title: Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain.
abstract: BACKGROUND
  Chronic pelvic pain is a common condition among women, and 10 to 30 % of causes originate from the abdominal wall, and are associated with trigger points. Although little is known about their pathophysiology, variable methods have been practiced clinically. The purpose of this study was to evaluate the efficacy of local anaesthetic injections versus ischemic compression via physical therapy for pain relief of abdominal wall trigger points in women with chronic pelvic pain.
  
  
  METHODS
  We conducted a parallel group randomized trial including 30 women with chronic pelvic pain with abdominal wall trigger points. Subjects were randomly assigned to one of two intervention groups. One group received an injection of 2 mL 0.5 % lidocaine without a vasoconstrictor into a trigger point. In the other group, ischemic compression via physical therapy was administered at the trigger points three times, with each session lasting for 60 s, and a rest period of 30 s between applications. Both treatments were administered during one weekly session for four weeks. Our primary outcomes were satisfactory clinical response rates and percentages of pain relief. Our secondary outcomes are pain threshold and tolerance at the trigger points. All subjects were evaluated at baseline and 1, 4, and 12 weeks after the interventions. The study was conducted at a tertiary hospital that was associated with a university providing assistance predominantly to working class women who were treated by the public health system.
  
  
  RESULTS
  Clinical response rates and pain relief were significantly better at 1, 4, and 12 weeks for those receiving local anaesthetic injections than ischemic compression via physical therapy. The pain relief of women treated with local anaesthetic injections progressively improved at 1, 4, and 12 weeks after intervention. In contrast, women treated with ischemic compression did not show considerable changes in pain relief after intervention. In the local anaesthetic injection group, pain threshold and tolerance improved with time in the absence of significant differences between groups.
  
  
  CONCLUSIONS
  Lidocaine injection seems to be better for reducing the severity of chronic pelvic pain secondary to abdominal wall trigger points compared to ischemic compression via physical therapy.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00628355. Date of registration: February 25, 2008.
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil. montenegro@usp.br.
authors.forename: Mary L L S
authors.initials: ML
authors.lastname: Montenegro
authors.affiliation: Department of Cardiology, Federal University of São Paulo, São Paulo, Brazil. carollabraz@hotmail.com.
authors.forename: Carolina A
authors.initials: CA
authors.lastname: Braz
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil. juliocrs@usp.br.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Rosa-e-Silva
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil. fjcreis@fmrp.usp.br.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Candido-dos-Reis
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil. aanoguei@fmrp.usp.br.
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Nogueira
authors.affiliation: Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil. polineto@fmrp.usp.br.
authors.forename: Omero B
authors.initials: OB
authors.lastname: Poli-Neto
mesh_terms: D034861:Abdominal Wall; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D017288:Pain Threshold; D017699:Pelvic Pain / Q000628:therapy*; D026741:Physical Therapy Modalities; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine