The Pelvis and Beyond: Musculoskeletal Tender Points in Women With Chronic Pelvic Pain.
To determine the feasibility of a detailed pain sensitivity assessment using body-wide musculoskeletal tender points (TPs) in women with different types of chronic pelvic pain (CPP) and compare phenotypic differences.



Seventy women with CPP and 35 pain-free women underwent musculoskeletal evaluation of TPs in the pelvic floor, abdomen, groin, inner thigh, and all 18 fibromyalgia TPs. Patients scored elicited pain on a numeric rating scale. TP pain scores were used for intergroup comparison and intragroup correlation.



Women with CPP were grouped as having either bladder pain syndrome (BPS, n=24) or myofascial pelvic pain (MPP, n=11) singularly or both concomitantly (BPS+MPP, n=35). TP pain scores for all evaluations were higher in women with CPP compared with healthy women (P<0.001). Women with BPS+MPP had elevated TP pain for each evaluation compared with women with BPS alone. Pelvic floor and fibromyalgia TP scores correlated strongly in the MPP group, moderately in the BPS+MPP group, and weakly in the BPS alone group. Although some moderate and strong correlations between different body locations were present in all 3 groups, only the BPS+MPP group showed moderate to strong correlations between all body TPs.



Detailed musculoskeletal evaluation of women with CPP is feasible and well tolerated. Careful phenotyping differentiated BPS, MPP, and BPS+MPP groups. Attending to the differences between these groups clinically may lead to more effective treatment strategies and improved outcomes for patients with CPP.
*University Hospitals Case Medical Center †Case Western R.U. School of Medicine, Department of Epidemiology and Biostatistics, Cleveland ∥College of Veterinary Medicine, The Ohio State University, Columbus, OH ‡Department of Neurology, The Medical College of Wisconsin, Milwaukee, WI §Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC ¶Children's Research Institute, Medical College of Wisconsin, Milwaukee, WI.
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D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000503:physiopathology*; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis / Q000503:physiopathology*; D010641:Phenotype; D010808:Physical Examination; D055815:Young Adult