Klotz SGR1, Ketels G2, Löwe B1, Brünahl CA1
1University Medical Centre Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany, 2University Medical Centre Hamburg-Eppendorf, Department of Physiotherapy, Hamburg, Germany
Background: Chronic pelvic pain syndrome (CPPS) is a common pain condition perceived in structures related to the pelvis. A multifactorial etiology seems reasonable as the clinical picture is dominated by diverse physio- and psychopathological symptoms. However, little is known about differences in myofascial symptoms and functional capacity in female and male persons with CPPS. Moreover, associations between myofascial and psychosocial symptoms have not yet been explored.
Purpose: The purpose of this study was to analyze myofascial and functional aspects in persons with CPPS and their associations with psychosocial factors with a special focus on sex differences.
Methods: A cross-sectional study was conducted at an interdisciplinary outpatient clinic for persons with CPPS at the University Medical Centre Hamburg-Eppendorf between August 2013 and March 2017. Participants were evaluated following a multimodal diagnostic algorithm including a thorough physiotherapeutical assessment. Descriptive statistics were used to characterize the sample and analyze the physiotherapeutical findings. Correlations were calculated for exploration of association between these findings with regard to sex differences. Median values of functional capacity measured with the 1-min sit-to-stand test in different age groups and separated for sex were compared with reference values.
Results: The sample consisted of N = 187 persons (56.7%female, mean age 49.06 years [SD 17.05], mean pain duration 5.71 years [SD 6.85]). Myofascial symptoms were highly present in external and internal muscles, whereas in women on average significant higher numbers of tender (M 17.53 [SD 9.58] vs. M 13.40 [SD 8.79]; p .003) and trigger points (M 6.23 [SD 6.64] vs. M 4.09 [SD 7.15]; p .036) could be revealed compared to male patients. Several significant correlations between myofascial and psychosocial factors exist, especially in male persons with CPPS, among them a significant association of the number of trigger points and health related quality of life. Functional capacity was substantially lower in both sexes among all age groups.
Conclusion(s): The study was able to demonstrate the different patterns of physiotherapeutical findings in women and men with CPPS. The study also showed a decreased functional capacity in these patients which might be linked to lower muscle strengths and endurance. Moreover it revealed associations between the physio- and the psychopathological symptoms, indicating a possible linkage between those groups. Future studies should explore the linkage in more detail also with regard to effective management of CPPS.
Implications: This study gives physical therapists a valuable insight into a broad range of physiotherapeutical findings including myofascial symptoms and functional capacity. Thus, physiotherapy should not remain on treating myofascial symptoms, but also improve functional capacity, muscular strengths and endurance. Furthermore, the connections between myofascial and psychopathological symptoms stress the need for multifactorial treatment strategies while and should encourage physical therapists to look beyond the physical level when treating persons with CPPS.
Keywords: chronic pelvic pain syndrome, physical therapy, interdisciplinary management
Funding acknowledgements: PRANA Foundation in the Stifterverband für die Deutsche Wissenschaft e.V.
Purpose: The purpose of this study was to analyze myofascial and functional aspects in persons with CPPS and their associations with psychosocial factors with a special focus on sex differences.
Methods: A cross-sectional study was conducted at an interdisciplinary outpatient clinic for persons with CPPS at the University Medical Centre Hamburg-Eppendorf between August 2013 and March 2017. Participants were evaluated following a multimodal diagnostic algorithm including a thorough physiotherapeutical assessment. Descriptive statistics were used to characterize the sample and analyze the physiotherapeutical findings. Correlations were calculated for exploration of association between these findings with regard to sex differences. Median values of functional capacity measured with the 1-min sit-to-stand test in different age groups and separated for sex were compared with reference values.
Results: The sample consisted of N = 187 persons (56.7%female, mean age 49.06 years [SD 17.05], mean pain duration 5.71 years [SD 6.85]). Myofascial symptoms were highly present in external and internal muscles, whereas in women on average significant higher numbers of tender (M 17.53 [SD 9.58] vs. M 13.40 [SD 8.79]; p .003) and trigger points (M 6.23 [SD 6.64] vs. M 4.09 [SD 7.15]; p .036) could be revealed compared to male patients. Several significant correlations between myofascial and psychosocial factors exist, especially in male persons with CPPS, among them a significant association of the number of trigger points and health related quality of life. Functional capacity was substantially lower in both sexes among all age groups.
Conclusion(s): The study was able to demonstrate the different patterns of physiotherapeutical findings in women and men with CPPS. The study also showed a decreased functional capacity in these patients which might be linked to lower muscle strengths and endurance. Moreover it revealed associations between the physio- and the psychopathological symptoms, indicating a possible linkage between those groups. Future studies should explore the linkage in more detail also with regard to effective management of CPPS.
Implications: This study gives physical therapists a valuable insight into a broad range of physiotherapeutical findings including myofascial symptoms and functional capacity. Thus, physiotherapy should not remain on treating myofascial symptoms, but also improve functional capacity, muscular strengths and endurance. Furthermore, the connections between myofascial and psychopathological symptoms stress the need for multifactorial treatment strategies while and should encourage physical therapists to look beyond the physical level when treating persons with CPPS.
Keywords: chronic pelvic pain syndrome, physical therapy, interdisciplinary management
Funding acknowledgements: PRANA Foundation in the Stifterverband für die Deutsche Wissenschaft e.V.
Topic: Women's & men's pelvic health; Pain & pain management
Ethics approval required: Yes
Institution: Medical Association Hamburg, Germany
Ethics committee: IRB of the Medical Association Hamburg
Ethics number: PV4220 (17 August 2012)
All authors, affiliations and abstracts have been published as submitted.
