Labat J-J, Guerineau M, Delavierre D, Sibert L, Rigaud J
Centre fédératif de pelvipérinéologie, clinique urologique, CHU de Nantes, 44093 Nantes, France.
Prog Urol. 2010 Nov;20(12):982-9. doi: 10.1016/j.purol.2010.08.059. Epub 2010 Oct 12.
Clinical examination of a patient with chronic pelvic and perineal pain often demonstrates muscle hypertonia or muscle contracture sometimes associated with local tenderness or real muscle trigger points. It is sometimes very difficult to determine whether this muscle pain detected on clinical examination is the cause or a consequence of the pain. The purpose of this article is to review musculoskeletal dysfunction in the context of chronic pelvic and perineal pain.
Review of the literature devoted to musculoskeletal aspects of pelvic and perineal pain.
Definitions of pelvic floor dysfunction, hyperactive pelvic floor, myofascial pain and muscle trigger points, and the concept of fibromyalgia.
Musculoskeletal pain is certainly underestimated in the management of chronic pelvic and perineal pain. The pathophysiology of musculoskeletal pain involves disorders of the lumbar, pelvic and femoral equilibrium, myofascial pain characterized by the presence of trigger points for which the pathophysiology remains controversial: a purely muscle disease, reaction to adjacent inflammatory reactions causing hypersensitization, or simply a sign of central hypersensitization in a context of chronic pain syndrome.
对患有慢性盆腔和会阴疼痛的患者进行临床检查时，常常会发现肌肉张力亢进或肌肉挛缩，有时还伴有局部压痛或真正的肌肉触发点。有时很难确定在临床检查中发现的这种肌肉疼痛是疼痛的原因还是结果。本文旨在回顾慢性盆腔和会阴疼痛背景下的肌肉骨骼功能障碍。
回顾有关盆腔和会阴疼痛肌肉骨骼方面的文献。
盆底功能障碍、盆底功能亢进、肌筋膜疼痛和肌肉触发点的定义，以及纤维肌痛的概念。
在慢性盆腔和会阴疼痛的治疗中，肌肉骨骼疼痛肯定被低估了。肌肉骨骼疼痛的病理生理学涉及腰椎、骨盆和股骨平衡紊乱，肌筋膜疼痛的特征是存在触发点，其病理生理学仍存在争议：是纯粹的肌肉疾病、对相邻炎症反应导致超敏反应的反应，还是仅仅是慢性疼痛综合征背景下中枢超敏反应的迹象。
