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definition of trigger points in chronic pelvic pain

by Diane K. Newman, RNC, MSN, CRNP, FAAN

 See also Patient Tip Sheets:

• Understanding Chronic Pelvic Pain And Vulvodynia
• Oxalate Diet for Pelvic Pain and Vulvodynia
• Self Care Practices For Pelvic Pain And Vulvodynia

Trigger points are superficial local areas of hyperesthesia that cause sharp pain and cause a pattern of referred pain that is specific to that muscle.

An active trigger point is tender, causes referred pain, prevents elongation of the muscle and gives rise to muscle weakness.

Trigger points may occur as a result of previous surgical incisions, maybe close to or fairly distant from the scar, or may occur from nerve irritation from a previous musculoskeltal strain or isolated dermatome hypersensitivity.   

Examples:

Trigger Point	Nerve Innervation	Referred Pain Site
Puboccoygeus/Levator Ani Muscle	S1 - S4	Pelvic floor Vagina Rectum Buttock
Piriformis muscle	L5 - S 3	Low back Buttock Pelvic floor
Obturator internal and external	L3 - S2	Pelvic floor Buttock Anterior thigh

Adapted from Newman, 2000; Ryder, 1996; Baker, 1993

References

Baker, PK. (1993) Musculoskeletal Origins of Chronic Pelvic Pain. Contemporary Management of Chronic Pelvic Pain, 20(4) December:719-742.05-227.

Duleba, A.J., Keltz, M.D., Olive, D.L. (1996) Evaluation and Management of Chronic Pelvic Pain. Journal American Association Gynecologic Laparoscopists, February 1996, 3 (2), 205-227.

Glazer,H.I.,Rodke,G.,Swencionis,C., Hertz,R.,Young,A.W.(2000) "Treatment of Vulvar Vestibulitis Syndrome with Electromyographic Biofeedback of Pelvic Floor Musculature". Journal of Reproductive Medicine, 40(4),11 pp.

Metts, J.F. (1999) Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management. American Family Physician, 59(6),1547-1556.

Newman, DK. (2000) "Pelvic Disorders in Women: Chronic Pelvic Pain and Vulvodynia". OstomyWound Management: December 46(12): 48-54.

Paavonen, J. (1995) "Vulvodynia - a complex syndrome of vulvar pain". Acta Obstet Gynecol Scand. 74,243-247.

Steege,J.F. (1997) Office Assessment of Chronic Pelvic Pain. Clinical Obstetrics and Gynecology, Vol.40(3),554-563.

Steege,J.F.,Metzger,D.A.,Levy, B.S. (1998) Chronic Pelvic Pain: An Integrated Approach. W.B.Saunders,Philadelphia, PA.

Yount,J.J., Solomons, C.C.,Willems, J.J., St. Amand, R.P. (1997) "Effective Nonsurgical Treatments for Vulvar Pain". Women's Health Digest, 3(2),88-93.

Last Updated: October 2007

See Also: Vulvar/vaginal Disease, Women's Sexuality

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