Article

Chronic pelvic pain in women is a debilitating, costly condition often treated by
physical therapists. The etiology of this condition is multifactorial and poorly
understood, given the complex interplay of muscles, bones, and soft tissue that
comprise the pelvis. There are few guidelines directing treatment interventions
for this condition. In the last decade, several investigators have highlighted
the role of psychological variables in conditions such as vulvodynia and painful
bladder syndrome. Pain-related fear is the focus of the fear-avoidance model
(FAM) of pain, which theorizes that some people are more likely to develop and
maintain pain after an injury because of their emotional and behavioral responses
to pain. The FAM groups people into 2 classes on the basis of how they respond to
pain: people who have low fear, confront pain, and recover from injury and people
who catastrophize pain-a response that leads to avoidance/escape behaviors,
disuse, and disability. Given the presence of pain-related cognitions in women
with chronic pelvic pain, including hypervigilance, catastrophizing, and anxiety,
research directed toward the application of the FAM to guide therapeutic
interventions is warranted. Isolated segments of the FAM have been studied to
theorize why traditional approaches (ie, medications and surgery) may not lead to
successful outcomes. However, the explicit application of the FAM to guide
physical therapy interventions for women with chronic pelvic pain is not routine.
Integrating the FAM might direct physical therapists' clinical decision making on
the basis of the pain-related cognitions and behaviors of patients. The aims of
this article are to provide information about the FAM of musculoskeletal pain and
to provide evidence for the relevance of the FAM to chronic pelvic pain in women.

Langue : ANGLAIS