Unni M. Kirste

Continuing improvement of chronic pelvic pain in women after short-term Mensendieck somatocognitive therapy: results of a 1-year follow-up study

OBJECTIVES Chronic pelvic pain is a common source of disability among women in the western world. Here we report that 3 months of Mensendieck somatocognitive intervention in chronic pelvic pain patients was followed by continued improvements of outcomes at 1-year follow-up in a randomized, controlled study design. METHODS Forty women with chronic pelvic pain unexplained by pelvic pathology were randomly assigned to 2 groups: (1) standard gynecologic treatment and (2) gynecologic treatment plus somatocognitive therapy aimed at reducing physical pain by changing posture, movement, and respiration patterns. A standardized Mensendieck test (SMT) of motor function (assessing posture, movement, gait, sitting posture, and respiration), a self-rating questionnaire assessing psychologic distress and general well-being (GHQ-30) and a visual analog score of pain (VAS) were obtained before, after 90 days of treatment and 1 year after inclusion. RESULTS Patients treated by standard gynecologic treatment/supervision did not improve significantly at 1-year follow-up in any of the test modalities. By contrast, those who in addition received somatocognitive therapy had improved scores for all motor functions and pain, as well as GHQ-30 scores for coping, and anxiety-insomnia-distress. CONCLUSION Mensendieck somatocognitive therapy combined with standard gynecologic care improves psychologic distress, pain experience, and motor functions of women with chronic pelvic pain better than gynecologic treatment alone. The effect lasted and even further improvement occurred 9 months after treatment.

Reliability and validity of a standardized Mensendieck physiotherapy test (SMT)

A standardized test was developed to evaluate posture, movement, gait, sitting posture, and respiration of patients with psychosomatic disorders, based on the Mensendieck principles of observation and analysis of motor function. To validate the test and to make a comprehensive body examination of a defined group of patients, it was applied in a study of women with chronic pelvic pain (CPP, ICD10 F45.4). Fifteen women with CPP and 15 matched, healthy controls were examined. Test subjects were video recorded and scored by three experienced Mensendieck physical therapists, blinded with respect to the selection of subjects. Scores from 0 (for least functional movement) to 7 (optimal function) were assigned to each test person according to a test manual. High intraclass correlations (Chronbachs alpha ranging from 0.82 to 0.97) were found among the testers. The standardized Mensendieck test (SMT) discriminated well between women with CPP and the controls (sensitivity 0.9, specificity 0.7, mean values). The CPP patients scored significantly lower than the controls in all subtests (p < 0.01). The largest difference in scores were found for gait (patients 2.70 ± 0.11, vs. control, 5.60 ± 0.09) and respiration (patients 2.88 ± 0.14, vs. control, 5.63 ± 0.10). The results indicate that, in the hands of experienced Mensendieck therapists, the SMT is a reliable tool, demonstrating a good discriminative validity. Furthermore, it may turn out to be a useful instrument in the evaluation of patients with somatoform disorders. It may also point toward a possible therapeutic treatment approach to patients with CPP.

Pain, psychological distress and motor pattern in women with provoked vestibulodynia (PVD) – symptom characteristics and therapy suggestions

Abstract Background and aims: Provoked vestibulodynia (PVD) represent a longstanding pain syndrome that affects large numbers of women worldwide. However, no standardized guidelines for PVD treatment exist. In a cross-sectional pilot study we examined 30 PVD patients on multidimensional parameters including pain, psychological distress and quality of movement, in order to obtain a broader understanding of the somatic and psychological symptoms in PVD, and for the future to develop better interventions. Additionally, we compare the findings to previously published results regarding the same parameters in women with chronic pelvic pain (CPP). Methods: Thirty women with PVD recruited from a tertiary care university clinic of gynecology were assessed for demographic data, pain intensity (VAS), psychological distress (GHQ-30 and Tampa scale of Kinesophobia) and quality of movement (standardized Mensendieck test, SMT). Results: Average age of the PVD women was 24.7±3.60 years, 60% of them were in permanent relationships, all were nulliparous, none had been subjected to surgical procedures, 100% were working full or part time and 90% were educated to at least undergraduate level. Mean VAS score was 7.77±1.97 (mean±SD), kinesiophobia 24.4±3.95 and anxiety domain of GHQ-30 9.73±4.06. SMT scores were particularly low for the domains of respiration and gait (less than 50% of optimal scores). Conclusions: PVD women display reduced quality of movement, especially for gait and respiration patterns, increased level of anxiety and high average pain scores. These findings are similar to what we have previously reported in CPP patients. However, in contrast to CPP group, PVD women are on average younger, have higher work participation, higher education level and have not been subjected to surgical procedures. Implications: Since PVD women display similar, although somewhat less severe, symptom profile than CPP, we suggest that a multidimensional approach to treatment, such as “somatocognitive therapy” should be investigated in this group as it has previously been shown to be promising in treatment of CPP.

Somatocognitive therapy in the management of chronic gynaecological pain. A review of current approach and historical background

Abstract Introduction We have developed somatocognitive therapy as a hybrid of Mensendieck physiotherapy and cognitive psychotherapy. Womenwith chronic pelvic pain (CPP) and vulvodynia (chronic pain of the vulvae and vestibulum, VD) were recruited into two separate treatment protocols as described. Methods 60 patients with CPP were recruited from the Department of Gynaecology at the Oslo University Hospital into a randomized, controlled intervention study. The patients were randomized into three treatment groups, receiving (1) treatment as usual, (2) somatocognitive therapy, and (3) in addition receiving cognitive therapy. The patients were assessed by means of SMT, Visual Analogue Score of Pain (VAS), and General Health Questionnaire (GHQ-30) at baseline, after three months of out-patient therapy and at 1 year follow-up. 9 women with VD were treated in an outpatient setting by physiotherapy students under senior supervision, each receiving in all 16 therapy sessions over 8 weeks, and scored for motor patterns (SMT) and pain (VAS) before and after therapy. Results In the control group, no significant change was found. In the group receiving somatocognitive therapy, significant reduction in pain score and improvement in motor function were found the end of therapy, and the significant improvement continued through the follow-up period. GHQ scores were significantly improved for the scores representing level of anxiety and coping, and improved for depression. In the group receiving cognitive therapy in addition, the VAS scores were reduced to the same level as the group receiving only somatocognitive therapy, whereas the motor patterns showed slightly less improvement than for those women that did not receive cognitive intervention. In the women with VD somatocognitive therapy resulted in significantly reduction in pain scores (by an average of 66%), and significant improvement of motor patterns, especially for the scores for gait (56%) and respiration (88%). Conclusions Somatocognitive therapy is a new approach that appears to be very promising in the management of chronic gynaecological pain. Short-term out-patient treatment significantly reduces pain scores and improves motor function, especially with respect to respiration, gait and movement (ability to relax). The approach is now being used in a randomized, controlled intervention study including patient with chronic low back, neck and shoulder, and widespread pain.