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Pain and Psychological Outcomes After Rehabilitative Treatment for a Woman With Chronic Pelvic Pain With Stage III Cervical Cancer: A Case Report

Alappattu, Meryl J. PT, DPT1,2

Journal of Women’s Health Physical Therapy: September/December 2013 - Volume 37 - Issue 3 - p 97–102
doi: 10.1097/JWH.0000000000000004
Case Report

Background: Chronic pelvic pain and sexual dysfunction are adverse effects of treatment of cervical cancer. Surgery and radiation therapies may result in soft tissue pain and dysfunction, including spasms and trigger points of the pelvic floor muscles that result in pain. In addition to physical restrictions, negative mood associated with pain is believed to intensify and prolong the pain experience.

Study Design: The purpose of this case report was to describe outcomes of pelvic physical therapy in a 58-year-old woman with chronic pelvic pain after medical treatments for cervical cancer.

Case Description: The patient reported dyspareunia, hip pain, and lower abdominal, pelvic pain, and fatigue with activities lasting greater than 30 minutes. Interventions included pelvic floor massage, dilator use, and patient education. Symptoms were assessed at baseline and completion of physical therapy, using the Female Sexual Function Index, Fear of Pain Questionnaire–III, Pain Catastrophizing Scale, and Numerical Pain Rating Scale.

Outcomes: The Female Sexual Function Index score decreased from 7.8 to 2.8, the Fear of Pain Questionnaire–III score decreased from 85 to 73, the Pain Catastrophizing Scale score decreased from 18 to 8, and lower abdominal and pelvic pain decreased from 4 of 10 to 0 of 10, while bilateral hip pain remained at 4 of 10. In addition, she exhibited increased tolerance to mechanical pressure, evidenced by progression in size of a vaginal dilator.

Discussion: These results suggest that pelvic physical therapy may be useful in treating chronic pelvic pain after cervical cancer treatments and may also help decrease the magnitude of negative mood aspects such as pain-related fear and catastrophizing.

1Department of Physical Therapy, University of Florida, Gainesville, Florida.

2Department of Physical Therapy, Rehabilitation Services, Shands Healthcare, Gainesville, Florida.

This work was supported in part by a Promotion of Doctoral Studies I Scholarship from the Foundation for Physical Therapy, the American Physical Therapy Association Section on Women's Health, and the National Institutes of Health T32 Interdisciplinary Training in Rehabilitation and Neuromuscular Plasticity Grant.

The author declares no conflicts of interest.

Copyright © 2013 by the Section on Women's Health, American Physical Therapy Association.
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