Widespread Pain Hypersensitivity and Lumbopelvic Impairments in Women Diagnosed with Endometriosis

• Published in: Pain medicine (Malden, Mass.) Vol. 22; no. 9; pp. 1970 - 1981
• Main Authors: Lara-Ramos, Ana, Álvarez-Salvago, Francisco, Fernández-Lao, Carolina, Galiano-Castillo, Noelia, Ocón-Hernández, Olga, Mazheika, Maryna, Salinas-Asensio, Ma Mar, Mundo-López, Antonio, Arroyo-Morales, Manuel, Cantarero-Villanueva, Irene, Artacho-Cordón, Francisco
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-09-2021
• Subjects: Back pain; Complications and side effects; Endometriosis; Hypersensitivity; Irritation; Low back pain; Medical diagnosis; Muscles; Musculoskeletal diseases; Pain; Pain management; Pelvic pain; Pelvis; Psychological aspects; Rehabilitation; Risk factors; Womens health; Spain; Endometriosis; Pain Pressure Threshold; Lumbopelvic Stability; Back Muscles; Pelvic Pain; Abdominal Muscles
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnaa463

Abstract
Objective
To explore hypersensitivity to pain and musculoskeletal impairments in the lumbopelvic area in women with and without endometriosis.
Methods
This cross-sectional study included 66 women (41 women with endometriosis and 25 healthy women). Pain and related catastrophizing thoughts were assessed through a numeric rating scale, pressure pain thresholds (PPTs), the slump test, and the Pain Catastrophizing Scale. Lumbopelvic muscles were evaluated through ultrasound imaging, flexor/extensor resistance tests, and the lumbopelvic stability test.
Results
Women with endometriosis showed increased self-reported intensity of current pelvic pain (CuPP), reduced local PPTs (42.8–64.7% in the affected area, P-value <.001) and higher prevalence of lumbar nerve root impingement/irritation pain and catastrophizing thoughts (P-value ≤.002). Moreover, affected women showed decreased thickness of transversus abdominis, reduced resistance of flexor and extensor trunk muscles and lower lumbopelvic stability (P-values <.030). Endometriosis stage and severity of CuPP were related to worse results in these parameters.
Conclusions
The presence of pain sensitization signs and lumbopelvic impairments, more pronounced in patients with stage IV endometriosis and moderate/severe CuPP, warrants the development of rehabilitation interventions targeting pain and lumbopelvic impairments in women with endometriosis.