Abstract
Chronic pelvic pain (CPP) is a complex condition with a high economic and social burden. Although it is usually treated with botulinum neurotoxin type A (BoNT/A) injected into the pelvic floor muscles (PFM), its effect on their electrophysiological condition is unknown. In this study, 24 CPP patients were treated with BoNT/A. Surface electromyographic signals (sEMG) were recorded at Weeks 0 (infiltration), 8, 12 and 24 from the infiltrated, non-infiltrated, upper and lower PFM. The sEMG of 24 healthy women was also recorded for comparison. Four parameters were computed: root mean square (RMS), median frequency (MDF), Dimitrov’s index (DI) and sample entropy (SampEn). An index of pelvic electrophysiological impairment (IPEI) was also defined with respect to the healthy condition. Before treatment, the CPP and healthy parameters of almost all PFM sides were significantly different. Post-treatment, there was a significant reduction in power (<RMS), a shift towards higher frequencies (>MDF), lower fatigue index (<DI) and increased information complexity (>SampEn) in all sites in patients, mainly during PFM contractions, which brought their electrophysiological condition closer to that of healthy women (<IPEI). sEMG can be used to assess the PFM electrophysiological condition of CPP patients and the effects of therapies such as BoNT/A infiltration.
Highlights
Chronic pelvic pain (CPP) syndrome is defined as a persistent or recurrent pelvic pain that lasts more than 6 months and has no proven infection or obvious pathology to account for its presence [1]
The aims of the present work were: (1) to study the changes in the pelvic floor muscles (PFM) electrophysiological state of women with CPP associated with myofascial pelvic syndrome after treatment with botulinum neurotoxin type A (BoNT/A), (2) to determine whether these changes lead to a more or less non-pathological electrophysiological state and (3) to define an indicator to assess the degree of PFM electrophysiological impairment and assist in the patient’s clinical evaluation
Relevant changes in the PFM myoelectrical activity of CPP patients were identified after their treatment with BoNT/A: a reduction of its energy, a shift of the spectral content towards higher frequencies and an increase in its information complexity
Summary
Chronic pelvic pain (CPP) syndrome is defined as a persistent or recurrent pelvic pain that lasts more than 6 months and has no proven infection or obvious pathology to account for its presence [1]. It can involve different organ systems such as the sexual, musculoskeletal, neurological or psychological and can be associated with a vast number of different symptoms, often in the form of dyspareunia (pain during intercourse) and vulvodynia (vulvar pain) in female patients [2]. Its impact on patient’s lives can disturb their professional and sexual life, sleep quality, relationships and self-perception, as well as the ability to perform physical activities and housework [5].
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