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Východiská: Existuje mnoho typov bolesti v oblasti panvy. U žien po pôrode sa často vyskytujú bolesti panvového pletenca, bolesti kostrče, bolesti z jaziev po epiziotómii a vulvodýnia. Cieľom práce bolo zrealizovať systematický prehľad štúdií o panvovej bolesti u žien po pôrode s hodnotením efektu fyzioterapeutických intervencií na jednotlivé typy bolesti. Metódy: Komplexný prehľad literatúry bol vykonaný prehľadaním PubMed, Ovid Embase, Scopus Web of Science s použitím kľúčových slov – panvová bolesť, ženy po pôrode, bolesť panvového pletenca, kokcygodýni, epiziotómia, vulvodýnia a fyzioterapia. Autor skontroloval všetky identifikované články a vybral na zaradenie články podľa relevantnosti k téme. Záver: Na základe analýzy uvedených výskumov môžeme konštatovať, že komplexnou fyzioterapiou určenou pre ženy po pôrode, ktorá zahŕňa manuálne techniky, behavioráne techniky, uvoľňovanie hypoertonických a skrátených svalov a posilnenie hypotonických svalov je možné pozitívne ovplyvniť širokú škálu bolestí a súvisiacich dysfunkcií svalov panvového dna a trupu.

Objective: There are many types of pelvic pain. Pelvic plexus pain, coccyx pain, pain from episiotomy scars, and vulvodynia are frequently seen in postpartum women. The aim of this study was to conduct a systematic review of studies on pelvic pain in postpartum women to assess the effect of physiotherapy interventions on each type of pain. Methods: A comprehensive literature review was conducted by searching on PubMed, Ovid Embase and Scopus Web of Science using the key words – pelvic pain, women after childbirth, pelvic girdle pain, coccygodynia, episiotomy, vulvodynia, and physiotherapy. The author reviewed all the identified articles and selected articles for inclusion according to relevance to the topic. Conclusion: Based on the analysis of the above studies, it can be concluded that a comprehensive physiotherapy designed for postpartum women that includes manual techniques, behavioral techniques, relaxation of hypo-tonic and shortened muscles and strengthening of hypotonic muscles can positively affect a wide range of pain and associated dysfunctions of the pelvic floor and trunk muscles.

MeSH
fyzioterapie (techniky) MeSH
klinická studie jako téma MeSH
lidé MeSH
pánevní bolest * etiologie rehabilitace MeSH
poporodní období MeSH
porod MeSH
vulvodynie etiologie rehabilitace MeSH
Check Tag
lidé MeSH
ženské pohlaví MeSH
Publikační typ
přehledy MeSH

Článek

Extracorporeal shock wave therapy for treatment of vulvodynia: a prospective, randomized, double-blind, placebo-controlled study

European Journal of Physical and Rehabilitation Medicine. 2020 ; 56 (2) : 169-174. [pub] 20200114

Eur. j. phys. rehabil. med.
ISSN 1973-9095
Medvik
Zdroj

BACKGROUND: Currently, there are no effective therapy strategies for idiopathic, non-organic vulvodynia in women. ESWT (extracorporeal shock wave therapy) is a nonsurgical/noninvasive technique widely used to treat musculoskeletal diseases, muscle spasticity and hypertonia, renal and biliary calculi and urological disorders. AIM: We examined the effects of ESWT on vulvodynia in women. DESIGN: A prospective, randomized, double-blind, placebo-controlled study was conducted between 2015 and 2018 following a feasibility study. SETTING: Obstetrics and Gynecology Hospital departments. POPULATION: The study included 62 women with vulvodynia for at least 3 months. METHODS: The women were randomly assigned to either a treatment group (N.=31) or a placebo group (N.=31). The patients in the treatment group received perineally applied ESWT weekly (3000 pulses each for four consecutive weeks). The energy flux density was 0.25 mJ/mm2, frequency 4 Hz, focus zone 0-30 mm, therapeutic efficacy 0-90 mm, stand-off II. The device used was a standard electromagnetic shock wave unit with a focused shock wave handpiece. The position of the shock wave transducer was changed six times after every 500 pulses. Patients in the placebo group underwent the same treatment procedure, but the handpiece was provided with a placebo stand-off that disabled energy transmission. Subjective pain was self-evaluated by each patient using two tools before and after treatment: a 10 cm linear visual analogue scale (VAS, 0-10) and a cotton-swab test (CST, Goetsch scale 0-4). Follow-ups were done 1, 4, and 12 weeks post-ESWT. RESULTS: In all, 61 women completed the study. We tested for differences in the VAS and CST within and between the treatment and placebo groups. The testing was between before treatment and particular follow-up. We found significant changes in the treatment group. Reductions in VAS (P<0.01) and CST (P<0.01) were observed at all three follow-ups. At all assessments, pain reduction was always >30%. In the placebo group there were no statistically significant changes between before and after treatment. There were no differences between the treatment and placebo groups before treatment but statistically significant differences at all three follow-ups (VAS P<0.01); CST P<0.01). CONCLUSIONS: ESWT seems to reduce pain perception in our treatment group. Thus, we are encouraged to explore this technique further. CLINICAL REHABILITATION IMPACT: The method is easily replicable, inexpensive, and without known side effects.

Článek online

Extrakorporeální rázová vlna v léčbě vulvodynie. Studie proveditelnosti
[Extracorporeal shock wave therapy for the treatment of vulvodyni. Feasibility study]

Aktuální gynekologie a porodnictví. 2019 ; 11 () : 18-22. [pub] 20190319

ISSN 1803-9588
Medvik
Zdroj

Úvod: V současnosti není k dispozici vhodná strategie k léčbě vulvodynie u žen. Extrakorporeální rázová vlna (Extracorporeal shock wave therapy – ESWT) je rozšířena pro léčbu muskuloskeletárních poruch, svalové spasticity, hypertonu, renální a biliární lithiázy, urologických a v poslední době i andrologických onemocnění. Rozhodli jsme se vyšetřit užití ESWT u vulvodynie u žen. Metody: Prospektivní studie byla prováděna v letech 2015 – 2018. Studie proveditelnosti zahrnovala 30 žen s vulvodynií nejméně 3 měsíce. Pacientky byly léčeny perineálně aplikovanou ESWT 1x týdně (3 000 pulzů vždy po 4 následující týdny). Použité zařízení bylo standardní elektromagnetický unit s fokusovanou rázovou hlavicí. Ošetřovaná oblast byla měněna vždy po 500 pulzech. Šesti okrsky byla ošetřena celá vulva a perineum. Stupeň bolesti byl hodnocen pomocí vizuální analogové škály o 11 stupních (VAS, 0 – 10) před a po léčbě. Cotton Swab test (CST, Goetsch škála 0 – 4) ve stejných termínech. Follow-up byla provedena po 1, 4 a 12 týdnech po ukončení poslední aplikace ESWT. Souhlas Etické komise a písemné informované souhlasy pacientek byly zajištěny. Výsledky: 29 žen dokončilo studii. Ve VAS a CST testování jsme prokázali signifikantní rozdíly mezi výsledky před aplikací a všemi výsledky follow-up (P < 0,001; P < 0,05) v tomto pořadí. Redukce bolesti ve VAS byla 53 % a CST 47 % při posledním testování Závěry: ESWT se zdá významně redukovat vnímání bolesti v naší skupině léčených žen. Výsledky nás povzbuzují k dalšímu zkoumání této moderní techniky. Tato metoda je jednoduše opakovatelná, levná a bez prokazatelných vedlejších účinků.

Introduction: There are no sufficient therapy strategies for vulvodynia in women. Extracorporeal shock wave therapy (ESWT) is widely used for the treatment of musculoskeletal diseases, muscle spasticity, hypertonus, renal and biliary calculi, urological and recently andrological disorders. We examined the effect of ESWT on vulvodynia in women. Methods: A prospective study was conducted between 2015 and 2018 years. The feasibility study involved thirty women with vulvodynia for at least 3 months. The patients received perineally applied ESWT treatment weekly (3 000 pulses each for 4 consecutive weeks). The device used was a standard electromagnetic shock wave unit with a focused shock wave handpiece. The access area was changed after every 500 pulses. Six areas covered the whole vulva and perineum.The grade of pain was evaluated with the visual analogue scale of 11 degrees (VAS, 0-10) before and after the treatment and Cotton Swab test (CST, Goetsch scale 0-4) at the same terms. Follow-ups were done after 1, 4, and 12 weeks having finished the last ESWT. Ethical committee agreement and written consents were provided. Results: 29 women completed the study. In VAS and CST testing we proved significant differences between before and all the follow-ups (P < 0.001; P < 0.05) respectively. The reduction of pain in VAS was 53 %; CST 47 % in the last testing. Conclusions: ESWT seems to reduce significantly the pain perception in our group of treated patients. We are encouraged to explore this technique further. The method is easily repeatable, inexpensive, and free of any side effects.