Abstract
Background
Women with dysmenorrhea plus symptomatic urinary calculosis experience enhanced pain and referred muscle hyperalgesia from both conditions than women with one condition only (viscero‐visceral hyperalgesia). The study aimed at verifying if enhanced dysmenorrhea persists after urinary stone elimination in comorbid women and if local anesthetic inactivation of myofascial trigger points (TrPs) in the lumbar area (of urinary pain referral) also relieves dysmenorrhea.
Methods
31 women with dysmenorrhea plus previous urinary calculosis (Dys+PrCal) and lumbar TrPs, and 33 women with dysmenorrhea without calculosis (Dys) underwent a 1‐year assessment of menstrual pain and muscle hyperalgesia in the uterus referred area (electrical pain threshold measurement in rectus abdominis, compared with thresholds of 33 healthy controls). At the end of the year, 16 comorbid patients underwent inactivation of TrPs through anesthetic injections, while the remaining 12 received no TrP treatment. Both groups were monitored for another year at the end of which thresholds were re‐measured.
Results
In year1, Dys+PrCal presented significantly more painful menstrual cycles and lower abdominal thresholds than Dys, thresholds of both groups being significantly lower than normal (p<0.001). Anesthetic treatment vs no treatment of the lumbar TrP significantly reduced the number of painful cycles during year2 and significantly increased the abdominal thresholds (p<0.0001).
Conclusion
Viscero‐visceral hyperalgesia between uterus and urinary tract may persist after stone elimination due to nociceptive inputs from TrPs in the referred urinary area, since TrPs treatment effectively reverses the enhanced menstrual symptoms. The procedure could represent an integral part of the management protocol in these conditions.
from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2H8y6xR
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