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The Somatic Connection  |   October 2012
Self-Treatment of Myofascial Trigger Points Relieves Chronic Pelvic Pain
Article Information
The Somatic Connection   |   October 2012
Self-Treatment of Myofascial Trigger Points Relieves Chronic Pelvic Pain
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 654-655. doi:10.7556/jaoa.2012.112.10.654
The Journal of the American Osteopathic Association, October 2012, Vol. 112, 654-655. doi:10.7556/jaoa.2012.112.10.654
Anderson R, Wise D, Sawyer T, Nathanson BH. Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome. Clin J Pain. 2011;27(9):764-768.  
Osteopathic physicians have used intrapelvic and intrarectal osteopathic manipulative treatment to relieve pelvic somatic dysfunction for more than a century. Physical therapists have reported using manual therapy such as myofascial release and inhibition of trigger points to treat chronic pain syndromes for at least half of a century; Janet G. Travell, MD, began teaching myofascial trigger point concepts to physical therapists in the 1950s, and osteopathic physicians at the Michigan State University College of Osteopathic Medicine have taught these procedures to physical therapists since the 1970s. Physical therapists have taught successive generations of physical therapists what they learned from these physician pioneers. More recently, physical therapists at Stanford University's urology department have reported success at relieving muscle-derived pelvic pain in patients with chronic pelvic pain by using these manual techniques. However, the large number of patients with chronic pelvic pain, the limited number of physical therapists available to apply the procedures, and the limited financial resources to pay for these manual services led the clinicians to devise a self-treatment protocol for patients. Using a plastic tool with a nitrile rubber tip, shaped like a finger, patients were able to apply sustained pressure to intrapelvic trigger points in the pelvic diaphragm muscles as an adjunct to self-massage, stretching exercises, and prescribed or over-the-counter medications for pain relief. 
In the study, researchers assessed the efficacy and safety of this personal tool, called a wand, in reducing pelvic muscle tenderness. Patients were eligible for the study if they had chronic pelvic pain refractory to standard medical treatment and if they self-enrolled in a 6-day course on pelvic muscle relaxation and external massage and stretching exercises for the perineal region. Patients were excluded from the study if they had other pelvic pathology that could account for complaints of pain. Patients who were included in the study were educated about the relevant anatomy and were taught how to use the wand. More than 1000 participants were enrolled (n=1157) but only 113 (106 men and 7 women; median [range] age, 41 [32.5-52.5] years) completed the 6-month follow-up. The median number of trigger points palpated in each patient was 6 (range, 4-6.5). One hundred fifty-seven participants completed the 1-month follow-up of wand use; the 44 participants that withdrew before study completion stated various reasons, including preference for using their own finger, lack of pain relief from the tool, or the need to use the wand more than once weekly. Of note, no participants cited an adverse event as a reason for discontinuing use of the wand. Three participants reported self-limited minor bleeding caused by the tool but did not cease using it for that reason. 
Participants used the wand at least once per week for 6 months. At 1 and 6 months of use, participants were evaluated for adverse events and assessments of pain sensitivity by intrapelvic physical examination. Almost all of the patients (95.5%) reported that the wand was either very or moderately effective in alleviating pain. No serious adverse events were reported. Baseline median (range) sensitivity to palpation using the 10-point visual analog scale was 7.5 (6-8.5), which decreased significantly at 6 months to 4 (2.5-5.5; P<.001). Almost all of the patients (93%) were at least moderately satisfied with using the wand. 
Researchers concluded that their multimodal protocol using an internal pelvic therapeutic wand seems to be a safe, viable treatment option in select chronic pelvic pain patients with muscle-derived pain and intrapelvic trigger points. This study had numerous limitations, including no placebo or control group, no monitoring or restriction of medication use, no disclosure of the use of complementary therapies, no comparison of manual therapy techniques applied by a physical therapist vs those applied by an osteopathic physician, and no cost analysis. In addition, it was unclear how long participants had experienced chronic pelvic pain and whether participants had previous surgical procedures, underlying pathology that may have been treated with medications, comorbidities, psychiatric problems, or personality (ie, fear avoidance) issues that could have factored into the perception of pain. There was also no accounting for the patients who dropped out of the study because of ineffective relief from the wand. Therefore, further studies are warranted to better understand the utility of this tool in clinical practice. —M.A.S., K.M.,* and D.J.Z.* 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of JAOA—The Journal of the American Osteopathic Association strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.  
 
   To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (mseffinger@westernu.edu), or Editorial Board Member Hollis H. King, DO, PhD (hollis.king@fammed.wisc.edu).
 
   *Kate McCaffrey, DO, and David Joyce Zuniga, OMS III, are guest authors from the Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest in Lebanon, Oregon.