title: Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction.
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.
authors.affiliation: National Institute of Neurological Disorders and Stroke, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland.
authors.forename: Jacqueline V
authors.initials: JV
authors.lastname: Aredo
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Heyrana
authors.affiliation: National Institute of Neurological Disorders and Stroke, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland.
authors.forename: Barbara I
authors.initials: BI
authors.lastname: Karp
authors.affiliation: Rehabilitation Medicine Department, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland.
authors.forename: Jay P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: National Institute of Neurological Disorders and Stroke, Clinical Center, Intramural Research Program NIH, Bethesda, Maryland.
authors.forename: Pamela
authors.initials: P
authors.lastname: Stratton
mesh_terms: D000700:Analgesics / Q000008:administration & dosage; D000777:Anesthetics / Q000008:administration & dosage; D001905:Botulinum Toxins / Q000008:administration & dosage; D059333:Central Nervous System Sensitization; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007267:Injections; D009209:Myofascial Pain Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D009434:Neural Pathways / Q000503:physiopathology; D010147:Pain Measurement; D058748:Pain Perception; D017288:Pain Threshold; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D026741:Physical Therapy Modalities; D016896:Treatment Outcome; D061028:Trigger Points
chemical_list: D000700:Analgesics; D000777:Anesthetics; D001905:Botulinum Toxins