Advertisement
Review| Volume 147, ISSUE 1, P21-24, November 2009

Abdominal myofascial pain syndrome must be considered in the differential diagnosis of chronic pelvic pain

      Abstract

      Chronic pelvic pain is lower abdominal pain lasting at least 6 months, occurring continuously or intermittently and not associated exclusively with menstruation or intercourse. The involvement of the musculoskeletal system in chronic pelvic pain has been increasingly demonstrated. However, few studies exclusively examining abdominal myofascial pain syndrome as a cause of chronic pelvic pain in women are available. Therefore the objective of this manuscript is to describe the association between abdominal myofascial pain syndrome and chronic pelvic pain in women, and comment on methods for diagnosis and therapeutic options. There is evidence that the musculoskeletal system is compromised in some way in most women with chronic pelvic pain and that in 15% of these cases chronic pelvic pain is associated with abdominal myofascial pain syndrome but the scarcity of published data impairs the definition of protocols for the diagnosis and treatment of this disease. Abdominal myofascial pain syndrome is a highly prevalent disease associated with CPP, and because of this physicians should get used to make a precise and early diagnosis in order to avoid additional and unnecessary investigation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Campbell F.
        • Collett B.J.
        Chronic pelvic pain.
        Br J Anaesth. 1994; 73: 571-573
        • Howard F.M.
        Chronic pelvic pain.
        Obstet Gynecol. 2003; 101: 594-611
        • Savidge C.J.
        • Slade P.
        Psychological aspects of chronic pelvic pain.
        J Psychosom Res. 1997; 42: 433-444
        • Grace V.
        • Zondervan K.T.
        Chronic pelvic pain in women in New Zealand: comparative well-being, comorbidity, and impact on work and other activities.
        Health Care Women Int. 2006; 27: 585-599
        • Zondervan K.T.
        • Yudkin P.L.
        • Vessey M.P.
        • Dawes M.G.
        • Barlow D.H.
        • Kennedy S.H.
        Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database.
        Br J Obstet Gynaecol. 1999; 106: 1149-1155
        • Zondervan K.T.
        • Barlow D.H.
        Epidemiology of chronic pelvic pain.
        Baillieres Best Pract Res Clin Obstet Gynaecol. 2000; 14: 403-414
        • Cheong Y.
        • William Stones R.
        Chronic pelvic pain: etiology and therapy.
        Best Pract Res Clin Obstet Gynaecol. 2006; 20: 695-711
        • Steege J.F.
        Office assessment of chronic pelvic pain.
        Clin Obstet Gynecol. 1997; 40: 554-563
        • Simons D.G.
        • Travell J.G.
        • Simons L.S.
        • Cummings B.D.
        Myofascial pain and dysfunction: the trigger point manual.
        2nd ed. Williams and Wilkins, London1999 (p. 1038)
        • Sharp H.T.
        Myofascial pain syndrome of the abdominal wall for the busy clinician.
        Clin Obstet Gynecol. 2003; 46: 783-788
        • Alvarez D.J.
        • Rockwell P.G.
        Trigger points: diagnosis and management.
        Am Fam Physician. 2002; 65: 653-660
        • Tough E.A.
        • White A.R.
        • Richards S.
        • Campbell J.
        Variability of criteria used to diagnose myofascial trigger point pain syndrome—evidence from a review of the literature.
        Clin J Pain. 2007; 23: 278-286
        • Borg-Stein J.
        • Simons D.G.
        Focused review: myofascial pain.
        Arch Phys Med Rehabil. 2002; 83 (S40–47, S48–49)
        • Cummings M.
        • Baldry P.
        Regional myofascial pain: diagnosis and management.
        Best Pract Res Clin Rheumatol. 2007; 21: 367-387
        • Perry C.P.
        Peripheral neuropathies and pelvic pain: diagnosis and management.
        Clin Obstet Gynecol. 2003; 46: 789-796
        • Yap E.C.
        Myofascial pain—an overview.
        Ann Acad Med Singapore. 2007; 36: 43-48
        • Hong C.Z.
        • Simons D.G.
        Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points.
        Arch Phys Med Rehabil. 1998; 79: 863-872
        • Ong K.S.
        • Seymour R.A.
        Pain measurement in humans.
        Surgeon. 2004; 2: 15-27
        • Pesudovs K.
        • Craigie M.J.
        • Roberton G.
        The visual analogue scale for the measurement of pain is not linear.
        Anaesth Intens Care. 2005; 33 (author reply 687): 686-687
        • Holroyd K.A.
        • Holm J.E.
        • Keefe F.J.
        • et al.
        A multi-center evaluation of the McGill Pain Questionnaire: results from more than 1700 chronic pain patients.
        Pain. 1992; 48: 301-311
        • Melzack R.
        The McGill pain questionnaire: from description to measurement.
        Anesthesiology. 2005; 103: 199-202
        • Montenegro M.L.
        • Vasconcelos E.C.
        • Candido Dos Reis F.J.
        • Nogueira A.A.
        • Poli-Neto O.B.
        Physical therapy in the management of women with chronic pelvic pain.
        Int J Clin Pract. 2008; 62: 263-269
        • Kamanli A.
        • Kaya A.
        • Ardicoglu O.
        • Ozgocmen S.
        • Zengin F.O.
        • Bayik Y.
        Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome.
        Rheumatol Int. 2005; 25: 604-611
        • Pearce J.M.
        Myofascial pain, fibromyalgia or fibrositis?.
        Eur Neurol. 2004; 52: 67-72
        • Thomson W.H.
        • Dawes R.F.
        • Carter SS
        Abdominal wall tenderness: a useful sign in chronic abdominal pain.
        Br J Surg. 1991; 78: 223-225
        • Schneider M.J.
        Tender points/fibromyalgia vs. trigger points/myofascial pain syndrome: a need for clarity in terminology and differential diagnosis.
        J Manipulative Physiol Ther. 1995; 18: 398-406
        • Peschers U.M.
        • Gingelmaier A.
        • Jundt K.
        • Leib B.
        • Dimpfl T.
        Evaluation of pelvic floor muscle strength using four different techniques.
        Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12: 27-30
        • Prendergast S.A.
        • Weiss J.M.
        Screening for musculoskeletal causes of pelvic pain.
        Clin Obstet Gynecol. 2003; 46: 773-782
        • Oyama I.A.
        • Rejba A.
        • Lukban J.C.
        • et al.
        Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction.
        Urology. 2004; 64: 862-865
        • Antonaci F.
        • Sand T.
        • Lucas G.A.
        Pressure algometry in healthy subjects: inter-examiner variability.
        Scand J Rehabil Med. 1998; 30: 3-8
        • Fischer A.A.
        Pressure threshold meter: its use for quantification of tender spots.
        Arch Phys Med Rehabil. 1986; 67: 836-838
        • Fischer A.A.
        Documentation of myofascial trigger points.
        Arch Phys Med Rehabil. 1988; 69: 286-291
        • Kuan L.C.
        • Li Y.T.
        • Chen F.M.
        • Tseng C.J.
        • Wu S.F.
        • Kuo T.C.
        Efficacy of treating abdominal wall pain by local injection.
        Taiwan J Obstet Gynecol. 2006; 45: 239-243
        • Zaralidou A.T.
        • Amaniti E.N.
        • Maidatsi P.G.
        • Gorgias N.K.
        • Vasilakos D.F.
        Comparison between newer local anesthetics for myofascial pain syndrome management.
        Methods Findings Exp Clin Pharmacol. 2007; 29: 353-357
        • Hains G.
        • Hains F.
        A combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy.
        J Manipulative Physiol Ther. 2000; 23: 225-230