Definition of Trigger Points in Chronic Pelvic Pain
by Diane K. Newman, RNC, MSN, CRNP, FAAN
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 |
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.
February 2003