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Myofascial Pelvic Pain

  • Myofascial Pain (RD Gerwin, Section editor)
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Abstract

Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings.

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References

Papers of particular interest, published recently, have been highlighted as: • Of major importance •• Of major importance

  1. Hahn L. Chronic pelvic pain in women. A condition difficult to diagnose—more than 70 different diagnoses can be considered. Lakartidningen. 2001;98:1780–5.

    PubMed  CAS  Google Scholar 

  2. Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87:321–7.

    Article  PubMed  CAS  Google Scholar 

  3. Zondervan KT, Yudkin PL, Vessey MP, et al. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Br J Gen Pract. 2001;51:541–7.

    PubMed  CAS  Google Scholar 

  4. Krieger JN, Riley DE, Cheah PY, et al. Epidemiology of prostatitis: new evidence for a world-wide problem. World J Urol. 2003;21:70–4.

    Article  PubMed  Google Scholar 

  5. ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 51. Chronic pelvic pain. Obstet Gynecol. 2004;103:589–605.

    Google Scholar 

  6. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37–49.

    Article  PubMed  Google Scholar 

  7. Krieger JN, Nyberg L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236–7.

    Article  PubMed  CAS  Google Scholar 

  8. Wesselmann U. Neurogenic inflammation and chronic pelvic pain. World J Urol. 2001;19:180–5.

    Article  PubMed  CAS  Google Scholar 

  9. Simons DG, Travell JG, Simons LS, editors. Travell & Simons’ myofascial pain and dysfunction: the trigger point manual. Volume 1: The upper half of body. .Volume 2: The lower extremities. Baltimore: Lippincott Williams & Wilkins; 1992, 1983.

  10. Baskin LS, Tanagho EA. Pelvic pain without pelvic organs. J Urol. 1992;147:683–6.

    PubMed  CAS  Google Scholar 

  11. Schmidt RA, Vapnek JM. Pelvic floor behavior and interstitial cystitis. Semin Urol. 1991;9:154–9.

    PubMed  CAS  Google Scholar 

  12. Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol. 2007;21:367–87.

    Article  PubMed  Google Scholar 

  13. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004;14:95–107.

    Article  PubMed  Google Scholar 

  14. Doggweiler-Wiygul R. Urologic myofascial pain syndromes. Curr Pain Headache Rep. 2004;8:445–51.

    Article  PubMed  Google Scholar 

  15. Herbert B. Chronic pelvic pain. Altern Ther Health Med. 2010;16:28–33.

    PubMed  Google Scholar 

  16. Hoffman D. Understanding multisymptom presentations in chronic pelvic pain: the inter-relationships between the viscera and myofascial pelvic floor dysfunction. Curr Pain Headache Rep. 2011;15:343–6.

    Article  PubMed  Google Scholar 

  17. Pezzone MA, Liang R, Fraser MO. A model of neural cross-talk and irritation in the pelvis: implications for the overlap of chronic pelvic pain disorders. Gastroenterology. 2005;128:1953–64.

    Article  PubMed  Google Scholar 

  18. Howard FM. Pelvic floor pain syndrome. In: Howard FM, Perry CP, Carter JE, editors. Pelvic pain: diagnosis & management. Baltimore: Lippincott Williams & Wilkins; 2000. p. 429–32.

    Google Scholar 

  19. Bouman HD. Discussion on terminology. Am J Phys Med. 1967;46:1051–84.

    Google Scholar 

  20. Head H. On disturbances of sensation with especial reference to the pain of visceral disease. Brain. 1893;16:1–133.

    Article  Google Scholar 

  21. •• Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152:S2–S15. This article is a well-done comprehensive explanation of central sensitization.

    Article  PubMed  Google Scholar 

  22. Fernández-Carnero J, Fernández-de-Las-Peñas C, de la Llave-Rincón AI, et al. Widespread mechanical pain hypersensitivity as sign of central sensitization in unilateral epicondylalgia: a blinded, controlled study. Clin J Pain. 2009;25:555–61.

    Article  PubMed  Google Scholar 

  23. Fernández-de-las-Peñas C, Galán-del-Río F, Fernández-Carnero J, et al. Bilateral widespread mechanical pain sensitivity in women with myofascial temporomandibular disorder: evidence of impairment in central nociceptive processing. J Pain. 2009;10:1170–8.

    Article  PubMed  Google Scholar 

  24. •• Xu Y, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in health subjects. J Pain. 2010;11:1348–55. This study demonstrates how myofascial trigger point can be an initiator of central sensitization.

    PubMed  Google Scholar 

  25. Langevin HM. Connective tissue: a body-wide signaling network? Med Hypotheses. 2006;66:1074–7.

    Article  PubMed  Google Scholar 

  26. • Stecco C, Stern R, Porzionato A, et al. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat. 2011;33:891–6. Physical changes within loose connective are documented and postulated as a possible source of pain in myofascial pain syndromes.

    Article  PubMed  Google Scholar 

  27. Fitzgerald CM, Neville CE, Mallinson T, et al. Pelvic floor muscle examination in female chronic pelvic pain. J Reprod Med. 2011;56:117–22.

    PubMed  Google Scholar 

  28. Shoskes DA, Berger R, Elmi A, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008;179:556–60.

    Article  PubMed  Google Scholar 

  29. Montenegro ML, Mateus-Vasconcelor EC, Rosa e Silva JC, et al. Importance of pelvic muscle tenderness evaluation in women with chronic pelvic pain. Pain Med. 2010;11:224–8.

    Article  PubMed  Google Scholar 

  30. Kavvadias T, Baessler K, Schuessler B. Pelvic pain urogynaecology. Part I: evaluation, definitions and diagnoses. Int Urogynecol J. 2011;22:385–93.

    Article  PubMed  Google Scholar 

  31. Itza F, Zarza D, Serra L, et al. Myofascial pain syndrome in the pelvic floor: a common urological condition. Actas Urol Esp. 2010;34:318–26.

    Article  PubMed  CAS  Google Scholar 

  32. Bassaly R, Tidwell N, Bertolino S, et al. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J. 2011;22:413–8.

    Article  PubMed  Google Scholar 

  33. •• FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009;182:570–80. This is the first randomized clinical trial that elucidates potential treatment options with a high success rate for patients with myofascial pelvic pain.

    Article  PubMed  Google Scholar 

  34. •• FitzGerald MP, Payne CK, Lukacz ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome (IC/PBS) and pelvic floor tenderness. J Urol. 2012; In Press. This is the second NIDDK funded trial to have a high positive responder rate with myofascial physical therapy.

  35. Lee SH, Lee BC. Use of acupuncture as a treatment method for chronic prostatitis/chronic pelvic pain syndromes. Curr Urol Rep. 2011;12:288–96.

    Article  PubMed  CAS  Google Scholar 

  36. Jabbari B, Machado D. Treatment of refractory pain with botulinum toxins—an evidence-based review. Pain Med. 2011;12:1594–606.

    Article  PubMed  Google Scholar 

  37. Doggweiler R, Stewart AF. Pelvic floor therapies in chronic pelvic pain syndrome. Curr Urol Rep. 2011;12:304–11.

    Article  PubMed  Google Scholar 

  38. Anderson RU, Wise D, Sawyer R, et al. 6-day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. J Urol. 2011;185:1294–9.

    Article  PubMed  Google Scholar 

  39. •• Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185:2162–70. This is the new American Urological Association’s guideline for evaluating and treating interstitial cystitis/painful bladder syndrome that acknowledges the need for treatment of myofascial dysfunction.

    Article  PubMed  Google Scholar 

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No potential conflicts of interest relevant to this article were reported.

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  1. Rhonda Kotarinos Physical Therapy, Ltd., One TransAm Plaza Drive, Suite 170, Oakbrook Terrace, IL, 60181, USA

    Rhonda Kotarinos

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  1. Rhonda Kotarinos
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Correspondence to Rhonda Kotarinos.

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Kotarinos, R. Myofascial Pelvic Pain. Curr Pain Headache Rep 16, 433–438 (2012). https://doi.org/10.1007/s11916-012-0277-8

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  • DOI: https://doi.org/10.1007/s11916-012-0277-8

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