High density Surface EMG Assessment of the Pelvic Muscle Hypertonicity Associated with Interstitial Cystitis/Bladder Pain Syndrome

摘要 间质性膀胱炎/膀胱痛综合征(IC/BPS)是一种衰弱的慢性盆腔疼痛状况，与 尿急和尿频影响着美国多达790万女性。这个 IC/BPS的病理生理学机制仍不完全清楚，但被认为涉及中枢和中枢神经 疼痛和内脏感觉信号处理过程中的外周干扰。可能存在盆底功能障碍 导致受影响妇女所经历的疼痛，如肌筋膜痛和盆底高张 85%的IC/BPS患者和其他慢性疼痛综合征患者存在功能障碍。还发现， 至少有一个肌筋膜触发点(TP)的IC患者中有78.3%的患者表现出肌筋膜疼痛。 目前针对盆底松弛的治疗方式包括TP注射和物理治疗， 在改善症状方面显示出积极的结果；然而，盆底TP和 高调性具有主观性、定性和操作者依赖性。手指触诊对TPS的识别 取决于治疗师对什么构成异常的主观感知，而且一直存在 专业泌尿科医生和治疗师对TPS的存在或不存在的分歧，他们的 异常的位置和程度。目前还没有关于骨盆的协议或标准化的协议 考试。缺乏对IC/BPS患者盆底肌功能的客观评价 有助于阐明盆底功能障碍在IC/BPS病理生理学中的作用 并提供了IC/BPS的客观表型特征。这项提议的目标是开发一种 IC/BPS患者盆底功能障碍的客观量化研究 高密度(HD)表面肌电(EMG)技术的最新进展。 这项研究是首次全面和定量地评估细胞的高渗性。 通过利用HD表面肌电的最新进展，与IC/BPS相关的PFMS 录音和信号处理技术。PI已成功捕获HD表面肌电信号 从使用多通道肌电探头的10名年轻健康女性受试者的PFM中，可以看到初步数据。 在这项提案中，这项创新将应用于IC/BPS患者。特定患者的高张严重程度 HD表面肌电信号客观测定PFMS的MAP、触发点MAP和神经支配带(IZ)图 将有助于了解IC/BPS潜在的PFM功能障碍。建议的高渗性严重程度 标测技术也可以作为一种新的工具来客观和定量地评价高渗性 IC/BPS患者外周血中的PFMS将PFM的TPS和IZS进行比较，以便更好地 了解它们之间的生理联系，进一步了解IC/BPS的病理生理机制。 TP和IZ检测技术还可以用来改进当前的治疗方法，例如 通过提供客观的注射或训练靶点进行TP注射和肌筋膜理疗。

Abstract Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic pelvic pain condition associated with urinary urgency and frequency that affects as many as 7.9 million women in the United States. The pathophysiology of IC/BPS remains incompletely understood but is thought to involve both central and peripheral disturbances in the processing of pain and viscerosensory signals. Pelvic floor dysfunctions likely contribute to the pain experienced by affected women, as myofascial pain and hypertonic pelvic floor dysfunction coexist in 85 % of patients with IC/BPS and other chronic pain syndromes. It was also found that myofascial pain was demonstrated in 78.3% of IC patients with at least one myofascial trigger point (TP). Current treatment modalities aimed at pelvic floor relaxation, including TP injection and physical therapy, have shown positive results on improving the syndromes; however, assessment of pelvic floor TP and hypertonicity is subjective, qualitative and operator-dependent. Identification of TPs through digital palpation depends on the therapist's subjective perception of what constitutes an abnormality and there has been disagreement between expert urologists and therapists regarding the presence or absence of TPs, their locations and degrees of abnormality. No agreement exists upon protocol or standardization of the pelvic exam. Objective measures of pelvic floor muscle (PFM) functions in IC/BPS patients are lacking, which would otherwise help elucidate the contribution of pelvic floor dysfunctions to the pathophysiology of IC/BPS and provide an objective phenotypic characteristic of IC/BPS. The goal of this proposal is to develop an objective and quantitative tool to standardize the characterization of pelvic floor dysfunction in IC/BPS using the most recent advances in high density (HD) surface electromyogram (EMG) techniques. This research represents the first effort to comprehensively and quantitatively assess the hypertonicity of the PFMs associated with IC/BPS, by taking advantage of the most recent advances in HD surface EMG recording and signal processing techniques. The PI has successfully captured HD surface EMG signals from the PFM of 10 young healthy female subjects using multi-channel EMG probes, see preliminary data. In this proposal, the innovation will be applied to IC/BPS patients. The patient-specific hypertonicity severity map, trigger point map and innervation zone (IZ) map of PFMs objectively determined with HD surface EMG will help understand the underlying PFM dysfunction in IC/BPS. The proposed hypertonicity severity mapping technique can also serve as a novel tool to objectively and quantitatively evaluate the hypertonicity the PFMs in patients with IC/BPS. The TPs and IZs of the PFM will be compared in order to better understand their physiological connections and further better understand the pathophysiology of IC/BPS. The TP and IZ detection techniques can also be utilized to improve current therapeutic approaches such as TP injection and myofascial physical therapy by providing objective injection or training targets.