WHAT Relationship between live musical interventions and chronic pelvic pain.
WHO Physical Medicine and Rehabilitation Department led by Dr. Jesús Vara.
WHY Acute pelvic pain is relatively easy to assess, diagnose and treat. However, diagnosis in patients with chronic pelvic pain is complex and often late, and they must be evaluated and treated in a multidisciplinary clinical unit. Given the complexity of these conditions, chronic pelvic pain patients (the majority are women) must be evaluated using a multidisciplinary approach, including an evaluation of their family and psychosocial environment in the anamnesis. The therapeutic approach must be based on all of the above, using all available treatment resources: conservative (rehabilitation, pharmacological and psychological therapy) and surgical approaches, in which laparoscopy is playing an increasingly important role, as the last option.
Chronic pelvic pain is a condition that is difficult to manage clinically and involves different pain production mechanisms, due to both the variety of anatomical structures involved and its chronic nature, without forgetting “pain memory” as the causal agent. Current therapeutic options do not offer definitive results for this syndrome; hence, this study proposes scientific evaluation of the efficacy of music therapy as part of the therapeutic approach and also to be able to assess quality of life after treatment.
No studies have yet been published on music therapy and chronic pelvic pain in the consulted literature (PubMed, EMBASE). The hypothesis in this study was that music therapy associated with rehabilitation can improve quality of life in patients with CPPS.
HOW The study analysed the effects of exposure to live music in chronic pelvic pain patients visiting the hospital on an outpatient basis. These patients regularly visit Hospital 12 de Octubre without being admitted to the centre. The treatment group received the rehabilitation intervention (massage therapy, kinesitherapy, TENS (transcutaneous electrical nerve stimulation), percutaneous neuromodulation of the posterior tibial tendon) and live music intervention. The applied procedures consisted of a clinical evaluation of pain, physical examination, measurement of physiological parameters, as well as an instrumental measurement based on validated scales.
Situation of the patients
These are patients who had been frequently visited by different specialists and had undergone multiple diagnostic tests without obtaining satisfactory results. Chronic pelvic pain syndrome (CPPS) is a pathology that occurs more frequently in women.
CPP can be defined as pain in the pelvic region, and may be associated with dyspareunia, vulvodynia and hypertonia of the pelvic floor muscles.
It can be of gynaecological (cyclical or non-cyclical), urological, gastrointestinal, musculature or psychiatric origin. The most frequent organic causes include: interstitial cystitis, endometriosis, pudendal nerve neuropathy, and myofascial pain syndromes.
The most affected anatomical structures are the levator ani muscle (comprising 3 fascicles: puborectalis, pubococcygeus, and ileococcygeus), the internal obturator muscle, and the piriformis muscle, as well as the pudendal and obturator nerves. However, a number of patients present no clear etiology, and this may persist despite the treatment performed.
The diagnosis is fundamentally clinical. The most frequently used complementary tests in daily practice are laboratory tests, gynaecological and urinary tract ultrasound, pelvic MRI (mainly of the pelvic floor), and EMF.
Treatment depends on the aetiology of the pain, even if a single aetiological agent is not found in a not insignificant number of patients. Conservative treatment of CPPS includes pharmacological therapy (non-NSAIDs, tramadol, gabapentin/pregabalin, local diazepam) and rehabilitation therapy.
Since November 2015, the pelvic floor unit of the Rehabilitation Department has participated, together with other specialties, in the multidisciplinary evaluation of this syndrome, with a view to improving clinical-therapeutic approaches. The departments involved in the management of this pathology are, in addition to Rehabilitation, Gynaecology, Urology, Gastroenterology, Psychiatry and the Pain Unit.
Patients are referred to the rehabilitation department for evaluation, implementation of conservative treatment therapy and evolution control. They are referred following consultations at the Organic Gynaecology, Pelvic Floor Gynaecology, Urology and Digestive System departments and the Pain Unit.
The Pelvic Floor Unit is formed by a rehabilitation doctor specialised in pelvic floor pathology (Dr. Vara Paniagua) and three physiotherapists, equally specialised in this pathology.
Once the patient has been assessed by the rehabilitation doctor, after a clinical evaluation and complementary tests on a case-by-case basis (analysis, ultrasound, MRI, EMG), the doctor prescribes the most appropriate rehabilitation treatment for each patient.
Analyse the effect of music associated with a rehabilitation programme in patients with chronic pelvic pain (CPP).
In this study, live music associated with the usual treatment did not improve the therapeutic prognosis in women with CPP.
This fact may be due both to a worse baseline status of the patient and to the larger number of dropouts in the intervention group. Likewise, other limitations of the study were the small number of patients and having randomised the groups without stratifying according to baseline pain, which may have contributed to the fact that no significant differences were observed between both treatments.