Caracterización del dolor y alteraciones musculoesqueléticas en pacientes con dolor pélvico crónico. Propuesta de intervención terapéutica

Resum

Antecedents. Chronic Pelvic Pain (CPP), also know as Chronic Pelvic Pain Syndrome (CPPS), is considerate as a complex pathological entity, not well defined, with high prevalence and woldwide incidence. It is characterized by presence of a continuous pain, lasting at least 6 months, located in the abdomen or pelvis. In addition, the physiopathology of CPP/CPPS has not been clarified, and its etiology has been classified as multifactorial. Which means that numerous systems may be affected, such as urological, gastrointestinal, gynecolical, musculoskeletal and/or nervous. There is a close relationship between CPP/CPPS and cognitive, behavioral, emotional and/or sexual alterations. As a result, CPP diagnosis and treatment are extremely complex. However, both must flee from the classical view focused in the presence of clinical signs and should be addressed from a multifactorial and multidisciplinary approach. Objectives. To review clinical trials about the effectiveness of physiotherapy in CPP/CPPS; establish a clinical profile; and assess the effectiveness of a physiotherapeutic treatment based on analgesic techniques and Global Posture Re-education (GPR) in patients with CPP/CPPS. Methods. In order to provide an appropriate answer to these objectives, four studies were carried out. In the first article, a bibliographic search about physiotherapeutic interventions and pelvic pain was done between 2010 and july 2016, in main databases health sciences (MEDLINE, CINAHL y Web of Science). In the second article, 96 womens was assessed, 48 with CPP/CPPS and 48 without CPP/CPPS, analyzing the parameters related to balance and posture. In the third article, neuromuscular alterations and painful sensitivity were measured, keeping single-blind of second studies and decreasing sample a 80 womens, 40 with and 40 without CPP/CPPS. Finally, the last study was a single-blind randomized clinical trial where 19 of the 39 patients realized a GPR and analgesia treatment 2 weekly sessions during 8 weeks. The control group received advice in the form of a leaflet. Balance, functionality and quality of life were the variables studied. Results. Despite having found benefits associated with physiotherapy interventions in patiens with CPP/CPPS, methodological quality, terminology and phenotypic heterogeneity of the articles result in little overall evidence to guide treatment. In this way, a clinical profile was established. It revealed alterations of balance (reactive postural control, sensory orientation, anticipatory responses, dynamic gait and dual task-related conditions), posture (increase of dorsal kyphosis and lumbar lordosis; higher dorsal inclination and lower sacral inclination; and less spine alignment), high percentage of Myofascial Trigger Point (MTrPs), generalized hyperalgesia, lower pain thresholds and decrease range of motion associated with neurodynamic tests, in CPP/CPPS subjects in relation to the control group. In the last place, once intervention protocol was completed. Patients showed significant improvements in sensory orientation, dynamic gait, performing dual task-related conditions and daily activities, mobility, anxiety and depression, and functionality. Conclusions. CPP/CPPS patients suffer from balance, posture and neuromuscular impairment with respect to not affected subjects. Improving their balance, their perceived state of health and their functionality after the application of a physiotherapy intervention based on GPR and analgesia techniques.