“Pain levels, as reported on a zero to 10 visual analog scale, decreased significantly between the first and last visits, from a mean of 5 to 3.5. And pain on the patient’s worst day also significantly improved, from a mean of 8 to 4.8,” Dr. Gaines said. “Distressful pelvic symptoms improved as measured by the [Pelvic Floor Distress Inventory Short Form 20], with significant and large improvements seen in urinary symptoms. And overall improvement in quality of life from pelvic floor physical therapy was noted on both validated questionnaires.”
While many urologists are already referring chronic pelvic pain patients to pelvic floor physical therapists, this study serves as a reminder of the importance of prompt and direct PT referrals for this group of patients.
“A majority of patients with chronic pelvic pain have levator myalgia, which is a musculoskeletal issue. Treatment with pain medications, in addition to the risk to the patient and the liability incurred by the physician, merely masks this issue and fails to treat the underlying cause,” Dr. Gaines said. “Physical therapy rehabilitates at the source of the pain and is a more appropriate treatment.”
In the long term, chronic pain causes neural remodeling in the cerebral cortex and spinal cord. While physical therapy can still improve pain and quality of life for patients with long-standing pain, complete pain resolution may be limited due to this central remodeling, she said.
“Patients with pelvic pain due to levator spasm are best treated with physical therapy; however, the presentation can be subtle. Because levator spasm can cause a myriad of symptoms, including constipation, urinary hesitancy from voiding against a tensed pelvic floor, symptoms of bladder overactivity due to inability to effectively empty from this same process, and sexual pain and dysfunction, it is important to query for these symptoms even in patients who seem to have bladder-centric pain on initial evaluation,” Dr. Gaines said.
Research is needed to examine a longer duration follow-up to evaluate how long physical therapy is efficacious for these patients, or if patients would benefit from a “refresher” course of PT after 18 months or 3 years, according to Dr. Gaines.
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