Rev. Soc. Esp. Dolor. 2022; 29(2): 88-96 / DOI: 10.20986/resed.2022.3970/2022
Diana Alejandra Mendez, Leonardo Arce, María Ana Tovar
ABSTRACT
Introduction: Pelvic floor myofascial pain syndrome in women is a frequent cause of acute and chronic pain, sometimes superimposed on other pathological entities. It is secondary to mechanical muscle overload that favors the appearance of trigger points.
Objective: To describe a frequent painful entity, its pathophysiology, and treatment possibilities.
Methodology: A literature review was carried out with Mesh terms in English and Spanish in the databases Embase, Pubmed, Lilacs, Sage, Google Academics, Scielo from 1983 to 2021. 240 articles were found and 50 were selected based on their clinical impact.
Results: Pelvic pain affects more than 50 % of women over 35 years of age. There are different clinical conditions that favor mechanical muscle overload and the formation of painful myofascial points. Diagnosis is clinical, but imaging studies may be requested. Treatment includes several modalities: physical therapy, psychotherapy, pharmacotherapy, and dry needling, electrical stimulation, and botulinum toxin.
Conclusion: Myofascial syndrome in the female pelvic musculature is a prevalent condition that should be considered within the diagnosis of pelvic pain and approached in a multidisciplinary manner.
RESUMEN
Introducción: El síndrome de dolor miofascial del suelo pélvico en la mujer es una causa frecuente de dolor agudo y crónico, en ocasiones superpuesto a otras entidades patológicas. Es secundario a la sobrecarga mecánica muscular que favorece la aparición de puntos gatillo.
Objetivo: Describir una entidad dolorosa frecuente, su fisiopatología y posibilidades de tratamiento.
Metodología: Se realizó una revisión de la literatura con términos Mesh en inglés y español en las bases de datos Embase, Pubmed, Lilacs, Sage, Google Acedemics y Scielo desde el año 1983 hasta el año 2021. Se encontraron 240 artículos y fueron seleccionados 50, basados en su impacto clínico.
Resultados: El dolor pélvico afecta a más del 50 % de las mujeres mayores de 35 años. Existen diferentes condiciones clínicas que favorecen la sobrecarga mecánica muscular y la formación de puntos miofasciales dolorosos. El diagnóstico es clínico, pero se pueden solicitar estudios imagenológicos. El tratamiento incluye varias modalidades: terapia física, psicoterapia, farmacoterapia e intervencionismo con aguja seca, estimulación eléctrica y toxina botulínica.
Conclusión: El síndrome miofascial en la musculatura pélvica femenina es una condición prevalente que debe ser considerada dentro del diagnóstico de dolor pélvico y abordada de manera multidisciplinaria.
Nuevo comentario
Comentarios
No comments in this article
Bibliografía
1. Li L, Stoop R, Clijsen R, Hohenauer E, Fernández-de-Las-Peñas C, Huang Q, et al. Criteria Used for the Diagnosis of Myofascial Trigger Points in Clinical Trials on Physical Therapy: Updated Systematic Review. Clin J Pain. 2020;36(12):955-67.
2. Duarte FCK, West DWD, Linde LD, Hassan S, Kumbhare DA. Re-Examining Myofascial Pain Syndrome: Toward Biomarker Development and Mechanism-Based Diagnostic Criteria. Curr Rheumatol Rep. 2021;23(8):69.
3. Fernández-de-Las-Peñas C, Dommerholt J. International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. Pain Med. 2018;19(1):142-50.
4. Gerwin RD. Diagnosis of myofascial pain syndrome. Phys Med Rehabil Clin N Am. 2014;25(2):341-55.
5. Kosek E, Clauw D, Nijs J, Baron R, Gilron I, Harris RE, et al. Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain. 2021;162(11):2629-34.
6. Arce Gálvez L, Mendez Vega DA. Role of microglia in the pathophysiology of neuropathic pain: Hormonal, neuroimmunological, and nociceptive differences by sex. Neurol Perspect. 2021;1:242-3.
7. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:523924.
8. Santoro G, Sultan A. Pelvic Floor Anatomy and Imaging. Semin Colon Rectal Surg. 2015;27(1):5-14.
9. Carrillo K, Sanguineti M. Anatomía del piso pélvico. Rev Med Clín Las Condes. 2013;24(2):185-9.
10. Spitznagle TM, Robinson CM. Myofascial pelvic pain. Obstet Gynecol Clin North Am. 2014;41(3):409-32.
11. Eickmeyer SM. Anatomy and Physiology of the Pelvic Floor. Phys Med Rehabil Clin N Am. 2017;28(3):455-60.
12. Aredo J V, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction. Semin Reprod Med. 2017;35(1):88-97.
13. Hsu AL, Sinaii N, Segars J, Nieman LK, Stratton P. Relating pelvic pain location to surgical findings of endometriosis. Obstet Gynecol. 2011;118(2 Pt 1):223-30.
14. Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual. Vol. 2. London: Lippincott Williams & Wilkins; 1983.
15. Shrikhande A, Ullger C, Seko K, Patil S, Natarajan J, Tailor Y, et al. A physiatrist’s understanding and application of the current literature on chronic pelvic pain: a narrative review. Pain Rep. 2021;6(3):e949.
16. Méndez DA, Arce L. Comentario al artículo “Radiofrecuencia pulsada del nervio pudendo: una técnica eficaz en la que debemos avanzar en el abordaje”. Rev Soc Esp Dolor. 2021;28(5):301-3. DOI: 10.20986/resed.2021.3951/2021.
17. Wolff BJ, Joyce CJ, Brincat CA, Mueller ER, Fitzgerald CM. Pelvic floor myofascial pain in patients with symptoms of urinary tract infection. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2019;145(2):205-11.
18. Bonder JH, Chi M, Rispoli L. Myofascial Pelvic Pain and Related Disorders. Phys Med Rehabil Clin N Am. 2017;28(3):501-15.
19. Hidalgo-Lozano A, Fernández-de-las-Peñas C, Calderón-Soto C, Domingo-Camara A, Madeleine P, Arroyo-Morales M. Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles. Scand J Med Sci Sports. 2013;23(1):66-73.
20. Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004;8(6):468-75.
21. Kosek E, Cohen M, Baron R, Gebhart GF, Mico J-A, Rice ASC, et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016;157(7):1382-6.
22. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895-926.
23. Arendt-Nielsen L, Graven-Nielsen T. Central sensitization in fibromyalgia and other musculoskeletal disorders. Curr Pain Headache Rep. 2003;7(5):355-61.
24. Botelho LM, Morales-Quezada L, Rozisky JR, Brietzke AP, Torres ILS, Deitos A, et al. A Framework for Understanding the Relationship between Descending Pain Modulation, Motor Corticospinal, and Neuroplasticity Regulation Systems in Chronic Myofascial Pain. Front Hum Neurosci. 2016;10:308.
25. Meister MR, Shivakumar N, Sutcliffe S, Spitznagle T, Lowder JL. Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review. Am J Obstet Gynecol. 2018;219(5):497.e1-497.e13.
26. Ross V, Detterman C, Hallisey A. Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain. J Midwifery Womens Health. 2021;66(2):148-60.
27. Rosenbaum TY, Owens A. Continuing Medical Education: The Role of Pelvic Floor Physical Therapy in the Treatment of Pelvic and Genital Pain-Related Sexual Dysfunction (CME). J Sex Med. 2008;5(3):513-23.
28. Wagner B, Steiner M, Huber DFX, Crevenna R. The effect of biofeedback interventions on pain, overall symptoms, quality of life and physiological parameters in patients with pelvic pain. Wien Klin Wochenschr. 2022;134(Suppl 1):11-48.
29. Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J. 2018;29(5):631-8.
30. Kalichman L, Ben David C. Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: A narrative review. J Bodyw Mov Ther. 2017;21(2):446-51.
31. Grinberg K, Weissman-Fogel I, Lowenstein L, Abramov L, Granot M. How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag. 2019;2019:6091257.
32. Prosser BL, Khairallah RJ, Ziman AP, Ward CW, Lederer WJ. X-ROS signaling in the heart and skeletal muscle: stretch-dependent local ROS regulates (Ca2+)i. J Mol Cell Cardiol. 2013;58:172-81.
33. Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680-91.
34. Garjón Parra J. Evaluación y selección de medicamentos. Farm Atención Primaria. 2011;9:8994.
35. Wilton J, Abdia Y, Chong M, Karim ME, Wong S, MacInnes A, et al. Prescription opioid treatment for non-cancer pain and initiation of injection drug use: large retrospective cohort study. BMJ. 2021;375:e066965.
36. Cashin AG, Folly T, Bagg MK, Wewege MA, Jones MD, Ferraro MC, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. 2021;374:n1446.
37. Chen J, Li L, Chen S-R, Chen H, Xie J-D, Sirrieh RE, et al. The α2δ-1-NMDA Receptor Complex Is Critically Involved in Neuropathic Pain Development and Gabapentin Therapeutic Actions. Cell Rep. 2018;22(9):2307-21.
38. Frederice CP, Brito LGO, Pereira GMV, Lunardi ALB, Juliato CRT. Interventional treatment for myofascial pelvic floor pain in women: systematic review with meta-analysis. Int Urogynecol J. 2021;32(5):1087-96.
39. Diep D, Chen KJQ, Kumbhare D. Ultrasound-guided interventional procedures for myofascial trigger points: a systematic review. Reg Anesth Pain Med. 2021;46(1):73-80.
40. Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res. 2019;12:1899-911.
41. Shah JP, Danoff J V, Desai MJ, Parikh S, Nakamura LY, Phillips TM, 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(1):16-23.
42. Chae Y, Chang D-S, Lee S-H, Jung W-M, Lee I-S, Jackson S, et al. Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation. J Pain. 2013;14(3):215-22.
43. Niddam DM, Chan R-C, Lee S-H, Yeh T-C, Hsieh J-C. Central modulation of pain evoked from myofascial trigger point. Clin J Pain. 2007;23(5):440-8.
44. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256-63.
45. Brennan KL, Allen BC, Maldonado YM. Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial. J Orthop Sports Phys Ther. 2017;47(4):232-9.
46. Fouad LS, Pettit PD, Threadcraft M, Wells A, Micallef A, Chen AH. Trigger Point Injections for Pelvic Floor Myofascial Spasm Refractive to Primary Therapy. J Endometr Pelvic Pain Disord. 2017;9:125-30.
47. Jha S, Toozs-Hobson P, Roper JC, Gurung S, Brair A, Bach F. Botulinum injections for myofascial pelvic pain. Int Urogynecol J. 2021;32(5):1151-6.
48. Park J, Park HJ. Botulinum Toxin for the Treatment of Neuropathic Pain. Toxins (Basel). 2017;9(9):260.
49. Meister MR, Brubaker A, Sutcliffe S, Lowder JL. Effectiveness of Botulinum Toxin for Treatment of Symptomatic Pelvic Floor Myofascial Pain in Women: A Systematic Review and Meta-analysis. Female Pelvic Med Reconstr Surg. 2021;27(1):e152-60.
50. Halder GE, Scott L, Wyman A, Mora N, Miladinovic B, Bassaly R, et al. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain. Investig Clin Urol. 2017;58(2):134-9.
Artículos relacionados
Pain: a "hotchpotch"
Rev. Soc. Esp. Dolor. 2020; 27(4): 278-280 / DOI: 10.20986/resed.2016.3507/2016