Maximierung der Therapieeffekte

AbstractBackground and aimsWomen with chronic pelvic pain represent a heterogeneous group, and it is suggested that the existence of sub-groups can explain varying results and inconclusiveness in clinical trials. Some predictors of treatment outcome are suggested, but the evidence is limited. The primary aim of this study was to explore if selected pre-treatment characteristics of the participants in a recently conducted randomized controlled trial were associated with treatment outcome.MethodsIn this study secondary analysis of data collected in a randomized trial were conducted. The participants were women with chronic pelvic pain randomized to two different physical therapy treatments. Analyses in this study were performed for the whole group as a cohort. The primary outcome measure was change in pain intensity from baseline to 12 months, measured with the numeric rating scale (0–10). The women were asked to rate their mean pelvic pain intensity during the last 7 days. Based on previous research and on available variables from the randomized controlled trial four potential predictive factors were derived from the baseline data and assessed one by one in a linear regression model, adjusted for age and treatment group. The variables with strongest association (p < 0.10) with the primary outcome were further included in a multivariable linear regression model with backward selection, adjusted for age and treatment group.ResultsFifty women (mean age 38.1, SD = 12.2) were included in the analysis. For these women the mean change in pain intensity was −1.2 points (95% CI −1.8 to −0.7) from baseline to 12 months. The multivariable regression model showed that pelvic pain duration of 6 years or more was associated with less decrease in pain intensity with a regression coefficient of 1.3 (95% CI 0.3–2.4). Baseline pain intensity was associated with higher pain reduction after PT treatment with a regression coefficient per SD increase in baseline pain of −0.6 (95% CI −1.1 to −0.1). None of the women with main pain site other places than in the pelvis reported any pain reduction after physical therapy treatment, but due to the small numbers the predictor was not included in the regression analysis.ConclusionsWe identified that pelvic pain duration of 6 years or more was associated with less pain reduction, and that higher baseline pain intensity was associated with higher pain reduction after physical therapy treatment in this sample of women with chronic pelvic pain. For the variable main pain site other places than the pelvis the results are unsure due to small numbers.ImplicationsBased on our finding of long pain duration as a negative predictor for pain reduction, we emphasize that early intervention is important. Many of the participants in our RCT reported pelvic surgeries or other treatments prior to referral for PT, and we suggest that referral to a non-invasive intervention such as PT should be considered at an earlier stage. In order to tailor interventions to the individual women’s needs, thorough baseline assessments, preferably in a multidisciplinary setting, should be performed.

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Physical Therapy Interventions for Musculoskeletal Impairments in Pelvic Pain

Management of Chronic Pelvic Pain ◽

10.1017/9781108877084.021 ◽

2021 ◽

pp. 207-222

Author(s):

Lauren Hill

Keyword(s):

Physical Therapy ◽

Pelvic Pain ◽

Musculoskeletal Impairments ◽

Therapy Interventions

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Chronic Pelvic Pain Research—a Physical Therapy Perspective

Pain Medicine ◽

10.1093/pm/pny251 ◽

2018 ◽

Vol 20 (1) ◽

pp. 1-2

Author(s):

Rebecca Stephenson ◽

Antje M Barreveld

Keyword(s):

Physical Therapy ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Pain Research

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Chronic Pelvic Pain, Physical Therapy Approaches and Myofascial Abnormalities

10.1007/springerreference_120738 ◽

2012 ◽

Keyword(s):

Physical Therapy ◽

Pelvic Pain ◽

Chronic Pelvic Pain

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Pelvic Pain and Floor Dysfunction

10.1093/med/9780199350940.003.0024 ◽

2018 ◽

Author(s):

Danielle Sarno ◽

Farah Hameed

Keyword(s):

Physical Therapy ◽

Pelvic Floor ◽

Pelvic Pain ◽

Multidisciplinary Approach ◽

Rehabilitation Program ◽

Painful Bladder ◽

Integral Role ◽

Comprehensive Rehabilitation ◽

Irritable Bowel ◽

Tract Infections

Chronic pelvic pain is defined as persistent pain perceived in structures related to the anatomic pelvis (lower abdomen below the umbilicus) of either women or men for greater than 6 months. The etiology may be related to gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic causes. Pelvic pain and floor dysfunction often are associated with a musculoskeletal disorder related to the pelvic girdle, spine, or hip. Myofascial pelvic pain may be related to other diagnoses, such as depression, irritable bowel syndrome, endometriosis, constipation, painful bladder syndrome, and chronic urinary tract infections. A thorough history and clinical examination, including an internal pelvic floor musculoskeletal examination, can help identify the underlying etiology. A multidisciplinary approach to management is essential. Pelvic floor physical therapy plays an integral role. Other treatments, such as medications, complementary therapies, and injections, may be used in conjunction with physical therapy to facilitate a comprehensive rehabilitation program and manage symptoms.

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How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Pain Research and Management ◽

10.1155/2019/6091257 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Keren Grinberg ◽

Irit Weissman-Fogel ◽

Lior Lowenstein ◽

Liora Abramov ◽

Michal Granot

Keyword(s):

Physical Therapy ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Chronic Pelvic Pain Syndrome ◽

Experimental Pain ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Therapeutic Effects ◽

Long Term Effects ◽

Clinical Pain

Background. Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose. This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods. The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results. Along with an improvement in the clinical pain intensity (p=0.001) and sensitivity to experimental pain tests (p=0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p=0.04; p=0.001; p=0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p=0.001). Conclusions. The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.

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