Myofascial Pelvic Pain: Prevalence and Treatment Trends in a Tertiary Pelvic Pain Clinic

INTRODUCTION: Chronic pelvic pain significantly impacts women in the United States, affecting up to 32% of those of reproductive age. Myofascial pelvic pain (MPP) accounts for an estimated 23% of chronic pelvic pain cases and is also a common comorbid condition. Although pelvic floor physical therapy (PFPT) is a recommended first-line treatment for MPP, barriers such as insurance coverage, co-pays, work commitments, and access to providers can impede therapy initiation and completion. Currently, skeletal muscle relaxants (SMRs) are indicated as adjunctive treatment for acute musculoskeletal pain. This study aims to examine referral and prescribing patterns in the management of myofascial pelvic pain. OBJECTIVE: To describe the clinical presentation of patients with MPP, the frequency of SMR prescriptions, and the proportion of referrals for PFPT within a tertiary pelvic pain clinic cohort. METHODS: A retrospective chart review was conducted for patients who visited the clinic between January 2021 and December 2023. Inclusion criteria included a diagnosis of MPP, indicated by ICD-9 and ICD-10 codes. Data collected comprised patient pain scores, diagnoses of other chronic overlapping pain conditions (COPCs), demographic information, and prescribed medications during the study period, as well as historical PFPT referrals including time in the study period and 5 years prior (2015–2023). RESULTS: A total of 2,559 individuals with MPP were identified as seeking care during the study period between 2021 and 2023. The mean age was 38.8 years (SD=12.7), with the majority identifying as White, (63.5%, n=1,625) with mean BMI of 33.8 (SD=16.5). Additionally, 35.9% (n=918) reported working full-time. Of the participants, 62.3% (n=1,593) had private insurance, 28.5% (n=730) had public insurance, and 9.2% (n=236) were missing insurance information (Table 1). 45.3% of patients (n=1,160) with MPP were prescribed SMRs. Most patients with MPP were noted to have COPCs, with 57.5% (n=1,471) having at least one COPC and 8.7% (n=222) having at least three COPCs, with the most common COPCs being fibromyalgia (n=747, 29.2%) and low back pain (n=567, 22.2%) (Table 2). Individuals with public insurance exhibited a statistically significant increase in the mean number of COPCs. Only 34.6% (n=885) of patients with MPP were referred for PFPT during the extended study period. Prior interventions, such as external referrals from other providers or completion of PFPT therapy outside the study timeframe, were not documented. CONCLUSIONS: The high prevalence of COPCs (57.5%) highlights the complexity of MPP, with conditions like fibromyalgia and low back pain potentially confounding the diagnosis. Approximately 45.3% of MPP patients were prescribed SMRs, indicating a trend toward long-term use, which requires further investigation regarding safety and efficacy. Notably, only one-third of patients with MPP were referred for PFPT, indicating underutilization of this first-line treatment. This underscores the need to identify barriers in a tertiary setting to improve the integration of PFPT into treatment plans.