How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Keren Grinberg, Irit Weissman-Fogel, Lior Lowenstein, Liora Abramov, Michal Granot, Keren Grinberg, Irit Weissman-Fogel, Lior Lowenstein, Liora Abramov, Michal Granot

Abstract

Background: Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated.

Purpose: This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients.

Methods: The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women.

Results: Along with an improvement in the clinical pain intensity (p = 0.001) and sensitivity to experimental pain tests (p = 0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p = 0.04; p = 0.001; p = 0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p = 0.001).

Conclusions: The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2019 Keren Grinberg et al.

Figures

Figure 1
Figure 1
An Hiatus biometry measurement on 3D endovaginal ultrasound, intact levator ani muscle. AP, anteroposterior; L-R, left-to-right width; SP, symphysis pubis; LA, levator ani.
Figure 2
Figure 2
Clinical pain scores (0–10 NPS) of women with CPPS at baseline and following MPT compared with CPPS women who did not undergo MPT; ∗∗p < 0.01, ∗∗∗p < 0.001. There was a significant improvement in clinical pain ratings among women receiving MPT as assessed before the treatment (t = 3.18, p=0.003) and at 3 (t = 3.97, p=0.000) and 9 months (t = 3.58 p=0.000) compared with the nontreated group. Baseline differences in clinical pain were controlled.

References

    1. Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):41–47.
    1. Engeler D. S., Baranowski A. P., Dinis-Oliveira P., et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. European Urology. 2013;64(3):431–439. doi: 10.1016/j.eururo.2013.04.035.
    1. Grinberg K., Granot M., Lowenstein L., Abramov L., Weissman-Fogel I. A common pronociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain. Pain. 2017;158(6):1021–1029. doi: 10.1097/j.pain.0000000000000869.
    1. Steege J. F., Siedhoff M. T. Chronic pelvic pain. Obstetrics & Gynecology. 2014;124(3):616–629. doi: 10.1097/aog.0000000000000417.
    1. Stones R. W., Cheong Y. C., Howard F. M., Singh S. Interventions for treating chronic pelvic pain in women (Review) Cochrane Database of Systematic Reviews. 2010;11:1–43. doi: 10.1002/14651858.cd000387.
    1. Twiddy H., Bradshaw A., Chawla R., Johnson S., Lane N. Female chronic pelvic pain: the journey to diagnosis and beyond. Pain Management. 2017;7(3):155–159. doi: 10.2217/pmt-2016-0052.
    1. Anderson R. U., Sawyer T., Wise D., Morey A., Nathanson B. H. Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. Journal of Urology. 2009;182(6):2753–2758. doi: 10.1016/j.juro.2009.08.033.
    1. Reissing E., Brown C., Lord M., Binik Y., Khalifé S. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. Journal of Psychosomatic Obstetrics & Gynecology. 2005;26(2):107–113. doi: 10.1080/01443610400023106.
    1. White G., Jantos M., Glazer H. Establishing the diagnosis of vulvar vestibulitis. Journal of Reproductive Medicine. 1997;42(3):157–160.
    1. Tu F. F., Holt J., Gonzales J., Fitzgerald C. M. Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. American Journal of Obstetrics and Gynecology. 2008;198(3):272.e1–277.e7. doi: 10.1016/j.ajog.2007.09.002.
    1. Bassaly R., Tidwell N., Bertolono S., Hyte L., Downes K., Hats S. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. International Urogynecology Journal. 2011;22(4):413–418. doi: 10.1007/s00192-010-1301-3.
    1. Lowenstein L., Kenton K., Mueller E. R., et al. Patients with painful bladder syndrome have altered response to thermal stimuli and catastrophic reaction to painful experiences. Neurourology and Urodynamics. 2009;28(5):400–404. doi: 10.1002/nau.20676.
    1. James A., Thompson J., Neumann P., Briffa K. Change in pain knowledge occurring after a neuroscience education seminar for women with chronic pelvic pain. Australian & New Zealand Continence Journal. 2016;22(4):90–91.
    1. Peters K. M., Carrico D. J., Kalinowski S. E., Ibrahim I. A., Diokno A. C. Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology. 2007;70(1):16–18. doi: 10.1016/j.urology.2007.02.067.
    1. Broto L. A., Sadownik L. A., Thomson S., et al. A comparison of demographic and psychosexual characteristics of women with primary versus secondary provoked vestibulodynia. The Clinical Journal of Pain. 2014;14(30):428–443. doi: 10.1097/ajp.0b013e31829ea118.
    1. Reed B. D., Legocki L. J., Plegue M. A., Sen A., Haefner H. K., Harlow S. D. Factors associated with vulvodynia incidence. Obstetrics & Gynecology. 2014;123(2, PART 1):225–231. doi: 10.1097/aog.0000000000000066.
    1. Cheng C., Rosamilia A., Healey M. Diagnosis of interstitial cystitis/bladder pain syndrome in women with chronic pelvic pain: a prospective observational study. International Urogynecology Journal. 2012;23(10):1361–1366. doi: 10.1007/s00192-012-1711-5.
    1. Davis N. F., Brady C. M., Creagh T. Interstitial cystitis/painful bladder syndrome: epidemiology, pathophysiology and evidence-based treatment options. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;175:30–37. doi: 10.1016/j.ejogrb.2013.12.041.
    1. Garnot M. Personality traits associated with perception of noxious stimuli in women with vulvar vestibulitis syndrome. The Journal of Pain. 2005;6(3):168–173. doi: 10.1016/j.jpain.2004.11.010.
    1. Lowenstein L., Fitzgerald M. P., Kenton K., et al. Evaluation of urgency in women, with a validated urgency, severity and impact questionnaire (USIQ) International Urogynecology Journal. 2009;20(3):301–307. doi: 10.1007/s00192-008-0770-0.
    1. Lowenstein L., Vardi Y., Deutsch M., et al. Vulvar vestibulitis severity- assessment by sensory and pain testing modalities. Pain. 2004;107(1-2):47–53. doi: 10.1016/j.pain.2003.09.012.
    1. Van Lankveld J. J. D. M., Granot M., Weijmar Schultz W. C. M., et al. Women’s sexual pain disorders. The Journal of Sexual Medicine. 2010;7(1):615–631. doi: 10.1111/j.1743-6109.2009.01631.x.
    1. Adams N., Field L. Pain management 1: psychological and social aspects of pain. British Journal of Nursing. 2001;10(14):903–911. doi: 10.12968/bjon.2001.10.14.5277.
    1. Kutch J. J., Tu F. F. Altered brain connectivity in dysmenorrhea. Pain. 2016;157(1):5–6. doi: 10.1097/j.pain.0000000000000364.
    1. Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: a perpetuating cycle. The Journal of Sexual Medicine. 2012;9(8):2077–2092. doi: 10.1111/j.1743-6109.2012.02803.x.
    1. Desrochers G., Bergeron S., Landry T., Jodoin M. Do psychosexual factors play a role in the etiology of provoked vestibulodynia? A critical review. Journal of Sex & Marital Therapy. 2008;34(3):198–226. doi: 10.1080/00926230701866083.
    1. Granot M., Lavee Y. Psychological factors associated with perception of experimental pain in vulvar vestibulitis syndrome. Journal of Sex & Marital Therapy. 2005;31(4):285–302. doi: 10.1080/00926230590950208.
    1. Khandker M., Brady S. S., Vitonis A. F., MacLehose R. F., Stewart E. G., Harlow B. L. The influence of depression and anxiety on risk of adult onset vulvodynia. Journal of Women’s Health. 2011;20(10):1445–1451. doi: 10.1089/jwh.2010.2661.
    1. Nickel J. C., Shoskes D., Irvine-Bird K. Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management. Journal of Urology. 2009;182(1):155–160. doi: 10.1016/j.juro.2009.02.122.
    1. Kuile M. M., Weijenborg P. T. M., Spinhoven P. Sexual functioning in women with chronic pelvic pain: the role of anxiety and depression. The Journal of Sexual Medicine. 2010;7(5):1901–1910. doi: 10.1111/j.1743-6109.2009.01414.x.
    1. Payne K. A., Binik Y. M., Pukall C. F., Thaler L., Amsel R., Khalifé S. Effects of sexual arousal on genital and non-genital sensation: a comparison of women with vulvar vestibulitis syndrome and healthy controls. Archives of Sexual Behavior. 2007;36(2):289–300. doi: 10.1007/s10508-006-9089-4.
    1. Miller- Matero L. R., Saulino C., Clark S., Bugensk M., Eshelman A., Eisenstein D. When treating the pain is not enough: a multidisciplinary approach for chronic pelvic pain. Archives of Women’s Mental Health. 2015;19(2):349–354. doi: 10.1007/s00737-015-0537-9.
    1. Romano A. P. M. S., Gorayeb R., Romano S., et al. High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain. International Journal of Clinical Practice. 2009;63(5):707–711. doi: 10.1111/j.1742-1241.2009.02034.x.
    1. Osborne T. L., Jensen M. P., Ehde D. M., Hanley M. A., Kraft G. Psychosocial factors associated with pain intensity, pain-related interference, and psychological functioning in persons with multiple sclerosis and pain. Pain. 2007;127(1):52–62. doi: 10.1016/j.pain.2006.07.017.
    1. Sullivan M. J. L., Thorn B., Haythornthwaite J. A., et al. Theoretical perspectives on the relation between catastrophizing and pain. The Clinical Journal of Pain. 2001;17(1):52–64. doi: 10.1097/00002508-200103000-00008.
    1. Thomtén J., Karlsson A. Psychological factors in genital pain: the role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden. Scandinavian Journal of Pain. 2014;5(3):193–199. doi: 10.1016/j.sjpain.2014.01.003.
    1. Engel G. E. The need for a new medical model. Science. 1977;196(4286):36–129. doi: 10.1126/science.847460.
    1. Engel G. L. The biopsychosocial model and the education of health professionals. General Hospital Psychiatry. 1979;1(2):156–165. doi: 10.1016/0163-8343(79)90062-8.
    1. Bartz R. The biopsychosocial model. A new approaches to doctor- patients interactions. Journal of Family Practice. 1999;48:607–610.
    1. Borrel-Carrio F., Suchman A. L., Epstein R. M. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Annalysis of Family Medicine. 2004;2(6):576–584. doi: 10.1370/afm.245.
    1. Gatchel R. J., Peng Y. B., Peters M. L., Fuchs P. N., Turk D. C. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin. 2007;133(4):581–624. doi: 10.1037/0033-2909.133.4.581.
    1. Burrows L. J., Goldstein A. T. The treatment of vestibulodynia with topical estradiol and testosterone. Sexual Medicine. 2013;1(1):30–33. doi: 10.1002/sm2.4.
    1. Landry T., Bergeron S., Dupuis M.-J., Desrochers G. The treatment of provoked vestibulodynia. The Clinical Journal of Pain. 2008;24(2):155–171. doi: 10.1097/ajp.0b013e31815aac4d.
    1. Cox A., Golda N., Nadeau G., et al. CUA guideline: diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Canadian Urological Association Journal. 2016;10(5-6):136–155. doi: 10.5489/cuaj.3786.
    1. FitzGerald M. P., Payne C. K., Lukacz E. S., et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. Journal of Urology. 2012;187(6):2113–2118. doi: 10.1016/j.juro.2012.01.123.
    1. Armstrong G. L., Vancaillie T. G. Combined site-specific sacral neuromodulation and pudendal nerve release surgery in a patient with interstitial cystitis and persistent arousal. BMJ Case Reports. 2016;9 doi: 10.1136/bcr-2015-213513.bcr2015213513
    1. Verrills P., Sinclair C., Barnard A. A review of spinal cord stimulation systems for chronic pain. Journal of Pain Research. 2016;9:481–492. doi: 10.2147/JPR.S108884.
    1. Grinberg K., Granot M., Lowenstein L., Abramov L., Weissman-Fogel I. Negative illness perceptions are associated with a pro-nociceptive modulation profile and augmented pelvic pain. The Clinical Journal of Pain. 2018;34(12):1141–1148. doi: 10.1097/ajp.0000000000000633.
    1. Rostaminia G., Manonai J., Leclaire E., et al. Interrater reliability of assessing levator ani deficiency with 360° 3D endovaginal ultrasound. International Urogynecology Journal. 2014;25(6):761–766. doi: 10.1007/s00192-013-2286-5.
    1. Yarnitsky D. Quantitative sensory testing. Muscle & Nerve. 1997;20(2):198–204. doi: 10.1002/(sici)1097-4598(199702)20:2<198::aid-mus10>;2-4.
    1. Le Bars D., Dickenson A. H., Besson J.-M. Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain. 1979;6(3):283–304. doi: 10.1016/0304-3959(79)90049-6.
    1. Yarnitsky D., Arendt-Nielsen L., Bouhassira D., et al. Recommendations on terminology and practice of psychophysical DNIC testing. European Journal of Pain. 2010;14(4):p. 339. doi: 10.1016/j.ejpain.2010.02.004.
    1. Speilberger C. D., Gorsuch R. L., Luchene R. The State- Trait Anxiety Inventory. Palo Alto, CA, USA: Consulting Psychologists press inc.; 1969.
    1. Teichman Y., Malineck F. Manual for the Hebrew State- Trait Anxiety Inventory: Tel Aviv. Tel Aviv, Israel: Tel Aviv University Press; 1978.
    1. Edwards R. R., Campbell C. M., Fillingim R. B. Catastrophizing and experimental pain sensitivity: only in vivo reports of catastrophic cognitions correlate with pain responses. The Journal of Pain. 2005;6(5):338–339. doi: 10.1016/j.jpain.2005.02.013.
    1. Canetty L., Shalev A. Y., Caplan De-Nour K. Israeli adolescent’s norms of the Brief Symptom Inventory. Israel Journal of Psychiatry and Related Sciences. 1994;31(1):13–18.
    1. Sullivan M. J. L., Bishop S. R., Pivik J. The pain catastrophizing scale: development and validation. Psychological Assessment. 1995;7(4):524–532. doi: 10.1037/1040-3590.7.4.524.
    1. Granot M., Ferber S. G. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity. The Clinical Journal of Pain. 2005;21(5):439–445. doi: 10.1097/01.ajp.0000135236.12705.2d.
    1. Beck A. T., Beck R. W. Screening depressed patients in family practice: a rapid technique. Postgraduate Medicine. 1972;52(2):81–85. doi: 10.1080/00325481.1972.11713319.
    1. Chiu I. M., Von Hehb C. A., Woolf C. J. Neurogenic inflammation- the peripheral nervous system’s role in host defense and immunopathology. Natural Neuroscience. 2013;15(8):1063–1067.
    1. Peters K. M., Carrico D. J., Ibrahim I. A., Diokno A. C. Characterization of a clinical cohort of 87 women with interstitial cystitis/painful bladder syndrome. Urology. 2008;71(4):634–640. doi: 10.1016/j.urology.2007.11.013.
    1. Heymen S., Maixner W., Whitehead W. E., Klatzkin R. R., Mechlin B., Light K. C. Central processing of noxious somatic stimuli in patients with irritable bowel syndrome compared with healthy controls. The Clinical Journal of Pain. 2010;26(2):104–109. doi: 10.1097/ajp.0b013e3181bff800.
    1. Clemens J. Q., Brown S. O., Calhoun E. A. Mental health diagnoses in patients with interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome: a case/control study. Journal of Urology. 2008;180(4):1378–1382. doi: 10.1016/j.juro.2008.06.032.
    1. Graven-Nielsen T., Wodehouse T., Langford R. M., Arendt-Nielsen L., Kidd B. L. Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis & Rheumatism. 2012;64(9):2907–2916. doi: 10.1002/art.34466.
    1. Jantos M. Underdtanding chronic pelvic pain. Pelviperineol. 2007;26:66–69.
    1. Pukall C. F., Binik Y. M., Khalife S., Amsel R., Abbott F. V. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain. 2002;96(1-2):163–175. doi: 10.1016/s0304-3959(01)00442-0.
    1. Kotarinos R. K. Myofascial pelvic pain: rationale and treatment. Current Bladder Dysfunction Reports. 2015;10(1):87–94. doi: 10.1007/s11884-014-0287-y.
    1. Bardley M. H., Rawlins A., Brinker C. A. Physical therapy treatment of pelvic pain. Physical Medicine and Rehabilitation Clinics of North America. 2017;28(3):589–601. doi: 10.1016/j.pmr.2017.03.009.
    1. Bergeron S., Binik Y. M., Khalifé S., et al. A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001;91(3):297–306. doi: 10.1016/s0304-3959(00)00449-8.
    1. Chiarioni G., Nardo A., Vantini I., Romito A., Whitehead W. E. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology. 2010;138(4):1321–1329. doi: 10.1053/j.gastro.2009.12.040.
    1. Cozean N., Cozean J. The Interstitial Cystitis Solution. Beverly, MA, USA: Quarto Publishing Group; 2016.
    1. FitzGerald M. P., Anderson R. U., Potts J., et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. Journal of Urology. 2009;182(2):570–580. doi: 10.1016/j.juro.2009.04.022.
    1. Loving S., Thomsen T., Jaszczak P., Nordling J. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain: a cross-sectional population-based study. European Journal of Pain. 2014;18(9):1259–1270. doi: 10.1002/j.1532-2149.2014.485.x.
    1. Oyama I. A., Rejba A., Lukban J. C., et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004;64(5):862–865. doi: 10.1016/j.urology.2004.06.065.
    1. Weiss J. M. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. The Journal of Urology. 2001;166(6):2226–2231. doi: 10.1016/s0022-5347(05)65539-5.
    1. Rosenbaum T. Y., Owens A. Continuing medical education: the role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME) The Journal of Sexual Medicine. 2008;5(3):513–523. doi: 10.1111/j.1743-6109.2007.00761.x.
    1. Klotz S. G. R., Schön M., Ketels G., Löwe B., Brünahl C. A. Physiotherapy management of patients with chronic pelvic pain (CPP): a systematic review. Physiotherapy Theory and Practice. 2019;35(6):516–532. doi: 10.1080/09593985.2018.1455251.
    1. Prendergast S. A. Pelvic floor physical therapy for vulvodynia. Obstetrics and Gynecology Clinics of North America. 2017;44(3):509–522. doi: 10.1016/j.ogc.2017.05.006.
    1. Arendt-Nielsen L., Yarnitsky D. Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. The Journal of Pain. 2009;10(6):556–572. doi: 10.1016/j.jpain.2009.02.002.
    1. LaMotte R. H., Shain C. N., Simone D. A., Tsai E. F. Neurogenic hyperalgesia: psychophysical studies of underlying mechanisms. Journal of Neurophysiology. 1991;66(1):190–211. doi: 10.1152/jn.1991.66.1.190.
    1. Giamberardino M. A., Tana C., Costantini R. Pain thresholds in women with chronic pelvic pain. Current Opinion in Obstetrics and Gynecology. 2014;26(4):253–259. doi: 10.1097/gco.0000000000000083.
    1. Kaya S., Hemans L., Willems T. Central sensitization in urogynecological chronic pelvic pain: a systematic literature review. Pain Physician. 2013;16(4):291–308.
    1. Pukall C. F., Meana M., Sutton K. S. Psych evalu & measur dyspareunia. In: Goldstein A., Pukall C. F., Goldstein I., editors. Female Sexual Pain Disorders: Evaluation and Measurement. Oxford, UK: Blackwell Publishing; 2009. pp. 21–26.
    1. Pukall C. F., Binik Y. M., Khalifé S. A new instrument for pain assessment in vulvar vestibulitis syndrome. Journal of Sex & Marital Therapy. 2004;30(2):69–78. doi: 10.1080/00926230490275065.
    1. Gerhardt A., Eich W., Treede R.-D., Tesarz J. Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia. Pain. 2017;158(3):430–439. doi: 10.1097/j.pain.0000000000000777.
    1. Yarnitsky D., Granot M., Granovsky Y. Pain modulation profile and pain therapy: between pro- and antinociception. Pain. 2014;155(4):663–665. doi: 10.1016/j.pain.2013.11.005.
    1. Kosek E., Ordeberg G. Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain. 2000;88(1):69–78. doi: 10.1016/s0304-3959(00)00310-9.
    1. Goodin B. R., McGuire L., Allshouse M., et al. Associations between catastrophizing and endogenous pain-inhibitory processes: sex differences. The Journal of Pain. 2009;10(2):180–190. doi: 10.1016/j.jpain.2008.08.012.
    1. Katz L., Tripp D. A., Nickel J. C., Mayer R., Reimann M., van Ophoven A. Disability in women suffering from interstitial cystitis/bladder pain syndrome. BJU International. 2012;111(1):114–121. doi: 10.1111/j.1464-410x.2012.11238.x.
    1. Whitmore K., Siegel J. F., Kellogg-Spadt S. Original research-sexual pain disorders: interstitial cystitis/painful bladder syndrome as a cause of sexual pain in women: a diagnosis to consider. The Journal of Sexual Medicine. 2007;4(3):720–727. doi: 10.1111/j.1743-6109.2007.00497.x.
    1. Hubstcher M., Moloney N., Rebbeck T., Traeger A., Refshauge K. Contributions of mood, pain catastrophizing, and cold hyperalgesia in acute and chronic low back pain: a comparison with pain-free controls. The Clinical Journal of Pain. 2014;30(10):886–993. doi: 10.1097/ajp.0000000000000045.
    1. Rhudy J. L., Williams A. E., McCabe K. M., Russell J. L., Maynard L. J. Emotional control of nociceptive reactions (ECON): do affective valence and arousal play a role? Pain. 2008;136(3):250–261. doi: 10.1016/j.pain.2007.06.031.
    1. George S. E., Clinton S. C., Borello-France D. F. Physical therapy management of female chronic pelvic pain: anatomic considerations. Clinical Anatomy. 2013;26(1):77–88. doi: 10.1002/ca.22187.
    1. Van Wilgen C. P., Van Ittersum M. W., Kaptein A. A., Van Wijhe M. Illness perceptions in patients with fibromyalgia and their relationship to quality of life and catastrophizing. Arthritis & Rheumatism. 2008;58(11):3618–3626. doi: 10.1002/art.23959.

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