Abstract
Aims: Reporting the effects of treating underlying myofascial dysfunction and neuropathic pain in women with chronic pelvic pain syndrome (CPPS).
Methods: Retrospective longitudinal study of 186 women with CPPS treated with ultrasound‐guided peripheral nerve blocks and trigger point injections to pelvic floor muscles alongside pelvic floor physical therapy once weekly for 6 weeks in an outpatient setting. Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS) questionnaires quantified pain and function in the pelvis. Working, intercourse, sleeping, walking, running, lifting, bladder, and bowel were the function categories. Statistical significance was established by p value less than .05 in paired two‐sample t‐test.
Results: VAS improved by 2.14 where average VAS before treatment was 6.61
(standard deviation [SD] 2.45; p < .05, 95% confidence interval [CI] = 6.26–6.96) and average VAS after treatment was 4.47 (SD 2.71; p < .05, 95% CI = 4.08–4.86). Total FPPS decreased by 3.38 from 11.26 (SD 6.51; p < .05, 95% CI = 10.32–12.19) before treatment to 7.88 (SD 6.22; p < .05, 95% CI = 6.99–8.78) after treatment. Working, intercourse, and sleeping accounted for the highest statistically significant improvement.
Conclusion: Findings support the success of the comprehensive treatment protocol. Patients who had persistent symptoms after a full course of pelvic floor physical therapy experienced improvements in pain levels and function once it was combined with ultrasound‐guided nerve blocks and trigger point injections, interactively treating underlying neuromuscular dysfunction.
Chronic pelvic pain syndrome (CPPS), a multifactorial, debilitating condition combining the anatomic malfunction of pelvic floor musculature and malfunction of pain perception.1 The noncyclical pain restricts function and is persistent for more than 6 months. Applying this rigorous definition of “noncyclical pain lasting at least 6 months,” a 2014 review found prevalence ranged from 5.7% to 26.6%. Additionally, the presence of overlapping pain syndromes such as endometriosis and bladder pain syndrome were 70% and 61%, respectively.2 The specific etiology of CPPS has not been identified, however its symptoms present as an interplay between dysfunction in the gastrointestinal, gynecological, urological, musculoskeletal, and neurological systems.1 Relevant underlying factors in CPPS include myofascial and neuropathic pain and dysfunction. The neuropathic factors in CPPS include the triad of peripheral sensitization, central sensitization, and cross‐sensitization. Essentially, experiencing pain long term alters the brain’s processing and perception of pain signals leading to an “exaggeration” phenomenon with amplification of pain.3 This minimally understood, complex disease process makes CPPS diagnosis and treatment unpredictable with ineffective patient outcomes.4 Traditional treatment approaches include (1) identifying and treating overlapping pain syndromes including endometriosis, interstitial cystitis/bladder pain syndrome, and irritable bowel syndrome2 ; (2) identifying and treating potential underlying primary pain generators such as a multitude of gynecological disorders, femoral acetabular impingement/labral tear, hernias, pelvic congestion syndrome, and gastroenterology disorders1 ; (3) pharmacological treatment options such as anti‐inflammatories, analgesics, central nervous system neuromodulators, muscle relaxers, and hormonal suppression2 ; (4) and nonpharmacological treatments such as pelvic floor physical therapy, physiatry, acupuncture, lifestyle modifications, nutrition, cognitive behavioral therapy, and yoga. Patient education on the benefits of a multimodal, comprehensive treatment plan to include a mixture of behavioral therapy, pelvic floor physical therapy, physiatry, nutrition, medications, and surgical options when applicable is important.1,2
