Skip to main content
Erschienen in: Lasers in Medical Science 5/2022

14.01.2022 | Original Article

Vaginal stretching therapy and class IIIB vaginal laser treatment for pelvic floor myofascial pain: a randomized clinical trial

verfasst von: Claudia Pignatti Frederice, Luiz Gustavo Oliveira Brito, Helymar Costa Machado, Amanda Martins Reis, Juliana Oliveira Fernandes, Cássia Raquel Teatin Juliato

Erschienen in: Lasers in Medical Science | Ausgabe 5/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Several treatment options are proposed for the management of pelvic floor myofascial pain (PFMP). Manual therapy, such as vaginal stretching (VS), is one of these options. Photobiomodulation therapy (PBMT) with a laser device is a treatment option for PFMP that has been tested on other muscles. The aim of this study was to evaluate the effect of VS combined or not with PBMT for PFMP treatment.

Methods

One hundred three women with PFMP were enrolled in a double-blind randomized trial and assigned to VS+PBMT (10 treatments over 2 weeks with 100 mw delivering 12 joules to surface intravaginally, using near-infrared light 808 nm) and VS+shamPBMT treatment groups. Pain severity was assessed by Visual Analog Scale (VAS). Pelvic floor muscle function was assessed by Oxford Scale and surface electromyography. Urinary symptoms were evaluated by ICIQ-OAB and ICIQ-SF questionnaires, and intestinal constipation was assessed by ROMA criteria.

Results

There was a significant improvement in pain intensity (VAS) after treatment in both groups, with no difference between groups (p = 0.46). More than 50% of the women complained of severe pain before treatment, and after treatments, it was reported by less than 20% of women (p < 0.001), with no difference between groups (p = 0.08). Urinary symptoms improved in both groups (p < 0.001) with no difference between groups (p = 0.37). Intestinal constipation improved in the VS+PBMT group only (p = 0.01).

Conclusion

VS and VS with near-infrared vaginal laser therapy were equally effective at decreasing myofascial pelvic pain and reducing urinary symptoms

Trial registration

REBEC (Registro Brasileiro de Ensaios Clínicos; Brazilian Registry of Clinical Trials) under no.RBR-2TDCQ4 (November 11, 2018)
Literatur
1.
Zurück zum Zitat Fitzgerald CM et al (2011) Pelvic floor muscle examination in female chronic pelvic pain. J Reprod Med 56(3–4):117–122PubMed Fitzgerald CM et al (2011) Pelvic floor muscle examination in female chronic pelvic pain. J Reprod Med 56(3–4):117–122PubMed
2.
Zurück zum Zitat Sedighimehr N et al (2018) Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J Bodyw Mov Ther 22(1):92–96CrossRef Sedighimehr N et al (2018) Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J Bodyw Mov Ther 22(1):92–96CrossRef
3.
Zurück zum Zitat Frawley H et al (2021) An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 40(5):1217–1260CrossRef Frawley H et al (2021) An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn 40(5):1217–1260CrossRef
4.
Zurück zum Zitat Moldwin RM, Fariello JY (2013) Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep 14(5):409–417CrossRef Moldwin RM, Fariello JY (2013) Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep 14(5):409–417CrossRef
5.
Zurück zum Zitat Bradley MH, Rawlins A, Brinker CA (2017) Physical therapy treatment of pelvic pain. Phys Med Rehabil Clin N Am 28(3):589–601CrossRef Bradley MH, Rawlins A, Brinker CA (2017) Physical therapy treatment of pelvic pain. Phys Med Rehabil Clin N Am 28(3):589–601CrossRef
6.
Zurück zum Zitat Meister MR et al (2019) Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: is there a correlation? Am J Obstet Gynecol 221(3):235.e1-235.e15CrossRef Meister MR et al (2019) Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: is there a correlation? Am J Obstet Gynecol 221(3):235.e1-235.e15CrossRef
7.
Zurück zum Zitat Ye AL et al (2020) Evaluating disability-related quality of life in women with chronic pelvic pain. Female Pelvic Med Reconstr Surg 26(8):508–513CrossRef Ye AL et al (2020) Evaluating disability-related quality of life in women with chronic pelvic pain. Female Pelvic Med Reconstr Surg 26(8):508–513CrossRef
8.
Zurück zum Zitat Spitznagle TM, Robinson CM (2014) Myofascial pelvic pain. Obstet Gynecol Clin North Am 41(3):409–432CrossRef Spitznagle TM, Robinson CM (2014) Myofascial pelvic pain. Obstet Gynecol Clin North Am 41(3):409–432CrossRef
9.
Zurück zum Zitat Reis, A.M., et al., Depression, anxiety, and stress in women with urinary incontinence with or without myofascial dysfunction in the pelvic floor muscles: a cross-sectional study. Neurourol Urodyn, 2020. Reis, A.M., et al., Depression, anxiety, and stress in women with urinary incontinence with or without myofascial dysfunction in the pelvic floor muscles: a cross-sectional study. Neurourol Urodyn, 2020.
10.
Zurück zum Zitat Itza F et al (2010) Myofascial pain syndrome in the pelvic floor: a common urological condition. Actas Urol Esp 34(4):318–326CrossRef Itza F et al (2010) Myofascial pain syndrome in the pelvic floor: a common urological condition. Actas Urol Esp 34(4):318–326CrossRef
11.
Zurück zum Zitat FitzGerald MP et al (2012) Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol 187(6):2113–2118CrossRef FitzGerald MP et al (2012) Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol 187(6):2113–2118CrossRef
12.
Zurück zum Zitat Gentilcore-Saulnier E et al (2010) Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program. J Sex Med 7(2 Pt 2):1003–1022CrossRef Gentilcore-Saulnier E et al (2010) Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program. J Sex Med 7(2 Pt 2):1003–1022CrossRef
13.
Zurück zum Zitat Rogers RG et al (2018) An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J 29(5):647–666CrossRef Rogers RG et al (2018) An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J 29(5):647–666CrossRef
14.
Zurück zum Zitat Clijsen R et al (2017) Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis. Eur J Phys Rehabil Med 53(4):603–610CrossRef Clijsen R et al (2017) Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis. Eur J Phys Rehabil Med 53(4):603–610CrossRef
15.
Zurück zum Zitat Chow RT, David MA, Armati PJ (2007) 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst 12(1):28–39CrossRef Chow RT, David MA, Armati PJ (2007) 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst 12(1):28–39CrossRef
16.
Zurück zum Zitat Hagiwara S et al (2008) Pre-Irradiation of blood by gallium aluminum arsenide (830 nm) low-level laser enhances peripheral endogenous opioid analgesia in rats. Anesth Analg 107(3):1058–1063CrossRef Hagiwara S et al (2008) Pre-Irradiation of blood by gallium aluminum arsenide (830 nm) low-level laser enhances peripheral endogenous opioid analgesia in rats. Anesth Analg 107(3):1058–1063CrossRef
17.
Zurück zum Zitat Chung H et al (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40(2):516–533CrossRef Chung H et al (2012) The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng 40(2):516–533CrossRef
18.
Zurück zum Zitat Kohli, N., et al., An observational cohort study of pelvic floor photobiomodulation for treatment of chronic pelvic pain. J Comp Eff Res, 2021. Kohli, N., et al., An observational cohort study of pelvic floor photobiomodulation for treatment of chronic pelvic pain. J Comp Eff Res, 2021.
19.
Zurück zum Zitat Boutron I et al (2017) CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts. Ann Intern Med 167(1):40–47CrossRef Boutron I et al (2017) CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts. Ann Intern Med 167(1):40–47CrossRef
20.
Zurück zum Zitat Bhide AA et al (2015) The pelvic floor muscle hyperalgesia (PFMH) scoring system: a new classification tool to assess women with chronic pelvic pain: multicentre pilot study of validity and reliability. Eur J Obstet Gynecol Reprod Biol 193:111–113CrossRef Bhide AA et al (2015) The pelvic floor muscle hyperalgesia (PFMH) scoring system: a new classification tool to assess women with chronic pelvic pain: multicentre pilot study of validity and reliability. Eur J Obstet Gynecol Reprod Biol 193:111–113CrossRef
21.
Zurück zum Zitat Drossman DA (2006) Rome III: the new criteria. Chin J Dig Dis 7(4):181–185CrossRef Drossman DA (2006) Rome III: the new criteria. Chin J Dig Dis 7(4):181–185CrossRef
22.
Zurück zum Zitat Tamanini JT et al (2004) Validation of the “International Consultation on Incontinence Questionnaire – Short Form” (ICIQ-SF) for Portuguese. Rev Saude Publica 38(3):438–444CrossRef Tamanini JT et al (2004) Validation of the “International Consultation on Incontinence Questionnaire – Short Form” (ICIQ-SF) for Portuguese. Rev Saude Publica 38(3):438–444CrossRef
23.
Zurück zum Zitat Pereira SB et al (2010) Validation of the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for Portuguese. Rev Bras Ginecol Obstet 32(6):273–278CrossRef Pereira SB et al (2010) Validation of the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for Portuguese. Rev Bras Ginecol Obstet 32(6):273–278CrossRef
24.
Zurück zum Zitat Nugent RP, Krohn MA, Hillier SL (1991) Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29(2):297–301CrossRef Nugent RP, Krohn MA, Hillier SL (1991) Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29(2):297–301CrossRef
25.
Zurück zum Zitat Collins S et al (2015) The effect of pessaries on the vaginal microenvironment. Am J Obstet Gynecol 212(1):60.e1–6CrossRef Collins S et al (2015) The effect of pessaries on the vaginal microenvironment. Am J Obstet Gynecol 212(1):60.e1–6CrossRef
26.
Zurück zum Zitat Laycock, J.J., D., Pelvic floor muscle assessment: the PERFECT Scheme. 2001, Physiotherapy. p. 631-42. Laycock, J.J., D., Pelvic floor muscle assessment: the PERFECT Scheme. 2001, Physiotherapy. p. 631-42.
27.
Zurück zum Zitat Moretti E et al (2017) Electromyographic assessment of women’s pelvic floor: What is the best place for a superficial sensor? Neurourol Urodyn 36(7):1917–1923CrossRef Moretti E et al (2017) Electromyographic assessment of women’s pelvic floor: What is the best place for a superficial sensor? Neurourol Urodyn 36(7):1917–1923CrossRef
28.
Zurück zum Zitat Burden A (2010) How should we normalize electromyograms obtained from healthy participants? What we have learned from over 25 years of research. J Electromyogr Kinesiol 20(6):1023–1035CrossRef Burden A (2010) How should we normalize electromyograms obtained from healthy participants? What we have learned from over 25 years of research. J Electromyogr Kinesiol 20(6):1023–1035CrossRef
29.
Zurück zum Zitat Oyama IA et al (2004) Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 64(5):862–865CrossRef Oyama IA et al (2004) Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 64(5):862–865CrossRef
30.
Zurück zum Zitat Mansoori, S.S., et al., Optimal duration of stretching exercise in patients with chronic myofascial pain syndrome: A randomized controlled trial. J Rehabil Med, 2020. Mansoori, S.S., et al., Optimal duration of stretching exercise in patients with chronic myofascial pain syndrome: A randomized controlled trial. J Rehabil Med, 2020.
31.
Zurück zum Zitat Murina F et al (2008) Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. BJOG 115(9):1165–1170CrossRef Murina F et al (2008) Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. BJOG 115(9):1165–1170CrossRef
32.
Zurück zum Zitat Gerwin RD, Dommerholt J, Shah JP (2004) An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep 8(6):468–475CrossRef Gerwin RD, Dommerholt J, Shah JP (2004) An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep 8(6):468–475CrossRef
33.
Zurück zum Zitat Hanten WP et al (2000) Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther 80(10):997–1003CrossRef Hanten WP et al (2000) Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther 80(10):997–1003CrossRef
34.
Zurück zum Zitat Grinberg K et al (2019) How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag 2019:6091257CrossRef Grinberg K et al (2019) How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome? Pain Res Manag 2019:6091257CrossRef
35.
Zurück zum Zitat Uemoto L et al (2013) Myofascial trigger point therapy: laser therapy and dry needling. Curr Pain Headache Rep 17(9):357CrossRef Uemoto L et al (2013) Myofascial trigger point therapy: laser therapy and dry needling. Curr Pain Headache Rep 17(9):357CrossRef
36.
Zurück zum Zitat Laasko EL et al (1994) Plasma Acth and β-Endorphin Levels in Response to low Level Laser Therapy (LLLT) for Myofascial Trigger Points. Laser Therapy 6:133–142CrossRef Laasko EL et al (1994) Plasma Acth and β-Endorphin Levels in Response to low Level Laser Therapy (LLLT) for Myofascial Trigger Points. Laser Therapy 6:133–142CrossRef
37.
Zurück zum Zitat Bjordal JM (2012) Low level laser therapy (LLLT) and World Association for Laser Therapy (WALT) dosage recommendations. Photomed Laser Surg 30(2):61–62CrossRef Bjordal JM (2012) Low level laser therapy (LLLT) and World Association for Laser Therapy (WALT) dosage recommendations. Photomed Laser Surg 30(2):61–62CrossRef
38.
Zurück zum Zitat Zipper, R. and B. Pryor, Evaluation of a novel deep tissue transvaginal near-infrared laser and applicator in an ovine model. Lasers Med Sci, 2021. Zipper, R. and B. Pryor, Evaluation of a novel deep tissue transvaginal near-infrared laser and applicator in an ovine model. Lasers Med Sci, 2021.
39.
Zurück zum Zitat Gerwin RD (2014) Diagnosis of myofascial pain syndrome. Phys Med Rehabil Clin N Am 25(2):341–355CrossRef Gerwin RD (2014) Diagnosis of myofascial pain syndrome. Phys Med Rehabil Clin N Am 25(2):341–355CrossRef
40.
Zurück zum Zitat Ge HY, Fernández-de-Las-Peñas C, Yue SW (2011) Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med 6:13CrossRef Ge HY, Fernández-de-Las-Peñas C, Yue SW (2011) Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med 6:13CrossRef
41.
Zurück zum Zitat Ball N, Scurr J (2013) Electromyography normalization methods for high-velocity muscle actions: review and recommendations. J Appl Biomech 29(5):600–608CrossRef Ball N, Scurr J (2013) Electromyography normalization methods for high-velocity muscle actions: review and recommendations. J Appl Biomech 29(5):600–608CrossRef
42.
Zurück zum Zitat Pastore EA, Katzman WB (2012) Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs 41(5):680–691CrossRef Pastore EA, Katzman WB (2012) Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs 41(5):680–691CrossRef
43.
Zurück zum Zitat Weiss JM (2001) Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 166(6):2226–2231CrossRef Weiss JM (2001) Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 166(6):2226–2231CrossRef
44.
Zurück zum Zitat Wolff BJ et al (2020) Consideration of pelvic floor myofascial release for overactive bladder. J Bodyw Mov Ther 24(2):144–150CrossRef Wolff BJ et al (2020) Consideration of pelvic floor myofascial release for overactive bladder. J Bodyw Mov Ther 24(2):144–150CrossRef
45.
Zurück zum Zitat Pavie MC et al (2019) Blue light-emitting diode in healthy vaginal mucosa-a new therapeutic possibility. Lasers Med Sci 34(5):921–927CrossRef Pavie MC et al (2019) Blue light-emitting diode in healthy vaginal mucosa-a new therapeutic possibility. Lasers Med Sci 34(5):921–927CrossRef
Metadaten
Titel
Vaginal stretching therapy and class IIIB vaginal laser treatment for pelvic floor myofascial pain: a randomized clinical trial
verfasst von
Claudia Pignatti Frederice
Luiz Gustavo Oliveira Brito
Helymar Costa Machado
Amanda Martins Reis
Juliana Oliveira Fernandes
Cássia Raquel Teatin Juliato
Publikationsdatum
14.01.2022
Verlag
Springer London
Erschienen in
Lasers in Medical Science / Ausgabe 5/2022
Print ISSN: 0268-8921
Elektronische ISSN: 1435-604X
DOI
https://doi.org/10.1007/s10103-022-03501-7

Weitere Artikel der Ausgabe 5/2022

Lasers in Medical Science 5/2022 Zur Ausgabe