Abstract
Dear Editor,
In a previous publication, our group presented 2 small cohort studies that assessed the improvements in endometriosis-associated pain, specifically dyspareunia and dysmenorrhea (1). These patients were treated with a manual physiotherapy (Wurn technique) at a private physical therapy clinic. Following the publication of the study in 2011, we conducted additional follow-up on the patients presented in Study II to assess the longevity of the improvement in dyspareunia and dysmenorrhea symptoms. A total of 7 of the 18 original patients from the prospective study were available for follow-up at 4 and 12 months posttreatment. Patients ranked their level of pain with menstruation and intercourse over the previous 4 weeks from 0 to 10 using the Mankoski pain scale. The age range of patients available for long-term follow-up was 31-41 years (mean 36.2, median 37.5), comprising a similar demographic to the original treatment group.
In the original study, there were significant decreases in both dyspareunia and dysmenorrhea observed at 6 weeks posttreatment via the Wilcoxon signed rank test. In addition, the patients available for follow-up maintained their improvements in both dyspareunia and dysmenorrhea at 4 and 12 months following treatment as compared with pretreatment values. Significant improvements in dysmenorrhea throughout both 4 and 12 month follow-up time points were observed. There were also significant improvements in dyspareunia at the 4-month follow-up (Fig. 1), with the average pain rating for dyspareunia at 12 months lower than before treatment but not significantly so. It is interesting to note that dyspareunia was reported to have returned to the pretreatment intensity by 3 of 7 patients, while 3 of 7 patients with pretreatment dyspareunia reported no pain with intercourse posttreatment. No patients reported an increase in dyspareunia following treatment.
Average reported pain scores for dysmenorrhea and dyspareunia over time. Error bars represent SEM. *p≤0.01; +p≤0.2, by Wilcoxon signed rank test (2-sided) for each time point, vs. pretreatment averages. The pain scale score range was 0 (no pain) to 10 (maximum pain) (n = 7).
Current data from endometriosis patients who undergo surgical intervention for pain show they experience approximately 12 months of reduced pain levels that gradually return after the surgery (2, 3). Although the follow-up from this original study had a limited number of subjects, the long-term results support the subjective observations from patients that the decrease in pain was maintained for 12 months after treatment. This finding is important for both physicians and patients, to identify additional options for minimally invasive, low-risk, first-line treatment for manual physiotherapy to address dyspareunia and dysmenorrhea. In an effort to identify predictors for positive outcomes with this manual physiotherapy, future research studies will assess a larger cohort of subjects for immediate and long-term improvements in dyspareunia and dysmenorrhea, focusing on patients with endometriosis, stratified by stage.