Interrelationship among levator spasm, sensitization, myofascial dysfunction, anxiety and depression in patients with endometriosis and chronic pelvic pain

To evaluate the interrelationships among levator spasm, sensitization, myofascial dysfunction (MyoDys), pain severity, anxiety and depression in women with chronic pelvic pain and endometriosis (CPP+E), chronic pelvic pain only (CPP), and healthy volunteers (HV). Prospective cohort study. Allodynia and hyperalgesia were assessed bilaterally from T9 to S2. Sensitization was defined as ≥6 abnormal segments/side. Myofascial trigger points (TrP) were examined in 7 muscles/side. MyoDys was defined as having TrP in ≥4 muscles/side. Pelvic floor muscle spasm, ie levator spasm, was assessed on pelvic exam. Headaches, body pain, pelvic pain, anxiety and depression were assessed by questionnaire. All CPP had symptoms suggesting endometriosis and underwent surgery for diagnosis and treatment of any endometriosis lesions. Data were analyzed using Kruskal-Wallis test for trend and logistic regression modeling. CPP+E (n=18), CPP (n=11) and HV (n=20) were included. 61% of women with CPP+E had levator spasm compared to 36% CPP vs 0% HV (p<0.0001). 87% with levator spasm had MyoDys whereas 45% with MyoDys had levator spasm. After adjusting for group, those with MyoDys were more likely to be sensitized (OR=6.81,95%CI:1.04-44.36;p=0.045). In considering any history of endometriosis instead of group, those with MyoDys were more likely to be sensitized (OR=9.41,95% CI:1.77-50.08;p=0.009). After adjusting for group, those with more severe headaches, body pain, and pelvic pain (OR=2.29, 95% CI:1.14-4.59;p=0.02), anxiety (OR=1.05, 95% CI: 1.004-1.099;p=0.03) or depression (OR=1.06,95%CI: 1.005-1.113; p=0.03) were more likely to be sensitized. Levator spasm, myofascial dysfunction, sensitization, pain severity, anxiety and depression appear to be interrelated in women with endometriosis-associated chronic pelvic pain. Assessment of these factors may be important in the treatment of endometriosis and chronic pelvic pain.