Asteria
This systematic review addresses the pathophysiology, diagnostic
evaluation, and treatment of several chronic pain syndromes affecting
the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia,
and chronic pelvic pain. Chronic or recurrent pain in the anal canal,
rectum, or other pelvic organs occurs in 7% to 24% of the population and
is associated with impaired quality of life and high health care costs.
However, these pain syndromes are poorly understood, with little
research evidence available to guide their diagnosis and treatment. This
situation appears to be changing: a recently published large
randomized, controlled trial by our group comparing biofeedback,
electrogalvanic stimulation, and massage for the treatment of chronic
proctalgia has shown success rates of 85% for biofeedback when patients
are selected based on physical examination evidence of tenderness in
response to traction on the levator ani muscle--a physical sign
suggestive of striated muscle tension. Excessive tension (spasm) in the
striated muscles of the pelvic floor appears to be common to most of the
pelvic pain syndromes. This suggests the possibility that similar
approaches to diagnostic assessment and treatment may improve outcomes
in other pelvic pain disorders.
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