Gynecological Pain, Endometriosis, Visceral Disease, and the Viscero-Somatic Connection

Abstract

Objectives: This study was conducted to evaluate the pattern of myofascial dysfunction and muscle tenderness among women presenting with chronic pelvic pain.

Methods: One-hundred and twelve women who presented with a history of chronic pelvic pain for more than 6 months were approached to be included in the database. The history and physical findings in relation to muscle tenderness and myofascial dysfunction were recorded. The specific anatomical areas of this review were the abdominal wall, perineum, levator ani, and obturator internus muscles. The patient's history was the source of prior surgery data and was corroborated with documentation wherever possible. Nonnormally distributed data were adjusted by logarithmic transformation or analyzed using nonparametric tests. Univariate analyses were undertaken of the relationships of age, duration of pain, prior surgical experience, and number of areas of myofascial dysfunction. Linear regression analysis was used to evaluate the relationship of clinical variables with the number of areas of myofascial dysfunction.

Results: The age of the women was 33.7 ± 11.7 [mean ± standard deviation] years. Duration of pain was 5.4 ± 5.1 years with a range of 1 to 34 years. The number of areas of myofascial dysfunction was found to range from 1 to 11, with a mean of 4.4 ± 2.6. There was a significantly negative association of the subjects' age with the number of myofascial dysfunction [r = −0.508, P < 0.001]. In a linear regression model, the number of areas of myofascial dysfunction was found to be predicted by the number of prior laparoscopies while adjusting for the significant confounder of age [Adj R² = 0.127, B = 0.369, 95 percent confidence interval C.I. = 0.193 – 0.587, P < 0.001]. Both the presence of prior visceral disease [P < 0.05] and the presence of endometriosis [P < 0.001] were associated with a significantly higher number of areas of myofascial dysfunction than the absence of these conditions.

Conclusions: The presence of myofascial dysfunction is common among a general population of women presenting with chronic pelvic pain from a variety of causes. Myofascial dysfunction is common in the presence of endometriosis and visceral disease. There is an interesting relationship of the number of reported laparoscopies and the number of areas of myofascial dysfunction. This may reflect the severity of the visceral disease being treated at laparoscopy but also raises the possibility that laparoscopy may in some way exacerbate the viscero-somatic appreciation of pain physiology.

KEYWORDS:

• Pelvic pain
• visceral pain
• endometriosis