Are Trigger Points Dead?

This is such an intriguing question for me, and I've been reflecting on it for a while. In early March we had the IUGA International Symposium, Birth and Beyond: Management, Assessment, and Prevention of Pelvic Floor Dysfunction. At the symposium we had a very rich session on pelvic pain in which we discussed trigger points. So, let’s check the last report on the terminology for pelvic floor muscle assessment (Frawley et. al., 2021) and try to understand trigger points better. There it says: “A trigger point is considered to be a tender nodule within a taut band. The trigger point is considered by some authors to be part of the active component of tone given the local disturbance in electrical activity, and by others as a separate category distinct from the active or passive components of tone. Given the uncertainty about the characterization of a trigger point, we propose describing palpatory findings by use of the terms “tender point” (2.1.15.1) and “increased tone” (2.2.3.4) if both observations coincide at the tested site or use only “tender point” (2.1.15.1) or “increased tone” (2.2.3.4) if only one of those signs is observed at the tested site” (Frawley et al 2021).

What we are observing in the literature is that there is no consensus on the definition and diagnostic criteria associated with trigger points. Since tender points are not an interchangeable term for trigger points, professionals should consider the use of tenderness to not pathologize the state of the muscle (Frawley et al 2021; Padoa et al 2021).

We should pay attention to the biopsychosocial approach to women with pelvic pain and not forget the great impact on these women's quality of life (depression, suicidal ideation, etc. (Windgassen & McKernan 2020). Some key points to consider are treatment strategies focusing on self-efficacy, pain biology education, and restoration of sensorimotor awareness.

REFERENCES

Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn [Internet]. 2021  12;40(5):1217–60. Available from: https://onlinelibrary.wiley.com/doi/10.1002/nau.24658.

Padoa A, McLean L, Morin M, Vandyken C. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med Rev. 2021;9(1):76–92.

Windgassen S, McKernan L. Cognition, Emotion, and the Bladder: Psychosocial Factors in Bladder Pain Syndrome and Interstitial Cystitis (BPS/IC). Curr Bladder Dysfunct Rep [Internet]. 2020 31;15(1):9–14. Available from: http://link.springer.com/10.1007/s11884-019-00571-2.