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被认为是 由内脏疼痛机制驱动，如间质性膀胱炎/膀胱疼痛综合征（IC/PBS）、易激惹 肠综合征（IBS）和子宫内膜异位症。还确定这些内脏疼痛状况与 外阴痛、纤维肌痛、抑郁和焦虑。最近，底层盆底肌筋膜（PFMP） 和协同失调被认为是另外的重叠CPP病症。先前的工作表明PFMP 可能是一种内脏-躯体反应，然而，PFMP作为其他区域性的代偿结果， 肌肉骨骼（MSK）条件也已被提出。事实上，在她们的一生中， 风险比男性多的MSK损伤和慢性MSK条件，包括增加患病率 运动相关损伤、关节过度活动、纤维肌痛、骨关节炎（绝经后），以及 骨质疏松症/骨质疏松症相关骨折。这些高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。目前的应用程序旨在解决有关 对CPP中PFM的神经肌肉功能以及重叠MSK的作用的了解有限 条件和MSK健康可能会影响PFM的反应。短期目标是检查PFM 生物力学通过确定最精确的肌肉措施，在妇女与CPP的各种重叠 与无症状对照相比，沿着评估总体MSK健康/身体活动。的 长期目标是确定MSK盆腔疼痛机制，以告知临床相关分类， 为CPP女性患者开发循证非药物（物理疗法/运动）治疗，以及 先进的研究工具，在该地区的PFM功能和CPP，因为它涉及到整体MSK健康。我们 创新的策略结合了使用新设备的神经肌肉测量和有效的测量， 评估CPP、MSK健康和身体活动。我们的中心假设是，患有CPP的女性 证明可量化的PFM异常和临床MSK特征，不同于无症状 对照这项研究的结果将对公共卫生产生重大影响， 客观、全面的PFM和MSK方法，适用于未来NIH的临床研究 网络/试验，以评价和评估MSK的贡献和潜在的治疗结果的妇女 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.