title: Referred pain patterns provoked on intra-pelvic structures among women with and without chronic pelvic pain: a descriptive study.
abstract: OBJECTIVE
  To describe referred pain patterns provoked from intra-pelvic structures in women with chronic pelvic pain (CPP) persisting after childbirth with the purpose to improve diagnostics and give implications for treatment.
  
  
  METHODS
  In this descriptive and comparative study 36 parous women with CPP were recruited from a physiotherapy department waiting list and by advertisements in newspapers. A control group of 29 parous women without CPP was consecutively assessed for eligibility from a midwifery surgery. Inclusion criterion for CPP was: moderate pain in the sacral region persisting at least six months after childbirth confirmed by pelvic pain provocation tests. Exclusion criteria in groups with and without CPP were: persistent back or pelvic pain with onset prior to pregnancy, previous back surgery and positive neurological signs. Pain was provoked by palpation of 13 predetermined intra-pelvic anatomical landmarks. The referred pain distribution was expressed in pain drawings and described in pain maps and calculated referred pain areas.
  
  
  RESULTS
  Pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions, with or without pain referred down the ipsilateral leg. The average pain distribution area provoked by palpation of all 13 anatomical landmarks was 30.3 mm² (19.2 to 53.7) in women with CPP as compared to 3.2 mm² (1.0 to 5.1) in women without CPP, p< 0.0001.
  
  
  CONCLUSIONS
  Referred pain patterns provoked from intra-pelvic landmarks in women with CPP are consistent with sclerotomal sensory innervation. Magnification of referred pain patterns indicates allodynia and central sensitization. The results suggest that pain mapping can be used to evaluate and confirm the pain experience among women with CPP and contribute to diagnosis.
authors: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Physiotherapy, Sundsvall Hospital, Sundsvall, Sweden.
authors: Thomas
authors: T
authors: Torstensson
authors: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Pain Center, Uppsala University Hospital, Uppsala, Sweden.
authors: Stephen
authors: S
authors: Butler
authors: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Physiotherapy, Sundsvall Hospital, Sundsvall, Sweden.
authors: Anne
authors: A
authors: Lindgren
authors: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Pain Center, Uppsala University Hospital, Uppsala, Sweden.
authors: Magnus
authors: M
authors: Peterson
authors: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors: Margaretha
authors: M
authors: Eriksson
authors: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors: Per
authors: P
authors: Kristiansson
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000175:diagnosis; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D053591:Referred Pain; D010173:Palpation; D017699:Pelvic Pain / Q000175:diagnosis* / Q000628:therapy; D010808:Physical Examination; D026741:Physical Therapy Modalities