19 julho, 2008

The Osteopath- Manual treatment of chronic pelvic pain

Osteopaths have treated patients with chronic pelvic pain (CPP) for many years; however, there is a shortage of literature documenting this aspect of clinical practice.

The authors of this review have examined the causes and management of CPP. The definition used is that of “nonmenstrual or non-cyclic pain in the lower abdominal region lasting for at least six months, sufficiently intense to interfere with habitual activities and requiring clinical or surgical management”.

The review reports that CPP is prevalent in 14-24% of women of reproductive age, and that 39% of women seen in primary care locations report pelvic pain. In the USA, follow-up investigations, including laparoscopies and other gynaecological consultations, produces direct and indirect costs exceeding $2billion.

The studies examined were unable to identify risk factors
for the disease, but have shown that 85% of patients presenting with CPP have dysfunction of the musculoskeletal system. Documented sources of dysfunction included postural changes (including increased lumbar lordosis), knee hyperextension, pelvic anteriorisation, and changes in the pelvic muscles, including spasm in the piriformis and levator ani. It was not wellestablished in the literature whether such musculoskeletal changes were caused by or compensations for CPP. Compensatory changes were documented to contribute to postural imbalance and symptoms becoming more chronic.

The review suggests that clear identification of the characteristics of the pain is essential in identifying its aetiology and the most effective measures to record pain were recommended as
visual analogue scales (VAS) and the McGill Pain Questionnaire.

Treatment strategies were discussed including the use of tricyclic antidepressants in combination with analgesia. There was a notable lack of recognition of the role of manual therapies in the paper, with much more space
dedicated to the description of transvaginal therapy for patients with pelvic floor dysfunction. There was little mention of the effect that manual therapy to the spine and pelvic joints could have on outcome, which highlights that more information needs to be documented concerning the osteopathic management of pelvic pain.
The Osteopath Jun/ Jul 08