A Novel, Non-opioid Treatment for Chronic Pelvic Pain in Women with Previously Treated Endometriosis Utilizing Pelvic-Floor Musculature Trigger-Point Injections and Peripheral Nerve Hydrodissection

摘要

Background Endometriosis is the abnormal growth of uterine tissue outside the uterine cavity that can cause chronic pain, dysmenorrhea, and dyspareunia. Although the disease is common and nonmalignant in nature, the symptoms can severely impact function and quality of life. Treatment options for endometriosis are limited and not well understood despite a growing need. Objective To determine the effectiveness of pelvic-floor musculature trigger-point injections and peripheral nerve hydrodissection in treating endometriosis symptoms, associated pain, and pelvic functionality. Design Retrospective longitudinal study case series. Setting Private practice. Patients Sixteen female patients with biopsy-confirmed endometriosis. Interventions Ultrasound-guided pelvic-floor trigger-point injections and peripheral nerve hydrodissection performed once a week for 6 weeks. Main Outcome Measurements Pelvic pain intensity as measured pretreatment and posttreatment by the 0 to 10 Visual Analogue Scale (VAS) and the Functional Pelvic Pain Scale (FPPS). Results Pretreatment, the mean VAS score was 6.0 (standard deviation [SD] 2.7), and posttreatment the mean VAS score was 2.9 (SD 2.6); P < .05, 95% confidence interval (CI) 1.16 to 4.97. The mean total FPPS score before treatment was 14.4 (SD 5.2) and posttreatment it was 9.1 (SD 5.8); P < .05, 95% CI 1.34 to 9.28. Analysis of the subcategories within the FPPS indicated that the improvement was statistically significant in the categories of intercourse, sleeping, and working. In the category of intercourse, the mean change in score after treatment was 1.3 (P < .05, 95% CI 0.26-2.31). In the category of sleeping, the mean change in score after treatment was 1.2 (P < .05, 95% CI 0.32-1.99). In the category of working, the mean change in score after treatment was 0.9 (P < .05, 95% CI 0.18-1.53). Conclusions Analysis suggests that the treatment was effective at relieving pain related to endometriosis; it also reflected promise in improving overall pelvic function, particularly in relation to intercourse, working, and sleeping. Level of Evidence IV