Chronic Pelvic Pain, Central Senstization and Viscero-Somatic Interactions: Integrating Novel Assessment and Management Techniques Into Your Clinical Practice with Alime Buyuk and Jay Shah

Chronic pelvic pain (CPP) occurs in women of all ages (i.e, pre-, peri- and post-menopausal) and lifestyles from sedentary office workers to elite athletes. Although CPP is highly prevalent, it too often is approached solely as a gynecological issue and managed only with standard medical treatments such as surgery and hormones. 

CPP has a variety of causes requiring accurate diagnosis and appropriate treatment if pain is to be effectively reduced and myofascial function (especially the pelvic floor muscles) is to be optimized. Unfortunately, CPP often persists despite multi-modal treatment. Furthermore, women with CPP have a higher prevalence of fibromyalgia and irritable bowel syndrome, among other conditions, than the general population.

This thought-provoking, evidence-informed and clinically impactful lecture will demonstrate  and explain why women with CPP have multiple symptoms (e.g., dyspareunia, vulvodynia, unexplained back pain, and hip and groin pain) and multiple co-morbidities (e.g., interstitial cystitis, irritable bowel syndrome, and pelvic inflammatory disease) associated with pain and central sensitization that are not limited to pelvic organs or musculoskeletal structures. This makes accurate diagnosis particularly challenging. Unfortunately, incorrect diagnoses too often result in needless patient harm and suffering because inappropriate and potentially deleterious treatments are mistakenly provided. 

Fortunately, new insights from the neurosciences into the relationship between musculoskeletal pain and visceral conditions (e.g., endometriosis, and painful baldder syndrome), powerfully illustrate that central sensitization and myofascial dysfunction (especially involving the pelvic floor muscles), as well as viscero-somatic interactions, play a foundational role in the accurate assessment and proper management of CPP. In addition, novel applications of transperineal ultrasound (demonstrating changes in muscle parameters following myofascial release techniques) will be presented and their potential clinical relevance discussed. 

Speaker Roles                                                                                                     

Alime Buyuk will discuss pelvic floor dysfunction related to common conditions such as endometriosis, dyspaureunia and painful bladder syndrome, the definition and effects of hyperactive pelvic floor muscles, essentilal pelvic floor rehabilitation concepts, and how to assess and manage chronic pelvic pain from a physical therapy perspective. 

In addition, she will present novel ultrasound research (on chronic myofascial pelvic pain and pelvic floor dysfunction) in which she and her co-investigators are utilizing transperineal ultrasound to measure changes in pelvic floor muscle parameters for the purpose of comparing the the pre- and post-treatment effects of external and internal pelvic myofascial trigger point release techniques. 

Jay Shah will present data showing that central sensitization, myofascial dysfunction, and somato-visceral interactions are critical aspects of endometriosis-related chronic pelvic pain that have recently emerged from the pain sciences and have profound implications for proper management of women with chronic pelvic pain.

Learning Objectives

After this lecture, participants will be able to:

1) Better understand the components and role of pelvic floor overactivity, particulary  in key aspects of female chronic pelvic pain assessment  and management.

2) To apply treatment techniques for chronic pelvic pain, progressing from external to internal pelvic examination (i.e., pelvic floor muscles) myofascial trigger point release tecniques. 

3) Better understand the complex and dynamic roles that nociceptive bombardment, neurogenic inflammation, wide dynamic range neurons, and dysfunctional descending inhibition play in abdominal and pelvic floor muscle sensitization, pain chronification, somato-visceral interactions, and in the objective, quantitative, and reproducible physical findings of central sensitization (i.e., allodynia, and  hyperalgesia) commonly observed in women with chronic pelvic pain

4) Better understand and integrate into your clinical practice the profoundly important patient management implications of findings of central sensitization and myofascial dysfunction in women with chronic pelvic pain in order to optimize their care

References

Turhan, S., Buyuk, A. (2022). Evaluation of sexual quality of life after bilateral total hip arthroplasty surgery. Orthopaedics & Traumatology: Surgery & Research, 108(1), 103125.

Buyuk, A., Cetin, S. Y., & Sakinci, M. (2021). The Effects of Pelvic Floor Muscle Training and Behavioral Training on Sexual Dysfunction, Incontinence, Physical Activity Level and Quality of Life in the Elderly. Sexuality and Disability, 39(3), 555-568.

Buyuk, A  et al., (2021).  Investigation of thoracolumbar mobility in musicians with and without pelvic pain. Abstracts from the International Pelvic Pain Society (IPPS) Annual Scientific Meeting on Pelvic Pain 2020. Pain Reports, 6(3).

Buyuk, A., Greene G., Jeffcoat H., Marsh S., Shaheed H. . (2021). Telehealth physical therapy in chronic pelvic pain. Abstracts from the International Pelvic Pain Society (IPPS) Annual Scientific Meeting on Pelvic Pain 2020. Pain Reports, 6(3).

Buyuk, A., et al., (2020).  Development of pelvic floor dysfunction awareness scale. Abstracts from the International Pelvic Pain Society (IPPS) Annual Scientific Meeting on Pelvic Pain 2019. Pain Reports, 5 (2). 

Cetin, S. Y., Buyuk, A., & Ayan, A. (2020). Investigation of the relationship between the pelvic floor and sexual dysfunction in women with Sjögren’s syndrome. International Journal of Rheumatic Diseases, 23(12), 1728-1733.

Speaker Bios: 

Alime Buyuk, MPT, PhD(c) is a pelvic health physiotherapist, academician and clinical investigator in the field of pelvic floor health in the Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation at Akdeniz University, Antalya, Turkey. Her interests include chronic myofascial pelvic pain and dysfunction and pelvic health physiotherapy. She received her masters degree from Hacettepe University in Ankara, Turkey in 2016.

Alime is a highly acclaimed educator and has given many invited lectures and taught hands-on workshops for physiotherapists and other clinicians in several countries including the UK, Germany, USA, Jordan, Turkey and Canada.

Since 2016, Alime has been conducting her doctoral research and part time has been at Sherbrooke University, Physiotherapy and Rehabilitation Department, Labo-Morin Urogynecology Laboratory in Quebec, Canada. She is a member of the International Pelvic Pain Society (IPPS) and is very active in organizing international meetings of the IPPS. She is also co-founder of the International Pelvic Health Institute and has been organizing and teaching local pelvic health educational scientific courses and workshops for physiotherapists in her native Turkey for the past 7 years. 

In 2021, Alime was selected by the IPPS to be an advisory board member, and she also became, notably, the first physiotherapist and foreigner (i.e., non-American) to ever receive the prestigious Dr. Fred Howard Early Investigator Award for her novel and clinically impactful studies on chronic pelvic pain.

Jay P. Shah, MD is a physiatrist and clinical investigator in the Rehabilitation Medicine Department at the National Institutes of Health in Bethesda, Maryland USA. His interests include the pathophysiology of myofascial pain and the integration of physical medicine techniques with promising complementary approaches in the management of neuro-musculoskeletal pain and dysfunction. He also completed the UCLA Medical Acupuncture course and a two-year Bravewell Fellowship at the Arizona Center for Integrative Medicine. 

Jay is a well-known lecturer on mechanisms of chronic pain, myofascial pain, acupuncture techniques and other related topics. He and his co-investigators have utilized novel microanalytical and ultrasound imaging techniques that have uncovered the unique biochemical milieu and viscoelastic properties of myofascial trigger points and surrounding soft tissue.  Their studies have demonstrated objective, reproducible and quantifiablemuscle tissue properties associated with MTrPs and the quantitative effects of dry needling of active MTrPs on these tissue properties, in addition to showing significant improvements in pain, range of motion and patient self-report outcomes in mental health and physical function. 

He has given many invited lectures and hands-on courses nationally and internationally for physicians, physiotherapists, chiropractors, dentists, acupuncturists, and massage therapists among other professional groups. His presentations integrate the fascinating and impactful knowledge emerging from the basic and clinical pain sciences, thereby helping clinicians to optimize their evaluation and management approaches to musculoskeletal pain and dysfunction. 

Jay was selected by the American Academy of Pain Management as the 2010 recipient of the Janet Travell Clinical Pain Management Award for excellence in clinical care and by the National Association of Myofascial Trigger Point Therapists as the 2012 recipient of the David G. Simons Award for excellence in clinical research.

This webinar will be live on Zoom Wednesday  15th of March 7.30pm AEDT. 

The single-use link to this webinar will be embedded into your virtual ticket from Humanitix. 

The recording of the presentation will be made available for one week after the scheduled delivery, where you'll be able to download and save a copy for yourself.