Impact of physical activity for chronic pelvic pain


Chronic pelvic pain is a complex, multifaceted condition defined as noncyclic pain of greater than six months duration localized to pelvis, lower abdominal wall, and lower back or buttocks, which is severe enough to cause functional disability or lead to medical care. Chronic pelvic pain is estimated to affect 3.8% to 14.7% of women worldwide. Chronic pelvic pain is increasingly being understood as a disorder of central pain amplification and is often refractory to surgical and medical therapy.

Fibromyalgia shares many characteristics of central pain amplification. Physical activity interventions have been shown to result in significant improvements in pain, quality of life and physical function in patients with fibromyalgia. Similar improvements have been demonstrated in other chronic pain conditions thought to share a similar centralized pain mechanism, such as irritable bowel syndrome, chronic headaches, low back pain and osteoarthritis. Physical activity intervention for chronic pelvic pain, however, has not been described in the literature to date.

The primary aim of this pilot study is to evaluate the feasibility of conducting a randomized controlled to assess the impact of moderate-intensity physical activity on pelvic pain in women with chronic pelvic pain. Data from this study will be used to calculate power estimate for a future RCT, as well as to develop the framework for an NIH K23 funding application to examine non-pharmacologic therapy strategies in patients with chronic pelvic pain. We will develop a moderate-intensity physical activity program for patients with chronic pelvic pain in conjunction with exercise physiologists and physical medicine and rehabilitation (PM&R) physicians. Based on prior research in fibromyalgia and other centralized pain disorders, we hypothesize that eight weeks of moderate-intensity physical activity will reduce pain intensity and pain interference in women with chronic pelvic pain. We will also evaluate the impact of moderate-intensity physical activity on physical function, fatigue, sexual function, sleep, anxiety, depression, catastrophization and patient global impression of change in women with chronic pelvic pain. We hypothesize that eight weeks of moderate-intensity physical activity will result in improvements in these measures of function and quality of life.

This pilot study will enroll 25 women age 18-65 with greater than six months of noncyclic pelvic pain.
Subjects will participate in an 8-week physical activity program specifically designed for patients with chronic pain and supervised by personal trainers and exercise physiologists in a rehab-focused, medicallybased fitness center. Subjects will complete web-based assessment tools at the start of the program, immediately after completion of the 8-week program and four weeks after the conclusion of the program (at the 12-week time point).

This pilot study will be the first to examine a physical activity intervention in patients with chronic pelvic pain and is expected to yield valuable information regarding impact on pain, physical function and quality of life in this population. We plan to use the data from this study to develop the framework for an NIH K-23 funding application to examine non-pharmacologic therapy strategies in patients with chronic pelvic pain.