A New Treatment Approach for Endometriosis?

A non-opioid procedure for chronic pelvic pain in women with endometriosis.

Key Points

Highlights:

• Pelvic-floor musculature trigger-point injections and peripheral nerve hydrodissection announced to be effective in treating endometriosis-associated chronic pelvic pain. 

Importance:

• With so few treatment options available for women with endometriosis, this minimally invasive approach may benefit many women with the disease.

What's done here:

• Researchers conducted a retrospective longitudinal study in 16 women with endometriosis to assess the potential benefit of pelvic-floor musculature trigger-point injections and peripheral nerve hydrodissection in reducing chronic pelvic pain.

Key results:

• The mean VAS score among the participants regressed to 2.9 after treatments (from 6 before treatment).
• The mean "Functional Pelvic Pain Scale (FPPS)" score also regressed to 9.1 following treatments (from 14.4 before treatment).
• The improvement was statistically significant in the categories of intercourse, sleeping, and working of the FPPS.
• The mean change in score after treatment was 1.3 points in the category of intercourse, 1.2 in the category of sleeping, and 0.9 in the category of work. 

Limitations:

• The study only involved only 16 women, and only followed for three months after treatment.
• The study had no control group.
• Multiple treatments were used together making it difficult to pinpoint the effect of each one.
• Patients were advised to continue their current medication during the study, which may also have had an effect on the results.

Lay Summary

A new approach may be effective at relieving pain associated with endometriosis according to a study published in the PM&R Journal. The new technique may also improve “overall pelvic function, particularly in relation to intercourse, working, and sleeping,” according to the authors. 

This new method involves pelvic-floor musculature trigger-point injections and peripheral nerve hydrodissection. 

Trigger point injection is usually used to treat muscle pain as well as fibromyalgia and tension headaches. Small amounts of anesthetic and steroid are injected into the trigger points to help alleviate pain. The process has also been used to treat myofascial pain conditions associated with chronic pelvic pain.

Peripheral nerve hydrodissection involves using an anesthetic or solution such as saline to separate the peripheral nerve from the surrounding tissue to reduce pain. 

To determine the effectiveness of these two treatments in reducing endometriosis-associated pelvic pain, a team of researchers led by Dr. Allyson Shrikhande at NYU Langone Health conducted a retrospective longitudinal study of 16 women with biopsy-confirmed endometriosis who had undergone ultrasound-guided pelvic-floor trigger-point injections and peripheral nerve hydrodissection once a week for six weeks. 

All women had their pelvic pain intensity assessed before and after treatment using a visual analog scale (VAS) and the functional pelvic pain scale (FPPS).

The visual analog scale is commonly used to characterized pain intensity. Participants are asked to mark their level of pain on a horizontal line from “no pain at all” to the left (0) to “worse pain imaginable” to the right (10).

In the Functional pelvic pain scale, participants are asked to rate different pelvic functions including, bladder, bowel, intercourse, walking, running, lifting, working, and sleeping from “normal function with no pain” (0 points) to “cannot function because of pain” (4 points). 

In the present study, the mean VAS score of the 16 women was 6 before treatment. This was reduced to 2.9 following treatment. The mean total FPPS score was also reduced following treatment from 14.4 to 9.1. The improvement in FPPS scores was statistically significant in the categories of intercourse, sleeping, and work. 

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31587480