Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study.
Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: A cross-sectional study.
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DOI：
10.1002/ejp.1713
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Shah JP
中科院分区：
文献类型：
--
作者：
Phan VT;Stratton P;Tandon HK;Sinaii N;Aredo JV;Karp BI;Merideth MA;Shah JP
即使在病灶切除和优化激素治疗后，一些患有子宫内膜异位症的女性仍持续存在慢性盆腔疼痛。描述患有子宫内膜异位症相关慢性盆腔疼痛的女性疼痛、肌筋膜功能障碍和骨盆以外的敏感化的存在和分布。在参加临床试验之前对 30 名女性进行的横断面研究。评估包括以疼痛为中心的腹部盆腔妇科检查，以识别盆底肌肉痉挛。神经肌肉骨骼检查评估了 13 对肌肉的双侧椎旁异常性疼痛和痛觉过敏以及肌筋膜触发点。测量棘间韧带和触发点的压痛阈值。女性完成了身体疼痛指数的身体区域要素。所有女性都患有盆底肌肉痉挛，她们认为这是疼痛的主要焦点。 30 名女性中有 20 名将她们的骨盆疼痛描述为局灶性疼痛。然而，在 26 个评估区域中，超过三分之二的区域都表现出广泛的肌筋膜功能障碍，压力疼痛阈值和触发点较低。 17/30 存在广泛的脊柱节段性敏化，21/30 存在胸部节段性敏化，18/30 存在腰骶/骨盆节段性敏化。宫颈过敏表现为压力疼痛阈值低，23/30 的人还报告反复出现严重头痛，21/30 的人经历口面部疼痛。那些报告弥漫性骨盆疼痛的人更有可能有广泛的 (p=.024) 和腰骶部/骨盆 (p=.036) 过敏，并报告超过 10 个身体部位疼痛 (p=.009)。患有子宫内膜异位症相关慢性盆腔疼痛的女性通常会出现盆腔区域以外的肌筋膜功能障碍和过敏，这可能是由持续的盆底痉挛引起或维持的。在处理该人群的疼痛时，需要考虑这些肌筋膜和神经系统表现。 ClinicalTrials.gov 标识符：NCT01553201
Chronic pelvic pain persists in some women with endometriosis even after lesion removal and optimized hormonal treatment. Characterize the presence and distribution of pain, myofascial dysfunction, and sensitization beyond the pelvis in women with endometriosis-associated chronic pelvic pain. 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. 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). 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. Clinicaltrials.gov identifier: NCT01553201
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5.3
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