Semin Reprod Med 2017; 35(01): 088-097
DOI: 10.1055/s-0036-1597123
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction

Jacqueline V. Aredo
1  National Institute of Neurological Disorders and Stroke, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland
,
Katrina J. Heyrana
2  Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
,
Barbara I. Karp
1  National Institute of Neurological Disorders and Stroke, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland
,
Jay P. Shah
3  Rehabilitation Medicine Department, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland
,
Pamela Stratton
1  National Institute of Neurological Disorders and Stroke, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2017 (eFirst)

Abstract

Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies target ectopic endometrial lesions, they do not directly address pain due to central sensitization of the nervous system and myofascial dysfunction, which can continue to generate pain from myofascial trigger points even after traditional treatments are optimized. This article provides a background for understanding how endometriosis facilitates remodeling of neural networks, contributing to sensitization and generation of myofascial trigger points. A framework for evaluating such sensitization and myofascial trigger points in a clinical setting is presented. Treatments that specifically address myofascial pain secondary to spontaneously painful myofascial trigger points and their putative mechanisms of action are also reviewed, including physical therapy, dry needling, anesthetic injections, and botulinum toxin injections.