Trans-perineal Trigger Point Dry Needling for Chronic Pelvic Pain

To Investigate the Use of Trans-perineal Trigger Point Dry Needling With Manual Therapy and to Compare the Outcome With Manual Therapy Treatment for Chronic Pelvic Pain With Dyspareunia. A Randomized Clinical Trial.

Chronic Pelvic Pain (CPP) are around 10% of gynaecology referrals.Non-relaxing pelvic floor dysfunction (NRPFD) is an under-appreciated cause for CPP with dyspareunia where no other pathology exists. The effectiveness of manual therapy in studies have shown statistically significant pre and post treatment differences.However no study has reviewed the efficacy of inclusion of trans- perineal trigger point dry needling used with manual therapy for NRPFD. This study will investigate the effectiveness of trans-perineal trigger point dry needling used with manual therapy techniques for CPP.

This study will investigate the effectiveness of inclusion of trans-perineal trigger point dry needling with manual therapy treatment for chronic pelvic pain with dyspareunia and associated pelvic floor dysfunctions.The use of trigger point dry needling (TrptDN) for chronic low back pain has proved beneficial.This study will evaluate the treatment outcomes of trans-perineal trigger point dry needling and manual therapy to only manual therapy for CPP.

The outcomes will evaluate the number of treatment requirements between the dry needling with manual therapy group and the manual therapy group and review which group has faster resolution in pain and other associated pelvic floor symptoms.

Inclusion Criteria:

• Patients reporting non-cyclical CPP with dyspareunia and associated PFD with no palpable pelvic floor pathology, but with palpable high pelvic floor muscle (PFM) tone and tenderness will be referred for physiotherapy by the gynaecology team.
• Visceral conditions like interstitial cystitis are difficult to exclude at gynaecology review, as they mimic CPP symptoms.
• Smokers and non-smokers included.
• Nulliparous, singleton and multiparous patients.

Exclusion Criteria:

• Body mass index greater than 30, makes it difficult to dry needle as the required needle length is not available.
• Chronic back pain over 6 months duration, under pain management team.
• Orthopaedic back surgeries with implants.
• Pelvic pathologies like endometriosis, fibroids, cysts, etc.
• Pregnancy related pelvic pain.
• Pregnant during the trial.
• Pelvic organ carcinomas.
• Undergoing cancer treatment.
• Post gynaecology surgeries, less than 16 weeks.
• Cardiovascular, gastroenterology, renal or orthopaedic surgery, less than 6 month's post-operative.
• Neurological conditions like stroke, epilepsy, Parkinson's disease etc.
• Exclusion criteria for dry needling:
• Extreme needle phobia, Rheumatoid arthritis, prolonged corticosteroid treatment, warfarin treatment, heart implants and blood clotting disorders.
• Participant with no significant learning disability and should be able to understand the procedure to consent for treatment.
• Participant should not require a chaperone during treatment.