Top

International Urogynecology Journal

Published in:

01-06-2015 | Original Article

A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain

Authors: Dani Zoorob, Mary South, Mickey Karram, Julie Sroga, Rose Maxwell, Aparna Shah, James Whiteside

Published in: International Urogynecology Journal | Issue 6/2015

Abstract

Introduction and hypothesis

Our aim was to determine the effects of pelvic floor physical therapy (PT) and levator-directed trigger-point injections (LTPI) on sexual function and levator-related pelvic pain.

Study design

A randomized trial among women with pelvic floor myalgia (PFM) was performed wherein participants received either PT or LTPI. Pain was assessed and 1 month posttreatment completion. Levator-based pain was assessed using a numeric rating scale (NRS) and the Patient Global Impression of Improvement (PGI-I) scale. Sexual function was assessed using the Female Sexual Function Index (FSFI).

Results

Twenty-nine women completed the study (17 had PT, 12 had LTPI). Both groups reported reduction in vaginal pain: mean NRS change from baseline of 4.47 [standard deviation (SD) 2.12) for PT and 4.67 (SD 1.72) for LTPI (p = 0.8)]. A >50 % improvement in NRS was documented among 59 % of women receiving PT and 58 % receiving LTPI (p = 1.0). Consistent with NRS scores, mean PGI-I score was 2.50 (SD 1.17) for PT and 2.17 (SD 1.01) for LTPI (p = 0.5). Mean change in FSFI favored PT [PT +8.87 (SD 5.60), LTPI +4.00 (SD 5.24), p = 0.04], reflecting improvement in the sexual pain domain favoring PT (p = 0.02). However, the time in weeks to effect improvement favored LTPI if controlling for the degree of change in NRS (p = 0.01) and FSFI (p = 0.01).

Conclusions

Vaginal myalgia and sex-related pain improved with pelvic floor PT and LTPI. Time-to-effect improvement and significance of therapy are dependent on treatment type.

Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF (1996) Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 87(3):321–327CrossRefPubMed

Cheong YC, Smotra G, Williams AC (2014) Non-surgical interventions for the management of chronic pelvic pain. Coch Data Syst Rev 3, CD008797. doi:10.1002/14651858.CD008797.pub2

Prendergast SA, Weiss JM (2003) Screening for musculoskeletal causes of pelvic pain. Clin Obstet Gynecol 46(4):773–782CrossRefPubMed

Rogalski MJ, Kellogg-Spadt S, Hoffmann AR, Fariello JY, Whitmore KE (2010) Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J 21(7):895–899. doi:10.1007/s00192-009-1075-7 CrossRefPubMed

Oyama IA, Rejba A, Lukban JC, Fletcher E, Kellogg-Spadt S, Holzberg AS, Whitmore KE (2004) Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 64(5):862–865. doi:10.1016/j.urology.2004.06.065 CrossRefPubMed

Srinivasan AK, Kaye JD, Moldwin R (2007) Myofascial dysfunction associated with chronic pelvic floor pain: management strategies. Curr Pain Headache Rep 11(5):359–364CrossRefPubMed

Dhingra C, Kellogg-Spadt S, McKinney TB, Whitmore KE (2012) Urogynecological causes of pain and the effect of pain on sexual function in women. Female Pelvic Med Reconstr Surg 18(5):259–267. doi:10.1097/SPV.0b013e3182686631 CrossRefPubMed

Adelowo A, Hacker MR, Shapiro A, Modest AM, Elkadry E (2013) Botulinum toxin type A (BOTOX) for refractory myofascial pelvic pain. Female Pelvic Med Reconstr Surg 19(5):288–292. doi:10.1097/SPV.0b013e3182989fd8 CrossRefPubMedCentralPubMed

Bedaiwy MA, Patterson B, Mahajan S (2013) Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy. J Reprod Med 58(11–12):504–510PubMed

10.

Simons DT, Travel JG, Simons LS (1999) In: Wilkins W (ed) Myofascial pain and dysfunction: the trigger point manual, 2nd edn. Williams & Wilkins, Baltimore, pp 94–173

11.

Langford CF, Udvari Nagy S, Ghoniem GM (2007) Levator ani trigger point injections: an underutilized treatment for chronic pelvic pain. Neurourol Urodyn 26(1):59–62. doi:10.1002/nau.20393 CrossRefPubMed

12.

Slocumb JC (1984) Neurological factors in chronic pelvic pain: trigger points and the abdominal pelvic pain syndrome. Am J Obstet Gynecol 149(5):536–543CrossRefPubMed

13.

Affaitati G, Fabrizio A, Savini A, Lerza R, Tafuri E, Costantini R, Lapenna D, Giamberardino MA (2009) A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther 31(4):705–720. doi:10.1016/j.clinthera.2009.04.006 CrossRefPubMed

14.

Hull TL, Milsom JW, Church J, Oakley J, Lavery I, Fazio V (1993) Electrogalvanic stimulation for levator syndrome: how effective is it in the long-term? Dis Colon Rectum 36(8):731–733CrossRefPubMed

15.

Wiegel M, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31(1):1–20. doi:10.1080/00926230590475206 CrossRefPubMed

16.

Weiss JM (2001) Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 166(6):2226–2231CrossRefPubMed

17.

Fitzgerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, Kotarinos R, Fraser L, Cosby A, Fortman C, Neville C, Badillo S, Odabachian L, Sanfield A, O'Dougherty B, Halle-Podell R, Cen L, Chuai S, Landis JR, Mickelberg K, Barrell T, Kusek JW, Nyberg LM, Urological Pelvic Pain Collaborative Research N (2013) Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol 189(1 Suppl):S75–S85. doi:10.1016/j.juro.2012.11.018

18.

Duncan GH, Bushnell MC, Lavigne GJ (1989) Comparison of verbal and visual analogue scales for measuring the intensity and unpleasantness of experimental pain. Pain 37(3):295–303CrossRefPubMed

19.

Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17(1):45–56CrossRefPubMed

20.

Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH (1990) Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 17(8):1022–1024PubMed

21.

Srikrishna S, Robinson D, Cardozo L (2010) Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 21(5):523–528. doi:10.1007/s00192-009-1069-5 CrossRefPubMed

22.

Verit FF, Verit A (2007) Validation of the female sexual function index in women with chronic pelvic pain. J Sex Med 4(6):1635–1641. doi:10.1111/j.1743-6109.2007.00604.x CrossRefPubMed

23.

Price DD, Bush FM, Long S, Harkins SW (1994) A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain 56(2):217–226CrossRefPubMed

24.

Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152(10):2399–2404. doi:10.1016/j.pain.2011.07.005 CrossRefPubMed

25.

Myles PS, Urquhart N (2005) The linearity of the visual analogue scale in patients with severe acute pain. Anaesth Intensive Care 33(1):54–58PubMed

26.

Thiele GH (1963) Coccygodynia: cause and treatment. Dis Colon Rectum 6:422–436CrossRefPubMed

27.

Kang YS, Jeong SY, Cho HJ, Kim DS, Lee DH, Kim TS (2000) Transanally injected triamcinolone acetonide in levator syndrome. Dis Colon Rectum 43(9):1288–1291CrossRefPubMed

28.

Caldwell JR (1996) Intra-articular corticosteroids. Guide to selection and indications for use. Drugs 52(4):507–514CrossRefPubMed

29.

Finamore PS, Goldstein HB, Whitmore KE (2008) Pelvic floor muscle dysfunction. J Pelvic Med Surg 14(6):417–422. doi:10.1097/SPV.0b013e3181907870 CrossRef

30.

Crisp CC, Vaccaro CM, Estanol MV, Oakley SH, Kleeman SD, Fellner AN, Pauls RN (2013) Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J 24(11):1915–1923. doi:10.1007/s00192-013-2108-9 CrossRefPubMed

Title: A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain
Authors: Dani Zoorob
Mary South
Mickey Karram
Julie Sroga
Rose Maxwell
Aparna Shah
James Whiteside
Publication date: 01-06-2015
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 6/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-014-2606-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain

Abstract

Introduction and hypothesis

Study design

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Study design

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2015

Correlation of patient age with CT-measured aorta–sacral promontory distance

The effect of pelvic factures on future stress incontinence and pelvic organ prolapse surgery

Is de novo stress incontinence after sacrocolpopexy related to anatomical changes and surgical approach? Response to comments by van der Weiden and Withagen

Comments on LeClaire et al.: Is de novo stress incontinence after sacrocolpopexy related to anatomical changes and surgical approach?

Recurrent urinary tract infections in women

Prevalence, risk factors and the bother of lower urinary tract symptoms in China: a population-based survey