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Treatment of myofascial pelvic pain syndrome in women

INTRODUCTION

The treatment of myofascial pelvic pain syndrome (MPPS) is multimodal and tailored to the individual patient. The general approach is to determine the trigger and then block or reduce ongoing stimuli that lead to pain. Most women will require a formalized program that includes pharmacologic treatment, physical therapy, and psychotherapy [1].

This topic will discuss the treatment of MPPS. Few large randomized trials have evaluated therapy of this disorder. Our approach is based on data from a few small trials and observational studies, as well as clinical experience. Many of these studies evaluated treatment of nonpelvic myofascial pain, such as myofascial pain associated with the back, neck, shoulder, or jaw. A limitation of observational studies of pain treatment is that patients may improve because of a true treatment effect, or because the natural history of the disease includes improvement in symptoms over time, or because of the Hawthorne effect (ie, improvement in symptoms simply because the patient is in a clinical trial) [2].

The clinical manifestations and diagnosis of MPPS are reviewed separately. (See "Clinical manifestations and diagnosis of myofascial pelvic pain syndrome in women".)

ADJUNCTIVE TREATMENT

Since identification and elimination of a specific trigger may not be possible, adjunctive therapies that provide symptom relief are also important in breaking the cycle of pain and urogenital dysfunction. Simple interventions such as meditation, progressive muscle relaxation, and attention to sleep hygiene can help to relieve physical and emotional tension.

PELVIC FLOOR PHYSICAL THERAPY

Primary treatment of MPPS involves manual myofascial release, stretching, and strengthening of affected areas via pelvic floor physical therapy (PFPT). Ideally, PFPT is performed by a physical therapist with specialized training in soft tissue manipulation and rehabilitation of the pelvis. (See "Pelvic floor physical therapy for management of myofascial pelvic pain syndrome in women".)

                           

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Literature review current through: Sep 2014. | This topic last updated: Nov 26, 2013.
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References
Top
  1. Yap EC. Myofascial pain--an overview. Ann Acad Med Singapore 2007; 36:43.
  2. Turner JA, Deyo RA, Loeser JD, et al. The importance of placebo effects in pain treatment and research. JAMA 1994; 271:1609.
  3. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:269.
  4. Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 2001; 166:2226.
  5. Fisher KA. Management of dyspareunia and associated levator ani muscle overactivity. Phys Ther 2007; 87:935.
  6. Oyama IA, Rejba A, Lukban JC, et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 2004; 64:862.
  7. FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol 2009; 182:570.
  8. Niraj G, Collett BJ, Bone M. Ultrasound-guided trigger point injection: first description of changes visible on ultrasound scanning in the muscle containing the trigger point. Br J Anaesth 2011; 107:474.
  9. Langford CF, Udvari Nagy S, Ghoniem GM. Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain. Neurourol Urodyn 2007; 26:59.
  10. Volknandt W. The synaptic vesicle and its targets. Neuroscience 1995; 64:277.
  11. Erbguth FJ, Naumann M. Historical aspects of botulinum toxin: Justinus Kerner (1786-1862) and the "sausage poison". Neurology 1999; 53:1850.
  12. Graven-Nielsen T, Mense S. The peripheral apparatus of muscle pain: evidence from animal and human studies. Clin J Pain 2001; 17:2.
  13. Issberner U, Reeh PW, Steen KH. Pain due to tissue acidosis: a mechanism for inflammatory and ischemic myalgia? Neurosci Lett 1996; 208:191.
  14. Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil 1998; 79:863.
  15. Knutson GA. The role of the gamma-motor system in increasing muscle tone and muscle pain syndromes: a review of the Johansson/Sojka hypothesis. J Manipulative Physiol Ther 2000; 23:564.
  16. Jarvis SK, Abbott JA, Lenart MB, et al. Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles. Aust N Z J Obstet Gynaecol 2004; 44:46.
  17. Abbott, JA, Jarvis, SK, Lyons, SD, et al. Botulinum toxin type A for chronic pain and pelvic floor spasm in women. Obstet Gynecol 2006:108:915.
  18. Yoon H, Chung WS, Shim BS. Botulinum toxin A for the management of vulvodynia. Int J Impot Res 2007; 19:84.
  19. Dykstra DD, Presthus J. Botulinum toxin type A for the treatment of provoked vestibulodynia: an open-label, pilot study. J Reprod Med 2006; 51:467.
  20. Thomson AJ, Jarvis SK, Lenart M, et al. The use of botulinum toxin type A (BOTOX) as treatment for intractable chronic pelvic pain associated with spasm of the levator ani muscles. BJOG 2005; 112:247.
  21. Romito S, Bottanelli M, Pellegrini M, et al. Botulinum toxin for the treatment of genital pain syndromes. Gynecol Obstet Invest 2004; 58:164.
  22. Ghazizadeh S, Nikzad M. Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol 2004; 104:922.
  23. Tough EA, White AR, Cummings TM, et al. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain 2009; 13:3.
  24. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:261.
  25. FitzGerald MP, Brensinger C, Brubaker L, et al. What is the pain of interstitial cystitis like? Int Urogynecol J Pelvic Floor Dysfunct 2006; 17:69.
  26. Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 2008; 89:16.
  27. Manfredini D, Landi N, Tognini F, et al. Muscle relaxants in the treatment of myofascial face pain. A literature review. Minerva Stomatol 2004; 53:305.
  28. Melis M, Secci S. Diagnosis and treatment of atypical odontalgia: a review of the literature and two case reports. J Contemp Dent Pract 2007; 8:81.
  29. Rogalski MJ, Kellogg-Spadt S, Hoffmann AR, et al. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J 2010; 21:895.
  30. Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction: serum diazepam levels and efficacy data. Urol Nurs 2011; 31:279.
  31. Tofferi JK, Jackson JL, O'Malley PG. Treatment of fibromyalgia with cyclobenzaprine: A meta-analysis. Arthritis Rheum 2004; 51:9.
  32. Vickerman KA, Margolin G. Rape treatment outcome research: empirical findings and state of the literature. Clin Psychol Rev 2009; 29:431.
  33. Posmontier B, Dovydaitis T, Lipman K. Sexual violence: psychiatric healing with eye movement reprocessing and desensitization. Health Care Women Int 2010; 31:755.
  34. Affaitati G, Fabrizio A, Savini A, et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther 2009; 31:705.
  35. Dannecker EA, Knoll V, Robinson ME. Sex differences in muscle pain: self-care behaviors and effects on daily activities. J Pain 2008; 9:200.
  36. Roth RS, Punch MR, Bachman JE. Patient beliefs about pain diagnosis in chronic pelvic pain: relation to pain experience, mood and disability. J Reprod Med 2011; 56:123.
  37. Hoftun GB, Romundstad PR, Rygg M. Factors associated with adolescent chronic non-specific pain, chronic multisite pain, and chronic pain with high disability: the Young-HUNT Study 2008. J Pain 2012; 13:874.
  38. Meltzer-Brody S, Leserman J. Psychiatric Comorbidity in Women with Chronic Pelvic Pain. CNS Spectr 2011.