Abstract
Background
Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment.
Objective
Characterize the presence and distribution of pain, myofascial dysfunction, and sensitization beyond the pelvis in women with endometriosis‐associated chronic pelvic pain.
Methods
Cross‐sectional study of 30 women prior to participation in a clinical trial. Evaluation included pain‐focused abdominopelvic gynecologic examination with identification of pelvic floor muscle spasm. Neuro‐musculoskeletal examination assessed paraspinal allodynia and hyperalgesia bilaterally and myofascial trigger‐points in 13 paired muscles. Pressure‐pain thresholds were measured over interspinous ligaments and trigger‐points. Women completed the body territories element of the Body Pain Index.
Results
All women had pelvic floor muscle spasm that they self‐identified as a major focus of pain. Twenty of 30 women described their pelvic pain as focal. However, all demonstrated widespread myofascial dysfunction with low pressure‐pain thresholds and trigger‐points in over two‐thirds of 26 assessed regions. Widespread spinal segmental sensitization was present in 17/30, thoracic in 21/30, and lumbosacral/pelvic in 18/30. Cervical sensitization manifested as low pressure‐pain thresholds with 23/30 also reporting recurrent, severe headaches and 21/30 experiencing orofacial pain. Those reporting diffuse pelvic pain were more likely to have widespread (p=.024) and lumbosacral/pelvic (p=.036) sensitization and report over 10 painful body areas (p=.009).
Conclusions
Women with endometriosis‐associated chronic pelvic pain often have myofascial dysfunction and sensitization beyond the pelvic region that may be initiated or maintained by on‐going pelvic floor spasm. These myofascial and nervous system manifestations warrant consideration when managing pain in this population.
from Wiley: European Journal of Pain: Table of Contents https://ift.tt/38dSF9h
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