Myofascial Pelvic Pain Research Articles

Pelvic myofascial pain is associated with restriction of sexual activity in women with pelvic pain: a cross-sectional study.

Background Dyspareunia and restriction of sexual activity are often reported by patients with chronic pelvic pain, but less is known about which conditions or factors contribute most to these symptoms. Methods This is a cross-sectional study of consecutive new patients who presented to a chronic pelvic pain and endometriosis referral clinic between January 2013 and December 2015. Patients completed a detailed questionnaire prior to their first visit and underwent a comprehensive standardised pelvic examination at their first visit. Patients were grouped according to description of sexual activity as 'normal activity without pain', 'normal activity but painful', 'severely restricted by pain', or 'absent due to pain.' Primary outcome was restriction of sexual activity due to pain. Multinomial logistic regression was performed with 'normal activity without pain' group as reference category and adjusted for age, depression, history of endometriosis, and pelvic myofascial pain. Results Over half of the 187 patients with chronic pelvic pain described severely restricted (n =75, 40.1%) or absent (n =21, 11.2%) sexual activity due to pain. Pelvic myofascial pain was highly prevalent in this population and pelvic myofascial tenderness score was associated with higher odds of sexual activity that was severely restricted by pain (OR 1.05, 95% CI 1.01-1.09, P =0.006) or absent due to pain (OR 1.09, 95% CI 1.04-1.13, P Conclusion Dyspareunia and sexual dysfunction are highly prevalent among patients with chronic pelvic pain, and pelvic myofascial pain is strongly associated with restriction of sexual activity due to pain.

274 - Comparative Study of Ultrasound-Guided Dry Needling vs. Exercise Intervention for Managing Pelvic Pain and Improving Bladder Neck Motility in Myofascial Pelvic Pain Syndrome: A Prospective Cohort Study

274 - Comparative Study of Ultrasound-Guided Dry Needling vs. Exercise Intervention for Managing Pelvic Pain and Improving Bladder Neck Motility in Myofascial Pelvic Pain Syndrome: A Prospective Cohort Study

Evaluating the Correlation between Myofascial Pelvic Pain and Female Sexual Function: A Prospective Pilot Study.

Introduction: Myofascial pelvic pain (MFPP) is a prevalent yet frequently overlooked condition characterized by myofascial trigger points located within the pelvic floor muscles. Women with MFPP often experience severely reduced quality of life due to impaired sexual health. Here, we examined the relationship between MFPP and sexual function. Materials and Methods: Eighty-three women with a benign gynecological condition were included in this pilot study. For each patient, we obtained a complete medical history, measured different types of subjective pain intensity using a visual analog scale, performed a validated standardized examination of the pelvic floor muscles for measuring MFPP, and used the German Female Sexual Function Index (FSFI-d) questionnaire. Results: Compared to women without MFPP (46 out of 83; 55.4%), the women with MFPP (37 out of 83; 44.6%) reported experiencing pain on more days per month (8 vs. 3 days/month; p = 0.002) and higher median VAS scores for dyspareunia (4 vs. 0; p < 0.001). We also found a significant inverse correlation between the severity of MFPP and overall FSFI-d scores (r = -0.35; p < 0.001), particularly in the FSFI-d subdomains of pain (r = -0.364; p < 0.001), lubrication (r = -0.230; p = 0.005), and arousal (r = -0.360; p < 0.001). Conclusions: Due to the higher prevalence of dyspareunia and pelvic pain, MFPP significantly impacts several aspects of female sexual health and function. This information, combined with increased awareness regarding MFPP, may provide a foundation for designing individualized therapies, thereby improving the quality of life of women affected by MFPP.

Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome.

To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.

Prediction of myofascial pelvic pain syndrome based on random forest model

The objective is to construct a random forest model for predicting the occurrence of Myofascial pelvic pain syndrome (MPPS) and compare its performance with a logistic regression model to demonstrate the superiority of the random forest model. We retrospectively analyze the clinical data of female patients who underwent pelvic floor screening due to chronic pelvic pain at the Pelvic Floor Rehabilitation Center of the Third Affiliated Hospital of Zhengzhou University from January 2021 to December 2023. A total of 543 female patients meeting the study's inclusion and exclusion criteria are randomly selected from this dataset and allocated to the MPPS group. Furthermore, 702 healthy female patients who underwent pelvic floor screening during routine physical examinations within the same timeframe are randomly selected and assigned to the non-MPPS group. Chi-square test and rank-sum test are used to select demographic variables, pelvic floor pressure assessment data variables, and modified Oxford muscle strength grading data for logistic univariate analysis. The selected variables are further subjected to multivariate logistic regression analysis, and a random forest model is also established. The predictive performance of the two models is evaluated by comparing their accuracy, sensitivity, specificity, precision, receiver operating characteristic (ROC) curve, and area under the curve (AUC) area. Based on a dataset of 1245 cases, we implement the random forest algorithm for the first time in the screening of MPPS. In this investigation, the Logistic regression model forecasts the accuracy, sensitivity, specificity, and precision of MPPS at 69.96%, 57.46%, 79.63%, and 68.57% respectively, with an AUC of the ROC curve at 0.755. Conversely, the random forest prediction model exhibits accuracy, sensitivity, specificity, and precision rates of 87.11%, 90.66%, 90.91%, and 83.51% respectively, with an AUC of the ROC curve at 0.942. The random forest model showcases exceptional predictive performance during the initial screening of MPPS. The random forest model has exhibited exceptional predictive performance in the initial screening evaluation of MPPS disease. The development of this predictive framework holds significant importance in refining the precision of MPPS prediction within clinical environments and elevating treatment outcomes. This research carries profound global implications, given the potentially elevated misdiagnosis rates and delayed diagnosis proportions of MPPS on a worldwide scale, coupled with a potential scarcity of seasoned healthcare providers. Moving forward, continual refinement and validation of the model will be imperative to further augment the precision of MPPS risk assessment, thereby furnishing clinicians with more dependable decision-making support in clinical practice.

Myofascial pelvic pain: the forgotten player in chronic pelvic pain.

In this review article, we discuss myofascial-related chronic pelvic pain, pathophysiology, symptomology, and management options. Despite high prevalence of myofascial pelvic pain, screening is not routinely performed by providers. Treatment modalities include pelvic floor physical therapy, pelvic floor trigger point injections with anesthetics or botulinum toxin A and cryotherapy. Other adjunct modalities, such as muscle relaxants and intravaginal benzodiazepines, are used, but data regarding their effectiveness is sparse. Myofascial pelvic pain is an important, though overlooked component of chronic pelvic pain. Multimodal, multidisciplinary approach including patient education, pelvic floor physical therapy, and trigger point injections is the mainstay of the management of myofascial pelvic pain.

Pain and daily interference among reproductive-age women with myofascial pelvic pain: Serial mediation roles of kinesiophobia, self-efficacy and pain catastrophizing.

Myofascial pelvic pain (MFPP), which is identified by tender points in the pelvic floor musculature, is a prevalent source of chronic pelvic pain in women. It may lead to physical and mental exhaustion, reproductive concerns, and coping difficulties in daily life and work than the disease itself. Pain-related cognitive processes can affect pain relief and quality of life. Kinesiophobia, self-efficacy and pain catastrophizing are frequently treated as mediators between pain and its related consequences. Greater kinesiophobia and pain catastrophizing have been shown to be associated with adverse functional outcomes, while higher self-efficacy has been related with improved quality of life. Regarding MFPP in females of childbearing age, it remains unclear whether the effects of kinesiophobia, self-efficacy and pain catastrophizing on daily interference are direct or indirect; the influence on each variable is, therefore, not entirely evident. The present study aimed to evaluate the relationship between pain and daily interference in reproductive-age women with MFPP through kinesiophobia, self-efficacy and pain catastrophizing, as well as to identify areas for future investigation and intervention based on the data collected from this population. This is a multi-center cross-sectional study. The study was conducted from November 15, 2022 to November 10, 2023, 202 reproductive-age women with MFPP were recruited from 14 hospitals in ten provinces of China. The demographic variables, Brief Pain Inventory, Tampa Scale of Kinesiophobia, Pain Self-Efficacy Questionnaire, and Pain Catastrophizing Scale were used to measure the participants' related information. The data was described and analyzed using Descriptive analyses, Pearson correlation analysis, and Serial mediation modeling. Pain not only had a direct positive impact (B = 0.575; SE = 0.081; 95%CI: LL = 0.415, UL = 0.735) on daily interference, but also had an indirect impact on daily interference through the independent mediating role of pain catastrophizing (B = 0.088; SE = 0.028; 95%CI: LL = 0.038, UL = 0.148), the chain mediating of kinesiophobia and catastrophizing (B = 0.057; SE = 0.019; 95%CI: LL = 0.024, UL = 0.098), and the four-stage serial mediating of kinesiophobia, self-efficacy and catastrophizing (B = 0.013; SE = 0.006; 95%CI: LL = 0.003, UL = 0.027). The proposed serial mediation model showed a good fit with the collected data. The findings illustrate the significance of addressing pain catastrophizing and kinesiophobia (especially catastrophizing), and increasing self-efficacy in pain therapy, and suggest that functional recovery be integrated into pain therapy for reproductive-age women suffering from MFPP.

Evaluating the Effectiveness of Radiofrequency Therapy and Manual Pelvic Fascial Release in Treating Myofascial Pelvic Pain.

Myofascial pelvic pain (MFPP), characterized by sensitive trigger points in the pelvic floor muscles, leads to chronic pain and affects various aspects of life. Despite the availability of different treatment modalities, there is limited comparative research on their effectiveness. This study compares radiofrequency (RF) therapy and myofascial manual therapy (MMT) in treating MFPP. We aimed to evaluate pelvic floor muscle strength changes, clinical symptoms, and patient comfort during treatment. The study involved 176 participants, divided equally into RF and MMT groups. We assessed pelvic floor pain using the Visual Analogue Scale (VAS), muscle strength using the Modified Oxford Scale (MOS) and surface electromyography (sEMG), clinical symptom improvement through questionnaires, and patient discomfort during treatment. Both RF and MMT groups significantly reduced pelvic floor and paraurethral muscle pain (VAS scores, p < 0.001). RF treatment significantly decreased vaginal laxity in its group (p < 0.001), with no notable change in the MMT group (p = 0.818). RF therapy also resulted in greater patient comfort than MMT (p < 0.001). Although both treatments improved clinical symptoms, there was no significant difference between the two (p = 0.692). MOS scores and pelvic floor sEMG values showed no significant differences between the groups before and after treatment (p > 0.05). Both RF and MMT effectively alleviate pelvic floor pain and improve clinical symptoms in MFPP patients. RF therapy, however, offers additional benefits in reducing vaginal laxity and enhancing treatment comfort.

Effect of Myofascial Therapy and Pelvic Relaxation Exercise Combined with Phonophoresis using Diclofenac Sodium gel in Myofascial Pelvic Pain Syndrome

Objective of The Study: To determine the effect of myofascial therapy and pelvic relaxation exercise combined with phonophoresis using Diclofenac sodium gel in subjects with myofascial pelvic pain syndrome (MPPS). Background of The Study: Myofascial pain syndrome is a disease that is characterized by hypersensitive point called trigger points found in one or more muscles and connective tissue. Myofascial Pelvic Pain Syndrome (MPPS) is a source of chronic pelvic pain in women. This pain can be continuous or episodic. This study is designed to compare the effects of interventions namely myofascial therapy and pelvic relaxation exercise combined with phonophoresis using Diclofenac sodium in subjects with MPPS. Methodology: This experimental study was conducted among 20 subjects at Faculty of Physiotherapy, Dr. M.G.R Educational and Research Institute. Study duration was 4 weeks. Subjects were selected by simple random sampling method. The subjects were selected based on Inclusion and exclusion criteria.Outcome measures included were visual analogue scale (VAS), Pelvic pain impact questionnaire (PPIQ), SF-36 questionnaire. Procedure: 20 female subjects with myofascial pelvic pain syndrome were randomly divided into two groups. Group A (n=10) subjects were treated with myofascial therapy. Group B (n=10) subjects were treated with pelvic relaxation exercise. Treatments for both the groups were given for 3 days in a week for 4 weeks. Results: On comparing the pre and post values within experimental group, it shows statistically significant improvement on visual analogue scale score (P ≤ 0.05) andPPI questionnaire score (P ≤ 0.05) and also in pre and post test values of experimental groups, it reveals significant difference on short form survey – 36 score (P ≤ 0.05)

Using Myofascial Therapy to Improve Psychological Outcomes, Quality of Life, and Sexual Function in Women with Chronic Pelvic Pain—A Case Series

(1) Background: Chronic pelvic pain represents a prevalent condition afflicting women. Research has highlighted the presence of psychological distress and sexual dysfunction in these individuals. Regrettably, myofascial pelvic pain often goes unnoticed and untreated despite its integral role in chronic pelvic pain. (2) Methods: By employing a longitudinal case series design, we studied eighteen women afflicted with chronic pelvic pain. Over a 12-week period, these participants underwent 15 sessions of myofascial therapy. Data encompassing sociodemographic particulars, the Hospital Anxiety and Depression Scale, the Medical Outcomes Study Short Form 12 questionnaire, and the Female Sexual Function Index were collected at baseline, 12 weeks post-intervention, and again at the 24-week mark. (3) Results: After a span of 12 weeks subsequent to the intervention, the participants demonstrated noteworthy enhancements (p &lt; 0.001) in their depression and anxiety scores, their overall Mental Component scores in the Medical Outcomes Study Short Form 12, as well as sexual function. Importantly, these gains were sustained at the 24-week juncture post-therapy. (4) Conclusions: The findings stemming from our prospective case study underscore the potential utility of myofascial therapy for women grappling with chronic pelvic pain. This form of intervention yields significant advancements in alleviating anxiety, depression, health-related quality of life, and sexual function.

Analysis of the characteristics and clinical significance of pelvic floor electrophysiology and imaging changes in female patients with MFPP

ObjectiveChronic Pelvic Pain (CPP) is a very common disease. Studies have found that some female patients with CPP have a myofascial trigger point for pain, which has classified as myofascial pelvic pain (MFPP). This study intends to compare the changes of pelvic floor electrophysiology and imaging between female patients with MFPP and normal women by measuring pelvic floor muscle potential, tension and two-dimensional and three-dimensional ultrasound, and then to explore the characteristics and significance of the changes. MethodsA total of 49 MFPP patients were randomly selected as the study group and 41 healthy women were randomly selected as the control group. Vaginal muscle potential was detected by pelvic floor muscle potential tester. The electronic tensioner was used to measure the muscle tension and the pelvic floor muscle contraction force of 5o and 10o, respectively. The parameters of the two groups were detected by transperineal 2D ultrasound and transvaginal 3D ultrasound respectively. Results1. The resting muscle potential and maximum muscle potential of the study group were higher than those of the control group. 2. The static tension, dynamic tension and contractile force of pelvic floor muscle in the study group were higher than those in the control group when the tensioner was opened for 5o. 3. In resting state, BND, BSD and anterior-to-posterior diameter of genital tract hiatus in the study group were smaller than those in the control group. The anal Angle in Valsalva state was greater in study group than in control group. 4. At rest, the hiatus area, anterior-posterior diameter, transverse diameter and defect score of the levator anal muscle in the study group were smaller than those in the control group. ConclusionMFPP presents a state of continuous spasm and loss of coordination of pelvic floor muscle fascia.

Manual therapy formyofascial pelvic pain: A case report and narrative review

Background. Myofascial pelvic pain (MFPP) is characterized by the presence of tender myofascial trigger points (MTrPs) in the muscles and fascia of the pelvic floor. Pelvic floor manual therapy is frequently suggested as the first line of treatment for MFPP. Main body of the abstract. The existing literature affirms the beneficial outcomes of manual therapy in the treatment of MFPP and offers a concise summary of how these techniques are applied to patients with MFPP. Literature includes ten techniques; (1) myofascial trigger point release, (2) Thiele massage, (3) internal self-massage, (4) perineal massage, (5) combined manual techniques, (6) pelvic myofascial mobilization, (7) manual visceral therapy, (8) connective tissue manipulation, (9) scar release, and (10) internal coccyx manipulation. Methods. A narrative review was carried out to summarize the available evidence on pelvic floor manual therapy techniques for MFPP. Key content and findings. Upon review of the current research landscape, twenty-five studies met the inclusion criteria. Available evidence suggests that pelvic floor manual therapy is effective in the treatment of MFPP. Conclusion. Although current available studies are limited in number with limitations in study design, manual therapy is considered a promising, effective, and safe option for the treatment of MFPP.

Cannabis use preferences in women with myofascial pelvic pain: A cross-sectional study

Myofascial tenderness is present in most chronic pelvic pain conditions and causes significant distress to patients. Treatment is challenging and often not curative. Cannabis is often used for self-management of chronic pelvic pain. However, we do not know which concentrations and routes of administration are most acceptable to users. We aimed to investigate patterns and willingness of cannabis product use among both habitual users and non-users with myofascial pelvic pain (MPP), to inform therapeutic development. We conducted a cross-sectional study of questionnaire responses from female patients with MPP from two tertiary pelvic pain centers. We aimed for a convenience sample of 100 responses with representation from both centers. Inclusion criteria were age over 18 with pelvic floor muscle tenderness on standard gynecologic examination. We collected information on demographics, pelvic pain history, cannabis use status, cannabis use preferences, validated opioid misuse risk assessment, and interest in using gynecologic cannabis products and used descriptive analyses. 77/135 (57%) questionnaire respondents were cannabis users and 58 (43%) were non-users. Most users consume cannabis daily, (48.1%) orally (66.2%) or by smoking (60.7%), and rated cannabis as effective at relieving pelvic pain. 37/58 (63.8%) non-cannabis users responded that they would be willing to use cannabis for pelvic pain. Lack of information and potential adverse effects were the most common reasons for unwillingness to use. Approximately 3 of 4 respondents were willing to try vaginal or vulvar application of cannabis products for pelvic pain. This cross-sectional study describes cannabis use patterns in MPP patients. Topical vulvar and vaginal cannabis products are of strong interest to both cannabis users and non-users and warrant further research.

Vaginal muscle spasm and myofascial pelvic pain, do we know what to do?

Vaginal muscle spasm and myofascial pelvic pain, do we know what to do?

The Effect of Pelvic Floor Magnetic Stimulation in Women with Myofascial Pelvic Pain Syndrome: A Prospective Cohort Pilot Study

The Effect of Pelvic Floor Magnetic Stimulation in Women with Myofascial Pelvic Pain Syndrome: A Prospective Cohort Pilot Study

The Effect of Polydioxanone Thread and Platelet Rich Plasma in Treating Myofascial Pelvic Pain

The Effect of Polydioxanone Thread and Platelet Rich Plasma in Treating Myofascial Pelvic Pain

Overactive Bladder Patients With and Without Urgency Incontinence: A Spectrum of One Condition or Different Phenotypes?

ABSTRACT The International Continence Society classifies overactive bladder (OAB) as a storage symptom syndrome characterized by “urgency, with or without urgency urinary incontinence, usually with increased daytime frequency and nocturia.” Although heterogenous in nature, some OAB patients exhibit only frequency and urgency (“OAB-dry”), whereas others exhibit frequency and urgency with urgency incontinence (“OAB-wet”). This study aimed to further explore the unique features of each of these diagnoses via comparison of data for women seeking lower urinary tract symptom (LUTS) care, including data such as physical examination findings, self-reported symptoms, and demographic data. Better understanding of OAB-wet and OAB-dry definitive features may lead to more effective treatment. Through the LURN (Lower Urinary Tract Dysfunction Research Network)—sponsored via the research network NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases)—physical examination, demographic data, and questionnaire data were obtained for women seeking LUTS-based care at 6 centers in the United States. Enrollment entailed categorization of patients into urinary incontinence subtypes, as determined by LURN clinical staff from patient LUTS Tool responses. Subgroups included both OAB-dry and OAB-wet categories, as well as a control LUTS group lacking symptoms. The multicenter data set found 545 LUTS-presenting women, with 84 patients being defined as OAB-wet, 56 patients defined as OAB-dry, and 67 patients defined as the control population. The study population was predominantly White (83%), with mean age of the cohort as 58.8 ± 14.1 years. Demographics did not vary between the categories. The groups experienced very similar symptoms, except OAB-wet patients had urgency incontinence, and OAB-dry reported significantly more bladder pain, incomplete emptying, and straining to urinate. Both OAB groups exhibited identical levels of frequency, nocturnal, urgency, and level of bother. Both OAB groups experienced more bother than controls. However, bother for OAB-wet was directly related to severity of incontinence, and bother for OAB-dry was directly related to pelvic floor tenderness on examination. These results may indicate that the individual conditions hail from divergent etiologies, which contradicts traditional disease concepts. Since OAB-dry patients commonly report sensations of incomplete emptying, bladder pain, and straining to urinate, the authors hypothesized that these symptoms may represent a pelvic floor muscle dysfunction rather than a true bladder pathology. This hypothesis is based on the significant overlap between bladder symptoms of OAB-dry and bladder symptoms in high-tone pelvic floor dysfunction (HTPFD) patients (or those with myofascial pelvic pain). Possible causes were this to be the case might be changes in muscle function leading to alterations in the resting angle of the urethrovesical junction and irritation of the bladder neck or urethra. In addition, neuromuscular dysfunction may lead to symptoms of HTPFD and OAB. Strengths of this study include its large study parameters involving multiple centers across the nation, including all patients seeking care for LUTS. Because most women in the study were White, generalizability of the study to a more diverse patient population is limited. In addition, patient self-reporting of incontinence type lacked simultaneous objective testing. Moreover, significant pelvic pain excluded patients from this cohort, which may have excluded patients with more severe forms of OAB-dry from the study population. Although traditionally grouped and treated together under a larger OAB diagnosis, OAB-wet and OAB-dry have unique symptomatic features, suggesting divergent etiologies. Unique symptoms such as pain, a feeling of incomplete emptying, and straining with urination all suggest pelvic floor myofascial dysfunction for OAB-dry patients. Further examination of a distinct pathophysiology for these 2 groups is warranted.

PD05-01 DISTINCT PHENOTYPES OF BLADDER PAIN IDENTIFIED IN THE MULTIDISCIPLINARY APPROACH TO THE STUDY OF CHRONIC PELVIC PAIN RESEARCH NETWORK DATASET

You have accessJournal of UrologyCME1 Apr 2023PD05-01 DISTINCT PHENOTYPES OF BLADDER PAIN IDENTIFIED IN THE MULTIDISCIPLINARY APPROACH TO THE STUDY OF CHRONIC PELVIC PAIN RESEARCH NETWORK DATASET Oluwarotimi Nettey, Nicholas Jackson, and A. Lenore Ackerman Oluwarotimi NetteyOluwarotimi Nettey More articles by this author , Nicholas JacksonNicholas Jackson More articles by this author , and A. Lenore AckermanA. Lenore Ackerman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with chronic urologic pelvic pain present a unique challenge as their underlying condition is largely a diagnosis of exclusion. In the present analysis, we extend symptom cluster definitions from a pilot study evaluating bladder pain among ambulatory females to a multicenter prospectively recruited dataset using unsupervised machine learning techniques to assess the stability and reproducibility of these bladder pain phenotypes. METHODS: Unsupervised machine learning techniques were applied to patient reported symptoms extracted from the female Genitourinary Pain Index and Interstitial Cystitis Symptom and Problems Indices. Responses from 130 premenopausal female subjects without current opioid use enrolled in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) research network were analyzed. Symptom clusters generated from the MAPP multisite cohort (MC) were compared to previously published pilot data results to assess for alignment and concordance. RESULTS: Symptom clusters included a nonurological pelvic pain group with localized pain unrelated to the micturition cycle (NUPP-MC), a myofascial pelvic pain group (MFP-MC) with stranguria, sensation of incomplete bladder emptying, urinary urgency and high symptom bother/severity, and a bladder specific-pain group (BPS-MC) with pain worsened by bladder filling and relieved by bladder emptying.Cluster comparisons demonstrated concordance by subtype between local and multisite cohorts on various domains of bladder pain (Figure 1). MFP–MC patients had more pain severity (p<0.001), diffuse body pain involvement (p=0.02), pelvic floor tenderness (p=0.01), and increased number of flares (p=0.009). MFP-MC cluster assignation was associated with severe sexual dysfunction, impaired relationship scores as well as sleep and anxiety disturbances. CONCLUSIONS: Patient reported symptoms can be utilized to perform deep phenotyping and identify distinct subgroups of perceived bladder pain. Phenotypic clusters appear stable both in a single institutional pilot cohort and a larger multi-site study. Further validation of these phenotypes and their associations with response to therapy will clarify how to target treatment of bladder pain. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e148 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oluwarotimi Nettey More articles by this author Nicholas Jackson More articles by this author A. Lenore Ackerman More articles by this author Expand All Advertisement PDF downloadLoading ...

Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain

Exploring the relationship between nociplastic pain and the severity and impact of pelvic pain symptoms could lend insight into the heterogeneous symptom presentation and treatment response that complicates management of chronic pelvic pain. In this prospective cross-sectional study, we sought to evaluate relationships between degree of nociplastic pain, measured by the Fibromyalgia (FM) Survey Score, and multiple aspects of the chronic pelvic pain (CPP) experience, including severity, frequency, tenderness during pelvic myofascial exam, interference with daily life, and high-impact pain. The study included 303 women who presented to a tertiary referral clinic for chronic pelvic pain and endometriosis. Multiple measures of pelvic pain, including pain severity, frequency, interference, pelvic myofascial pain, and high-impact pain were examined in General Linear Models with FM Survey Score as the primary predictor of interest in models controlling for endometriosis, surgical history, use of opioids, body mass index, and patient age. Higher level of nociplastic pain was associated with greater pelvic pain severity, frequency, interference, and pelvic myofascial pain (all P < .05). For all models, degree of nociplastic pain was more strongly associated with pain outcomes than the presence of endometriosis, and use of opioids was the only stronger predictor of worse pain outcomes. The likelihood of high impact pain increased 7% for each additional point on the FM Survey Score. Degree of nociplastic pain was robustly associated with severity, frequency, and impact of pelvic pain, and was independent of the presence of endometriosis, history of surgical procedures for pelvic pain, age, and BMI.Trial registration: not applicable PerspectiveThis article evaluates the impact of nociplastic pain on symptoms and functional status in chronic pelvic pain. These findings raise the possibility that a simple screening tool for nociplastic pain might provide clinically actionable information without the need for deep neurobiological phenotyping and may inform development of personalized management strategies.

The prediction and treatment of postpartum myofascial pelvic pain.

The clinical manifestations of myofascial pelvic pain (MFPP) are mainly acute or chronic muscle pain at one or more trigger points in the pelvic cavity or pelvic floor. This study aims to explore the predictive value of pelvic floor myoelectric parameters with respect to MFPP and the effect of its clinical treatment. Two hundred and one women followed up in the Wenzhou People's Hospital 6-12 weeks postpartum between July 2020 and July 2021. They were divided into an MFPP group (n= 90) and a non-MFPP group (n= 102), but 9 MFPP patients without a pelvic floor electromyography evaluation were not included. The general demographic data and pelvic floor electromyography evaluation parameters of the two groups were compared; the related factors of postpartum women suffering from MFPP were analyzed, and a nomogram model of the postpartum risk of suffering from MFPP was established. The 99 patients with postpartum MFPP were divided into a treatment group (n= 10) and a control group (n= 89). The difference in visual analog scale scores between the two groups initially and after three months of treatment was compared to evaluate the effective remission rate of postpartum MFPP after treatment. A significant difference was observed in the relaxation time at the rapid contraction stage (z= 4.369, p< 0.05) and the tension contraction stage (z= 135.645, p< 0.01) between the MFPP group and the non-MFPP group. The nomogram model for predicting postpartum MFPP was established with nine variables as potential predictors. The calibration chart and C index of 0.68 (95% CI: 0.65-0.71) proved that the model had a certain degree of discrimination. The clinical decision-making curve showed that the model could increase the net benefit rate of patients. The pain relief rate in the treatment group was significantly higher than that in the control group (p< 0.01). There is a significant correlation between postpartum MFPP and relaxation time at rapid contraction stage and tension contraction stage. The risk prediction nomogram model of postpartum MFPP established with nine potential predictors has a certain prediction capability, and clinical treatment can effectively relieve MFPP in postpartum patients.