An observational cohort study of pelvic floor photobiomodulation for treatment of chronic pelvic pain
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: This research is the first to evaluate the effectiveness of trans-vaginal photobiomodulation therapy (TV-PBMT) for chronic pelvic pain. Materials & methods: Observational analysis of 128 women, undergoing TV-PBMT for chronic pelvic pain. Minimal clinically important difference, defined as ≥2-point drop on a 0–10 numeric pain rating scale (NPRS), and effect size Cohen d coefficient, was calculated over nine treatments for overall pain, and pain with activities. Results: Compared with baseline, 64.5% of women showed improvement in overall pain, pain with bowel movement, intercourse, exercise, urination, sitting and vulvar pain (minimal clinically important difference = -2.4, -2.0, -2.4, -2.1, -2.1, -2.0, -3.1; d = 0.9, 0.7, 0.9, 0.7, 0.7, 0.7, 0.9) by treatment 9. Conclusion: In this cohort, TV-PBMT resulted in improvement of pelvic pain without serious adverse events.
Lay abstract
Low-level laser is a therapy that can help pain, but this type of treatment has not been available to women with chronic pelvic pain because traditional laser devices cannot access the pelvic structures. In this research we studied a novel low-laser device that can be used in the vagina, to treat pain arising from pelvic organs and muscles. Our preliminary research shows that this approach significantly reduced pelvic pain, and pain with activities such as exercise, urination, bowel movements and intercourse, in two-thirds of women who completed the therapy.
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References
1.
Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet. Gynecol. 87(3), 321–327 (1996).
2.
Zondervan KT, Yudkin PL, Vessey MP et al. Chronic pelvic pain in the community--symptoms, investigations, and diagnoses. Am. J. Obstet. Gynecol. 184(6), 1149–1155 (2001).
3.
Lamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic pelvic pain in women: a review. JAMA 325(23), 2381–2391 (2021).
4.
Fitzgerald CM, Neville CE, Mallinson T, Badillo SA, Hynes CK, Tu FF. Pelvic floor muscle examination in female chronic pelvic pain. J. Reprod. Med. 56(3–4), 117–122 (2011).
5.
Mieritz RM, Thorhauge K, Forman A, Mieritz HB, Hartvigsen J, Christensen HW. Musculoskeletal dysfunctions in patients with chronic pelvic pain: a preliminary descriptive survey. J. Manipulative Physiol. Ther. 39(9), 616–622 (2016).
6.
Sedighimehr N, Manshadi FD, Shokouhi N, Baghban AA. Pelvic musculoskeletal dysfunctions in women with and without chronic pelvic pain. J. Bodyw. Mov. Ther. 22(1), 92–96 (2018).
7.
Bonder JH, Chi M, Rispoli L. Myofascial pelvic pain and related disorders. Phys. Med. Rehabil. Clin. N. Am. 28(3), 501–515 (2017).
8.
Lamvu G, Carrillo J, Witzeman K, Alappattu M. Musculoskeletal considerations in female patients with chronic pelvic pain. Semin. Reprod. Med. 36(2), 107–115 (2018).
9.
Fuentes-Marquez P, Cabrera-Martos I, Valenza MC. Physiotherapy interventions for patients with chronic pelvic pain: a systematic review of the literature. Physiother. Theory Pract. 35(12), 1131–1138 (2019).
10.
FitzGerald MP, Payne CK, Lukacz ES et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J. Urol. 187(6), 2113–2118 (2012).
11.
Clijsen R, Brunner A, Barbero M, Clarys P, Taeymans J. Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis. Eur. J. Phys. Rehabil. Med. 53(4), 603–610 (2017).
12.
Glazov G, Yelland M, Emery J. Low-level laser therapy for chronic non-specific low back pain: a meta-analysis of randomised controlled trials. Acupunct. Med. 34(5), 328–341 (2016).
13.
Yeh SW, Hong CH, Shih MC, Tam KW, Huang YH, Kuan YC. Low-level laser therapy for fibromyalgia: a systematic review and meta-analysis. Pain Physician 22(3), 241–254 (2019).
14.
Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop. Rheumatol. 2(5), 00068 (2015).
15.
Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus photobiomodulation therapy. Photomed. Laser Surg. 33(4), 183–184 (2015).
16.
Brown GC. Nitric oxide regulates mitochondrial respiration and cell functions by inhibiting cytochrome oxidase. FEBS Lett. 369(2–3), 136–139 (1995).
17.
Lane N. Cell biology: power games. Nature 443(7114), 901–903 (2006).
18.
de Freitas LF, Hamblin MR. Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J. Sel. Top Quantum Electron. 22(3), 7000417 (2016).
19.
Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys. 4(3), 337–361 (2017).
20.
Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann. Biomed. Eng. 40(2), 516–533 (2012).
21.
Zipper R, Pryor B. Evaluation of a novel deep tissue transvaginal near-infrared laser and applicator in an ovine model. Lasers Med. Sci. (2021) (Epub ahead of print).
22.
Preti M, Vieira-Baptista P, Digesu GA et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: an ICS/ISSVD best practice consensus document. Neurourol. Urodyn. 38(3), 1009–1023 (2019).
23.
Alshiek J, Garcia B, Minassian V et al. Vaginal energy-based devices. Female Pelvic Med. Reconstr. Surg. 26(5), 287–298 (2020).
24.
Preti M, Vieira-Baptista P, Digesu GA et al. The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: an ICS/ISSVD best practice consensus document. J. Low Genit. Tract. Dis. 23(2), 151–160 (2019).
25.
Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94(2), 149–158 (2001).
26.
Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur. J. Pain 8(4), 283–291 (2004).
27.
American College of Obstetricians and Gynecologists. Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218. Obstet. Gynecol. 135(3), e98–e109 (2020).
28.
Allaire C, Williams C, Bodmer-Roy S et al. Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort. Am. J. Obstet. Gynecol. 218(1), 114 e1–e12 (2018).
29.
Bachmann GA, Rosen R, Arnold LD et al. Chronic vulvar and other gynecologic pain: prevalence and characteristics in a self-reported survey. J. Reprod. Med. 51(1), 3–9 (2006).
30.
Haggerty CL, Peipert JF, Weitzen S et al. Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease. Sex. Transm. Dis. 32(5), 293–299 (2005).
31.
Lamvu G, Williams R, Zolnoun D et al. Long-term outcomes after surgical and nonsurgical management of chronic pelvic pain: one year after evaluation in a pelvic pain specialty clinic. Am. J. Obstet. Gynecol. 195(2), 591–598 (2006).
32.
Trutnovsky G, Plieseis C, Bjelic-Radisic V, BertholinyGalvez MC, Tamussino K, Ulrich D. Vulvodynia and chronic pelvic pain in a gynecologic outpatient clinic. J. Psychosom. Obstet. Gynaecol. 40(3), 243–247 (2019).
33.
Woodburn KL, Tran MC, Casas-Puig V, Ninivaggio CS, Ferrando CA. Compliance With Pelvic Floor Physical Therapy in Patients Diagnosed With High-Tone Pelvic Floor Disorders. Female Pelvic Med Reconstr Surg. 27(2), 94–97 (2019).
34.
Shannon MB, Genereux M, Brincat C et al. Attendance at prescribed pelvic floor physical therapy in a diverse, urban urogynecology population. PM R 10(6), 601–606 (2018).
35.
Oyama IA, Rejba A, Lukban JC et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 64(5), 862–865 (2004).
36.
Agency for Healthcare Research and Quality. Effectiveness of treatments for noncyclic chronic pelvic pain in adult women. Comparative Effectiveness Review Summary Guides for Clinicians. MD, USA (2012). https://effectivehealthcare.ahrq.gov/products/pelvic-pain/research
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Pages: 1291 - 1299
PubMed: 34490787
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© 2021 The authors. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 2 August 2021
Accepted: 19 August 2021
Published online: 7 September 2021
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An observational cohort study of pelvic floor photobiomodulation for treatment of chronic pelvic pain. (2021) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2021-0187
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