Effectiveness of a Manual Therapy Protocol on Women With Pelvic Pain Due to Endometriosis
Condition: Endometriosis; Pelvic Pain
MeSH terms: Endometriosis; Pelvic Pain
Study type: Interventional

Summary: 
      Endometriosis is a debilitating disease with features of chronic inflammation that affects
      10-15% of women of reproductive age. Pelvic pain is one of the most common symptoms in women
      with endometriosis, and many of them report that it affects their quality of life. In
      addition, women with endometriosis, especially those with pelvic pain, also have an increased
      vulnerability to various psychiatric disorders, such as depression and anxiety.

      In this context, physical therapy can contribute to the multidisciplinary assessment and
      treatment of pelvic pain. In addition, manual therapy could improve certain variables related
      to central sensitization, such as inhibitory pain regulation and neuronal excitability in the
      dorsal horn of the medulla, in patients with chronic pain. Some prospective studies have
      applied manual therapy in patients with pelvic pain due to endometriosis, and have shown a
      trend towards improvement of pain and quality of life. Moreover, it is considered a
      well-tolerated and accepted treatment by patients.

      However, to date, it has not been investigated whether the application of a manual therapy
      protocol improves pelvic pain and other endometriosis-associated symptoms, lumbar mobility,
      medication intake, depression and anxiety levels, and quality of life in women with
      endometriosis-associated pelvic pain compared to a placebo treatment.
    

Detailed description: 
      Endometriosis is a debilitating disease with features of chronic inflammation that affects
      10-15% of women of reproductive age. Pelvic pain is one of the most common symptoms in women
      with endometriosis, and many of them report that it affects their quality of life. In
      addition, women with endometriosis, especially those with pelvic pain, also have an increased
      vulnerability to various psychiatric disorders, such as depression and anxiety.

      In this context, physical therapy can contribute to the multidisciplinary assessment and
      treatment of pelvic pain. In addition, manual therapy could improve certain variables related
      to central sensitization, such as inhibitory pain regulation and neuronal excitability in the
      dorsal horn of the medulla, in patients with chronic pain. Some prospective studies have
      applied manual therapy in patients with pelvic pain due to endometriosis, and have shown a
      trend towards improvement of pain and quality of life. Moreover, it is considered a
      well-tolerated and accepted treatment by patients.

      However, to date, it has not been investigated whether the application of a manual therapy
      protocol improves pelvic pain and other endometriosis-associated symptoms, lumbar mobility,
      medication intake, depression and anxiety levels, and quality of life in women with
      endometriosis-associated pelvic pain compared to a placebo treatment.

      Therefore, this is a randomized clinical trial in which two groups of twenty people in each
      group will participate, with different interventions:

        -  Experimental group: manual therapy protocol.

        -  Placebo group: placebo treatment. Participants will be evaluated in four moments, at
           baseline, post-intervention, 1-month follow-up and 6-month follow-up.

      Data analysis will be performed with SPSS statistic program (v24). Normality and
      homoscedasticity will be analyzed by Shapiro-Wilk t-test and Levene test, respectively.
      Multifactorial ANOVA will be performed with two groups (experimental and placebo group) and
      four-time assessments. For comparation between groups Bonferroni will be used. When p<0.05
      statistically significant differences will be assumed.
    

Intervention name(s): Manual therapy; Placebo treatment
Intervention type(s): Other; Other
Intervention description(s): Participants will received a manual therapy protocol consisting of the following techniques: manipulation of the occipito-atlanto-axial joint (C0-C1-C2), suboccipital inhibition technique, manipulation of the thoracolumbar hinge (T12-L1), global manipulation of the bilateral pelvis, global abdominal hemodynamic technique, functional technique of the pelvic diaphragm and stretching of the lumbopelvic musculature.; Participants will receive light contact on the same points and for the same amount of time as the experimental group, with no intention to treat.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment