HEALTH OF WOMAN. 2020.5-6(151-152):103-108; doi 10.15574/HW.2020.151-152.103
Sukhanova А. А., Osadchuk R. V.
Shupyk National Medical Academy of Postgraduate Education, Kiev

According to the classification of chronic pain syndromes proposed by the International Association for the Study of Pain (IASP) and due to the high clinical significance, chronic pelvic pain (CPP) represents an independent nosological structure and is defined as pain in the pelvic region (in the lower abdomen and the lower back), mainly between the navel and the pubic symphysis, which lasts for at least six months and disrupts the normal functioning of the body.
Myofascial pelvic pain syndrome (MPPS) in English literature is included in the subgroup of etiology of CPP. Myofascial pelvic pain syndrome itself is not a direct threat to life and health and does not require urgent help. But today it is almost not diagnosed and is not considered as a source of chronic pain and dysfunction in the pelvic region. Such patients, unfortunately, are left without appropriate treatment and cannot get rid of the oppressive pain. They often receive unnecessary treatment, including surgical interventions. This problem causes neurosis, depression, sexual dysfunction and, as a result, leads to the deterioration in the quality of life. CPP can often have multiple causes and should be evaluated in terms of the pathology of various physiological systems, including reproductive, urogenital, gastrointestinal, musculoskeletal and nervous system.
Based on a full picture of the multifactorial nature of CPP, the treatment of this category of patients requires an integrated approach involving specialists in various fields. Particular attention in the differential diagnosis of chronic pelvic pain in women should be paid to abdominal myofascial pain syndrome, the role of which is currently underestimated. Therefore, doctors should be aware of the main directions of diagnosis and treatment of CPP due to myofascial pain syndrome.
Keywords: chronic pelvic pain, myofascial syndrome, nidling, post-isometric relaxation of muscles, relising.

REFERENCES

1. Bubnov RV. 2010. Ispolzovanie triggernoy tochki «suhoy» iglyi pod ultrazvukovyim kontrolem dlya lecheniya miofastsialnoy boli (tehnologicheskie innovatsii i obzor literaturyi). LIkarska sprava 5–6(1106):56–64.

2. Zozulya IS, Bredihin AV. 2011. Miofastsialnyiy bolevoy sindrom: diagnostika, lechenie. Ukrainskiy medichniy chasopis 3(83):V–VI.

3. Ivanichev GA. 1997. Manualnaya terapiya: Rukovodstvo. Kazan, Progress:448.

4. Kuznetsova IV. 2017. Hronicheskaya tazovaya bol – zhenskaya problema. Ginekologiya 19;36:62–67.

5. Levit K, Zahse Y, Yanda V. 1993. Manualnaya meditsina. Per. s cheshsk.: 512.

6. Makatsariya AD, Bitsadze VO. 2011. Tazovaya bol v ginekologii. Ginekologiya 13(1):39–44.

7. Pravdivtsev VA, Kozlov SB, Efremenkov SV i dr. 2003. Fiziologiya boli i obezbolivayuschey sistemyi organizma. Vestnik Smolenskoy meditsinskoy akademii 4:87–96.

8. Trevell DG, Simons DG. 2005. Miofastsialnyie boli. M, Meditsina.

9. ACOG practice bulletin no. 51. chronic pelvic pain. Obstetrics and Gynecology 103(3):589-605. 2004. https://doi.org/10.1097/00006250-200403000-00045; PMid:14990428

10. Ahmed S, Khattab S, Haddad C, Babineau J, Furlan A, Kumbhare D. 2018, Dec. Effect of aerobic exercise in the treatment of myofascial pain: a systematic review. J Exerc Rehabil. 14(6):902-910. https://doi.org/10.12965/jer.1836406.205; PMid:30656147 PMCid:PMC6323330

11. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, Kvarstein G, Stubhaug A. 2008. Assessment of pain. British Journal of Anaesthesia 101(1):17-24. https://doi.org/10.1093/bja/aen103; PMid:18487245

12. Bron C, Dommerholt JD. 2012. Etiology of myofascial trigger points. Curr Pain Headache Rep. 16:439-444. https://doi.org/10.1007/s11916-012-0289-4; PMid:22836591 PMCid:PMC3440564

13. Coosemans A, Moerman P, Vergote I et al. 2009. Wilm's tumor gene 1(WT1) over expression in neurons in deep endometriosis: a pilot study. Fertil Steril 91(4):1441-4. https://doi.org/10.1016/j.fertnstert.2008.06.042; PMid:18722603

14. Chapron C, Santulli P, Steuli I et al. 2012. Endometriosis: causes of pain. Int J Gynecol Obstet 119:S177. https://doi.org/10.1016/S0020-7292(12)60095-2

15. Edwards J, Knowles N. 2003. Superficial dry needling and active stretching in the treatment of myofascial pain – A randomised controlled trial. Acupunct in Med. 21:80-86. https://doi.org/10.1136/aim.21.3.80; PMid:14620302

16. Flor H, Turk DC. 2011. Chronic Pain: An Integrated Biobehavioral Approach. Seattle: IASP Press.

17. Giamberardino MA. 2008. Women and visceral pain: are the reproductive organs the main protagonists? Minireview at the occasion of the "European week against pain in women 2007". Eur J Pain 12(3):257-60. https://doi.org/10.1016/j.ejpain.2007.11.007; PMid:18249016

18. Gunter J. Neurobiology of chronic pelvic pain. In: Chronic Pelvic Pain, ed. P. Vercellini; London, UK: Blackwell Publishing. 2011: 1-6 https://doi.org/10.1002/9781444391855.ch1; PMid:21205289 PMCid:PMC3024246

19. Gunter J. Neurobiology of chronic pelvic pain. In: Chronic Pelvic Pain, ed. P. Vercellini; London, UK: Blackwell Publishing. 2011: 1-6. https://doi.org/10.1002/9781444391855.ch1; PMid:21205289 PMCid:PMC3024246

20. Gyang A, Hartman M, Lamvu G. 2013, Mar. Musculoskeletal causes of chronic pelvic pain: what a gynecologist should know. Obstet. Gynecol. 121;3:645-650. https://doi.org/10.1097/AOG.0b013e318283ffea; PMid:23635629

21. Kalichman K, Vulfsons S. 2010. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 23:640-646. https://doi.org/10.3122/jabfm.2010.05.090296; PMid:20823359

22. Lucas N, Macaskill P, Irwig L et al. 2009. Reliability of physical examination for diagnosis of myofascial trigger points. A systematic review of the literature. Clin J Pain. 25:80-89. https://doi.org/10.1097/AJP.0b013e31817e13b6; PMid:19158550

23. Lundeberg T, Lund I. 2008. Is there a role for acupuncture in endometriosis pain, or "endometrialgia." Acupunct Med. 26:94-110. https://doi.org/10.1136/aim.26.2.94; PMid:18591909

24. Meister MR, Shivakumar N, Sutcliffe S, Spitznagle T, Lowder JL. 2018, Nov. Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review. Am J Obstet Gynecol. 219(5):497.e1-497.e13. Epub 2018 Jun 28; https://doi.org/10.1016/j.ajog.2018.06.014; PMid:29959930 PMCid:PMC6239942

25. Mustafa Aziz YILDIRIM, Kadriye ÖNEŞ, Gökşen GÖKŞENOĞLU. 2018, Dec. Effectiveness of Ultrasound Therapy on Myofascial Pain Syndrome of the Upper Trapezius: Randomized, Single-Blind, Placebo-Controlled Study. Arch Rheumatol. 33(4): 418-423. https://doi.org/10.5606/ArchRheumatol.2018.6538; PMid:30874250 PMCid:PMC6409164

26. Sikdar S, Shah JP, Gebreab T et al. 2009. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 90:1829-838. https://doi.org/10.1016/j.apmr.2009.04.015; PMid:19887205 PMCid:PMC2774893

27. Spitznagle TM, Robinson CM. 2014, Sep. Myofascial pelvic pain. Obstet Gynecol Clin North Am. 41(3):409-32. Epub 2014 Jul 9. https://doi.org/10.1016/j.ogc.2014.04.003; PMid:25155122

28. Jarrell JF, Vilos GA, Allaire C et al. 2005. Consensus guidelines for the management of chronic pelvic pain. Journal of Obstetrics and Gynaecology Canada. 27(8):781-826. https://doi.org/10.1016/S1701-2163(16)30732-0

29. Jarell J, Giamberardino MA, Robert M, Nasr-Esfahani M. 2011. Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain. Pain Res Treat. 201:692102. https://doi.org/10.1155/2011/692102; PMid:22135736 PMCid:PMC3216293

30. Unverzagt C, Berglund K, Thomas JJ. 2015, Jun. Dry Needling for Myofascial Trigger Point Pain: A Clinical Commentary. Int J Sports Phys Ther. 10(3):402–418. https://www.practicalpainmanagement.com/treatments/rehabilitation/vibration-chronic-pain