluate the Effect of a Supervised and Adapted Therapeutic Exercise Program to Improve Quality of Life in Symptomatic Women Diagnosed with Endometriosis

“…However, this is, to our knowledge, the first randomized controlled trial specifically designed to explore the contribution of a supervised tailored program of therapeutic exercise with special emphasis on the lumbopelvic area on physical and occupational impairments, as well as on the HRQoL of women with endometriosis and a clinical history of symptoms. In this regard, it is acknowledged that, apart from a neuromuscular control of lumbopelvic stability (i.e., a sensory input that alerts the central nervous system about interaction between the body and the environment, providing constant feedback and allowing refinement of movement), deep abdominal muscles (specifically TrA) and lumbar multifidus, whose thicknesses and strengths were found to be reduced in women with endometriosis [18,44], are the main muscles responsible for lumbopelvic stability [89]. Moreover, it has been reported that TrA and the lumbar multifidus are recruited prior shoulder and leg movements in healthy people (30 and 110 ms, respectively) [90,91].…”

“…Indeed, a case-control study focused on visceral osteopathy [37], a retrospective study evaluating electrical muscle stimulation [38] and two randomized controlled trials exploring the potential benefits of pulsed high-intensity laser therapy [39] and yoga [40] have reported a significant improvement in HRQoL in these patients, although the contribution to individ-ual occupational roles have not been addressed yet. Moreover, in contrast to osteopathy (with limited scientific evidence) or laser therapy (with non-standardized dosimetry), therapeutic exercise has been widely demonstrated to induce either soft tissue remodelling [41] and modifications in the nervous system [42], of particular interest in endometriosis given the elevated prevalence of central sensitization in these patients [43,44]. Additionally, it has been shown that regular physical exercise also exerts a protective effect against diseases that involve oxidative and/or inflammatory processes since it induces an increase in the systemic levels of mediators with anti-oxidant and anti-inflammatory properties [45].…”

“…Chronic pelvic and visceral pain are typically referred to as somatic structures (skin, subcutis and muscle) leading to significant trophic changes of soft tissues, such as decreased muscle thickness [48], probably due to pain-derived physical inactivity. In this context, a vicious circle is often identified in which pain in the lumbopelvic area [17,49] leads to physical inactivity and thus to muscle deconditioning that potentially affects deep abdominal muscles (with a postural function), which, in turn, might jeopardize motor control of the lumbopelvic area [44], increasing pain and decreasing the capacity to carry out their occupational roles [21]. In particular, recent findings of our research group have identified a number of physical impairments in women with endometriosis, including reduced pressure pain thresholds (PTTs), flexibility, body balance, muscle thickness and/or muscle strength of the lumbopelvic and abdominal regions; lower lumbopelvic stability and functional capacity; and increased fatigue when compared with healthy women [18,44].…”

“…In this context, a vicious circle is often identified in which pain in the lumbopelvic area [17,49] leads to physical inactivity and thus to muscle deconditioning that potentially affects deep abdominal muscles (with a postural function), which, in turn, might jeopardize motor control of the lumbopelvic area [44], increasing pain and decreasing the capacity to carry out their occupational roles [21]. In particular, recent findings of our research group have identified a number of physical impairments in women with endometriosis, including reduced pressure pain thresholds (PTTs), flexibility, body balance, muscle thickness and/or muscle strength of the lumbopelvic and abdominal regions; lower lumbopelvic stability and functional capacity; and increased fatigue when compared with healthy women [18,44]. In spite of the fact that few studies have recently reported benefits of exercise on HRQoL in endometriosis patients [40,50], none of them have been focused on the stabilization of the lumbopelvic area.…”

Effectiveness of a Manual Therapy Protocol in Women with Pelvic Pain Due to Endometriosis: A Randomized Clinical Trial

“…Furthermore, as a chronic pain condition, women with endometriosis may have decreased physical activity and experience physical deconditioning, which, in turn, may cause musculoskeletal consequences. Indeed, a poorer physical status, such as lower lumbopelvic mobility and increased fatigue, have been found in women with endometriosis when compared with healthy women [12], which may negatively impact their daily living activities.…”