Síndrome de dolor miofascial en pacientes con dismenorrea primaria

Laburpena

Introduction: Primary dysmenorrhea is considered one of the most prevalent gynecological disorders in women of reproductive age, implying a decrease in their quality of life and the development of their academic and/or professional activity, presenting itself as the main cause of absenteeism. It is an underdiagnosed and undertreated pathology, with few therapeutic alternatives beyond pharmacological treatment. There is limited information on myofascial trigger points and specific symptoms of chronic pelvic pain, and more specifically dysmenorrhea. The objective of our work was to determine if patients suffering from primary dysmenorrhea present an alteration in mechanosensitivity to pressure and pain patterns, which may lead to a greater presence of myofascial trigger points in the abdominal and pelvic floor muscles in women. with dysmenorrhea compared to those women who do not suffer from this problem. Material and method: A cross-sectional descriptive study of cases and controls was carried out with a total sample of 84 participants, distributed based on whether or not they suffered from primary dysmenorrhea, and whether or not they were under any contraceptive treatment, and divided into 4 groups. of 21 women each. Data on pain, quality of life, and productivity and work absenteeism were collected; and 3 assessments were performed, in different phases of the menstrual cycle, to report data on pressure pain threshold, the presence of myofascial trigger points and the areas of referred pain from these points. Results: The one-way ANOVA test showed statistically significant differences (p <0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitive in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active myofascial trigger points is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and being higher than 70% in women with primary dysmenorrhea, in the menstrual phase; and the internal obturator muscle (100%) in the menstrual phase. Conclusions: There are hardly any differences in musculoskeletal mechanosensitive between women with and without primary dysmenorrhea, but we did find greater differences, within groups, between the different phases of the menstrual cycle. There is a higher prevalence of active myofascial trigger points of the rectus abdominis, gluteus maximus, ischiocavernosus and pubococcygeus muscles in the menstrual phase, and a higher prevalence of active myofascial trigger points of the iliococcygeus muscle and latent myofascial trigger points of the ischiocavernosus muscle in the periovulatory or intermenstrual phase, in women with primary dysmenorrhea. And it is observed how the areas of pain referred to by the myofascial trigger points of the pelvic floor muscles increase in all the women in the study, and more notably in those with primary dysmenorrhea.