Montenegro Mary L L S, Braz Carolina A, Rosa-e-Silva Julio C, Candido-dos-Reis Francisco J, Nogueira Antonio A, Poli-Neto Omero B
Department of Gynecology and Obstetrics, Ribeirão Preto Medical School of University of Sao Paulo, Bandeirantes Avenue, 3900, Campus Universitário s/n. Monte Alegre, Ribeirão Preto, SP, CEP 14048-900, Brazil.
Department of Cardiology, Federal University of São Paulo, São Paulo, Brazil.
BMC Anesthesiol. 2015 Dec 1;15:175. doi: 10.1186/s12871-015-0155-0.
Chronic pelvic pain is a common condition among women, and 10 to 30 % of causes originate from the abdominal wall, and are associated with trigger points. Although little is known about their pathophysiology, variable methods have been practiced clinically. The purpose of this study was to evaluate the efficacy of local anaesthetic injections versus ischemic compression via physical therapy for pain relief of abdominal wall trigger points in women with chronic pelvic pain.
We conducted a parallel group randomized trial including 30 women with chronic pelvic pain with abdominal wall trigger points. Subjects were randomly assigned to one of two intervention groups. One group received an injection of 2 mL 0.5 % lidocaine without a vasoconstrictor into a trigger point. In the other group, ischemic compression via physical therapy was administered at the trigger points three times, with each session lasting for 60 s, and a rest period of 30 s between applications. Both treatments were administered during one weekly session for four weeks. Our primary outcomes were satisfactory clinical response rates and percentages of pain relief. Our secondary outcomes are pain threshold and tolerance at the trigger points. All subjects were evaluated at baseline and 1, 4, and 12 weeks after the interventions. The study was conducted at a tertiary hospital that was associated with a university providing assistance predominantly to working class women who were treated by the public health system.
Clinical response rates and pain relief were significantly better at 1, 4, and 12 weeks for those receiving local anaesthetic injections than ischemic compression via physical therapy. The pain relief of women treated with local anaesthetic injections progressively improved at 1, 4, and 12 weeks after intervention. In contrast, women treated with ischemic compression did not show considerable changes in pain relief after intervention. In the local anaesthetic injection group, pain threshold and tolerance improved with time in the absence of significant differences between groups.
Lidocaine injection seems to be better for reducing the severity of chronic pelvic pain secondary to abdominal wall trigger points compared to ischemic compression via physical therapy.
ClinicalTrials.gov NCT00628355. Date of registration: February 25, 2008.
慢性盆腔疼痛在女性中很常见，10%至30%的病因源于腹壁，并与触发点有关。尽管对其病理生理学了解甚少，但临床上已采用多种方法。本研究的目的是评估局部麻醉剂注射与通过物理治疗进行缺血性按压对慢性盆腔疼痛女性腹壁触发点疼痛缓解的疗效。
我们进行了一项平行组随机试验，纳入30名患有慢性盆腔疼痛且伴有腹壁触发点的女性。受试者被随机分配到两个干预组之一。一组在触发点注射2毫升不含血管收缩剂的0.5%利多卡因。另一组在触发点进行三次物理治疗缺血性按压，每次持续60秒，两次按压之间休息30秒。两种治疗均每周进行一次，共四周。我们的主要结局是满意的临床反应率和疼痛缓解百分比。次要结局是触发点的疼痛阈值和耐受性。所有受试者在基线以及干预后1、4和12周进行评估。该研究在一家与大学相关的三级医院进行，该医院主要为接受公共卫生系统治疗的工人阶级女性提供帮助。
在1、4和12周时，接受局部麻醉剂注射的患者的临床反应率和疼痛缓解情况明显优于通过物理治疗进行缺血性按压的患者。接受局部麻醉剂注射治疗的女性在干预后1、4和12周疼痛缓解情况逐渐改善。相比之下，接受缺血性按压治疗的女性在干预后疼痛缓解情况没有明显变化。在局部麻醉剂注射组，疼痛阈值和耐受性随时间改善，组间无显著差异。
与通过物理治疗进行缺血性按压相比，利多卡因注射似乎更能有效减轻腹壁触发点继发的慢性盆腔疼痛的严重程度。
ClinicalTrials.gov NCT00628355。注册日期：2008年2月25日。
