A Novel, Non‐opioid Treatment for Chronic Pelvic Pain in Women with Previously Treated Endometriosis Utilizing Pelvic‐Floor Musculature Trigger‐Point Injections and Peripheral Nerve Hydrodissection

Kathy Plavnik, Amy Tenaglia, Charity Hill, Tayyaba Ahmed, Allyson Shrikhande
PM & R : the journal of injury, function, and rehabilitation · 2019 · vol. 12(7) , pp. 655–662 · doi:10.1002/pmrj.12258 · PMID:31587480 · W2978069540
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Abstract

BACKGROUND: Endometriosis is the abnormal growth of uterine tissue outside the uterine cavity that can cause chronic pain, dysmenorrhea, and dyspareunia. Although the disease is common and nonmalignant in nature, the symptoms can severely impact function and quality of life. Treatment options for endometriosis are limited and not well understood despite a growing need. OBJECTIVE: To determine the effectiveness of pelvic-floor musculature trigger-point injections and peripheral nerve hydrodissection in treating endometriosis symptoms, associated pain, and pelvic functionality. DESIGN: Retrospective longitudinal study case series. SETTING: Private practice. PATIENTS: Sixteen female patients with biopsy-confirmed endometriosis. INTERVENTIONS: Ultrasound-guided pelvic-floor trigger-point injections and peripheral nerve hydrodissection performed once a week for 6 weeks. MAIN OUTCOME MEASUREMENTS: Pelvic pain intensity as measured pretreatment and posttreatment by the 0 to 10 Visual Analogue Scale (VAS) and the Functional Pelvic Pain Scale (FPPS). RESULTS: Pretreatment, the mean VAS score was 6.0 (standard deviation [SD] 2.7), and posttreatment the mean VAS score was 2.9 (SD 2.6); P < .05, 95% confidence interval (CI) 1.16 to 4.97. The mean total FPPS score before treatment was 14.4 (SD 5.2) and posttreatment it was 9.1 (SD 5.8); P < .05, 95% CI 1.34 to 9.28. Analysis of the subcategories within the FPPS indicated that the improvement was statistically significant in the categories of intercourse, sleeping, and working. In the category of intercourse, the mean change in score after treatment was 1.3 (P < .05, 95% CI 0.26-2.31). In the category of sleeping, the mean change in score after treatment was 1.2 (P < .05, 95% CI 0.32-1.99). In the category of working, the mean change in score after treatment was 0.9 (P < .05, 95% CI 0.18-1.53). CONCLUSIONS: Analysis suggests that the treatment was effective at relieving pain related to endometriosis; it also reflected promise in improving overall pelvic function, particularly in relation to intercourse, working, and sleeping.

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Outcome instruments

VAS-pain

Condition tags

mesh:D004715mesh:D017699endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Chronic Pain Chronic Pain Chronic Pain Endometriosis Endometriosis Endometriosis Pelvic Pain Pelvic Pain Pelvic Pain Analgesics, Opioid Combined Modality Therapy Dissection Female Humans Injections Longitudinal Studies Pain Measurement Peripheral Nerves Quality of Life Retrospective Studies

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