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Quantification of Abdominal Wall Pain Using Pain Pressure Threshold Algometry in Patients With Chronic Pelvic Pain

Fenton, Bradford W. MD, PhD*; Palmieri, Patrick A. PhD; Durner, Christopher DO; Fanning, James DO*

doi: 10.1097/AJP.0b013e31819a3cf9
Original Articles
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Objective Chronic pelvic pain (CPP) is a syndrome involving 1 or more pain generating organs in the pelvis, which includes pain from the lower anterior abdominal wall. This entity has been termed myofascial pain syndrome (MFPS), but its characteristics, definition, and quantification have not been well described. In this study, pain pressure threshold (PPT) testing of the lower anterior abdominal wall in CPP patients was performed to determine the range and distribution of values at each site, and the clinical utility of using PPT in a definition of MFPS.

Methods Fifty-six patients evaluated in a CPP specialty clinic underwent PPT algometry of 14 sites on the lower anterior abdominal wall. These values were described and evaluated before and after treatment. PPT values were also evaluated in patients found to be drug seeking.

Results Twenty percent of the PPT tests reached the threshold of 3 kgf/cm2. The abnormal tests usually formed a normal distribution. PPT testing had a weak but appropriate correlation with other pain symptom measures. After trigger point injection there was a 75% improvement in PPT, and response to medical therapy resulted in a 60% improvement. A composite measure was able to distinguish drug-seeking patients with statistical accuracy.

Discussion PPT testing can be used to evaluate MFPS in CPP patients. One suggested definition would exclude patients with low scores in the upper abdomen while including patients with low scores in the lower abdomen.

*Department of Obstetrics and Gynecology, The Chronic Pelvic Pain Specialty Center

Department of Psychiatry, Center for the Treatment and Study of Traumatic Stress, Summa Health System, Akron, OH

Supported by the Summa Foundation.

Reprints: Bradford W. Fenton, MD, PhD, Department of Obstetrics and Gynecology, The Chronic Pelvic Pain Specialty Center, Summa Health System, 525 E Market St, MED 271, Akron, OH 44309-2090 (e-mail: fentonb@summa-health.org).

Received for publication October 22, 2008; revised December 15, 2008; accepted December 21, 2008

© 2009 Lippincott Williams & Wilkins, Inc.