Assessing multifactorial etiology of IC/BPS using a novel PFM-Hip-Trunk muscle network analysis

摘要 间质性膀胱炎/膀胱痛综合征(IC/BPS)是最使人虚弱的慢性盆腔疼痛之一 (CPP)对生活质量和性行为产生负面影响的情况占2.7%至6.5% 美国的女性。盆底肌(PFM)过度活动，其特征是 紧张性肌肉活动是一种与肌筋膜痛有关的情况，出现在大多数CPP中。 疾病，包括高达85%患有IC/BPS的妇女。然而，盆底疼痛本质上是一种 可归因于姿势问题、肌筋膜触发点和异常的多因素功能障碍 肌肉紧张度。肌筋膜疗法，包括特定的盆底肌肉软组织松动术和 肌肉拉伸是IC/BPS合并PFM患者的标准治疗方法 温柔。不幸的是，即使在检查时有PFM压痛的IC/BPS患者中，也只有 59%的患者报告说在肌筋膜治疗后症状有所改善。盆底肌筋膜 然而，治疗并不能解决躯干和臀部的运动障碍，这也是 与骨盆疼痛有关。盆底肌肉表型框架将允许IC/BPS 对患者进行分类，便于个体化治疗。不幸的是，没有一种技术是 目前可用于定量和客观地评估与PFM相关的病因 IC/BPS，否则将促进对基本机制和 允许对患者进行适当的表型干预。 我们团队已经成功开发出一种新型的阴道内高密度表面 肌电(HD-sEMG)技术对PFM过度活动的可靠定量评估 患有IC/BPS的女性和2)开发了一种新的肌肉网络分析技术，以揭示 第一次，肌间连接模式的改变在患者中出现 神经肌肉状况，以及3)证明了IC/BPS患者聚类的可行性 形成表型亚群，这取决于潜在的机制。这项研究旨在 综合评估PFM过度活动、髋关节/躯干肌肉活动改变、PFM-to-Hip/ 躯干肌肉间连通性和IC/BPS中不同的PFM表型。这项研究 代表了第一个全面评估PFM过度活动、髋部/躯干肌肉活动的努力 PFM改变、PFM到髋部/躯干肌肉间的连通性和不同的PFM表型 IC/BPS。这些多因素评估的整合将促进我们的理解 IC/BPS的多因素病理改变。这些因素的相对重要性的量化 病理贡献者将允许IC/BPS患者的表型。烤瓷冠的鉴定 表型亚型可能有助于个性化的物理治疗。

Abstract Interstitial cystitis/ bladder pain syndrome (IC/BPS) is one of the most debilitating chronic pelvic pain (CPP) conditions that negatively impacts the quality of life and sexual activities in 2.7% to 6.5% of women in the US. Pelvic floor muscle (PFM) overactivity, characterized by an increase in the tonic muscle activity, is a condition related to myofascial pain that presents in the majority of CPP conditions, including up to 85% of women with IC/BPS. However, pelvic floor pain is intrinsically a multifactorial dysfunction that is attributed to postural issues, myofascial trigger points, and abnormal muscle tone. Myofascial therapy, including specific pelvic floor muscle soft tissue mobilization and muscle stretching, is standard treatment for patients with IC/BPS and concomitant PFM tenderness. Unfortunately, even among IC/BPS patients with PFM tenderness on exam, only 59% of patients report symptom improvement after myofascial therapy. Pelvic floor myofascial therapy, however, does not address movement impairments of the trunk and hips, which are also associated with pelvic pain. A pelvic floor muscle phenotyping framework would allow IC/BPS patients to be categorized to facilitate individualized treatment. Unfortunately, no technology is currently available for quantitatively and objectively assessing PFM etiologic factors associated with IC/BPS, which, otherwise, would advance the understanding of the underlying mechanisms and allow for phenotyping patients for appropriate intervention. Our team has successfully 1) developed a novel intra-vaginal high-density surface electromyography (HD-sEMG) technique to reliably and quantitatively assess PFM overactivity in women with IC/BPS and 2) developed a novel muscle network analysis technique to reveal, for the first time, the inter-muscular connectivity pattern alterations among patients with neuromuscular conditions, and 3) demonstrated the feasibility to cluster patients with IC/BPS into phenotypic subgroups, depending on the underlying mechanism. This study aims to comprehensively assess the PFM overactivity, hip/trunk muscle activity alteration, PFM-to-Hip/ Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in IC/BPS. This research represents the first effort to comprehensively assess the PFM overactivity, hip/trunk muscle activity alteration, PFM-to-Hip/Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in IC/BPS. The integration of these multifactorial assessments will advance our understanding of the multifactorial pathology of IC/BPS. The quantification of relative importance of these pathological contributors will allow for IC/BPS patient phenotyping. Identification of PFM phenotypic subtypes may facilitate personalized physical therapy treatments.