Musculoskeletal and Pelvic Floor Health in Female Chronic Overlapping Pelvic Pain Conditions (The MSK-PELVIC Study)

项目摘要 慢性盆腔疼痛(CPP)可能影响多达四分之一的女性。传统上，CPP一直被认为是 由内脏疼痛机制驱动，如间质性膀胱炎/痛性膀胱综合征(IC/PBS)，易怒 肠综合征(IBS)和子宫内膜异位症。还证实，这些内脏疼痛状况与 外阴疼痛、纤维肌痛、抑郁和焦虑。最近，盆底下肌筋膜(PFMP) 和协同失调已被确定为额外的重叠的CPP条件。先前的研究表明，全氟甲烷管理计划 可能是内脏-躯体反应，然而，PFMP作为其他区域的代偿结果 肌肉骨骼(MSK)条件也被提出。事实上，在她们的一生中，女性面临更高的 MSK损伤过多和慢性MSK疾病的风险比男性高，包括患病率增加 运动相关损伤、关节活动过度、纤维肌痛、骨关节病(绝经后)，以及 骨质疏松/骨质疏松相关骨折。这些升高的风险被认为是由于独特的 解剖(结构)、生物力学和激素因素，可归因于生理过程 怀孕和衰老。目前的申请旨在解决关于以下方面的重大知识差距 对CPP患者PFM的神经肌肉功能以及重叠MSK的作用认识有限 可能影响PFM反应的条件和MSK健康状况。短期目标是检查烤瓷修复体 通过确定不同重叠的CPP女性最精确的肌肉测量进行生物力学研究 诊断与无症状对照的比较，以及评估整体MSK健康/体力活动。这个 长期目标是确定MSK盆腔疼痛的机制，这将为临床相关的分类提供信息， 为患有慢性阻塞性肺病的妇女开发循证的非药物(物理治疗/运动)治疗方法，以及 PFM功能和CPP领域的高级研究工具，因为它关系到MSK的整体健康。我们的 创新策略结合了使用新设备的神经肌肉测量和经过验证的测量 评估CPP、MSK健康状况和体力活动。我们的中心假设是患有CPP的女性 显示可量化的PFM异常和不同于无症状的临床MSK特征 控制。这项研究的结果将对公共卫生产生重大影响，严谨的贡献 客观、全面的PFM和MSK方法，适用于NIH今后的临床研究 网络/试验，以评估和评估MSK对妇女的贡献和潜在的治疗结果 CPP。

Project Abstract Chronic pelvic pain (CPP) may affect up to a quarter of all women. Traditionally, CPP has been thought to be driven by visceral pain mechanisms such as Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), Irritable bowel syndrome (IBS) and endometriosis. It is also established that these visceral pain conditions overlap with vulvodynia, fibromyalgia, depression, and anxiety. More recently, underlying pelvic floor myofascial (PFMP) and dyssynergia have been identified as additional overlapping CPP conditions. Prior work suggests PFMP may be a viscera-somatic response, however, PFMP as a compensatory consequence of other regional musculoskeletal (MSK) conditions has also been proposed. Indeed, across their lifespan, women face higher risks than men for a plethora of MSK injuries and chronic MSK conditions, including an increased prevalence of sports-related injuries, joint hypermobility, fibromyalgia, osteoarthritic conditions (post-menopause), and osteoporosis/osteoporosis-associated fractures. These elevated risks are thought to be due to the unique anatomic (structural), biomechanical, and hormonal factors that can be attributed to the physiologic process of pregnancy and aging. The current application aims to address the significant knowledge gap regarding the limited understanding of the neuromuscular function of the PFM in CPP as well as the role of overlapping MSK conditions and MSK health that may be influencing PFM response. The short-term goal is to examine PFM biomechanics by identifying the most precise muscle measures in women with CPP of various overlapping diagnoses compared to asymptomatic controls, along with assessing overall MSK health/physical activity. The long-term goal is to determine MSK pelvic pain mechanisms that will inform clinically relevant classification, develop evidence-based non-pharmacologic (physical therapy/exercise) treatments for women with CPP, and advance research tools in the area of PFM function and CPP as it relates to overall MSK health. Our innovative strategy combines neuromuscular measures using novel devices and validated measures in evaluating CPP, MSK health, and physical activity. Our central hypothesis is that women with CPP will demonstrate quantifiable PFM abnormalities and clinical MSK characteristics that differ from asymptomatic controls. The results from this study will have a significant public health impact with contributions of rigorous objective and comprehensive PFM and MSK methods, which will be suitable for future NIH clinical research networks/trials, to evaluate and assess the MSK contribution and potential treatment outcomes in women with CPP.