1
|
Sedighimehr N, Razeghi M, Rezaei I. Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial. Heliyon 2024; 10:e31699. [PMID: 38841514 PMCID: PMC11152953 DOI: 10.1016/j.heliyon.2024.e31699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/05/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the "static needling", the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception. Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1).
Collapse
Affiliation(s)
- Najmeh Sedighimehr
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Rezaei
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Wu Z, Liu C, Peng Y, Zhou F, Xu B, Zhang Y, Hu Z, Lu M. Traditional Chinese herbal medicine retention enema combined with perineal massage (THREM): a promising therapeutic strategy for refractory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Transl Androl Urol 2024; 13:759-768. [PMID: 38855610 PMCID: PMC11157392 DOI: 10.21037/tau-23-386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/10/2024] [Indexed: 06/11/2024] Open
Abstract
Background Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating condition characterized by lower urinary tract symptoms and persistent pelvic pain or discomfort lasting for more than three months. Currently available oral drug therapies exhibit limited efficacy in the treatment of CP/CPPS. Therefore, personalized and combination therapies are recommended by Chinese CP/CPPS guidelines, which primarily include traditional Chinese medicine, radiofrequency therapy, urethral lavage, transrectal prostate massage, extracorporeal shock wave therapy. However, a significant number of patients do not respond well to all types of these therapeutic methods. Among those who have sequentially or simultaneously undergone at least three different treatment modalities, in addition to oral medications, for more than 1 year, they are defined as patients with refractory CP/CPPS. This retrospective study aims to evaluate the clinical effect of traditional Chinese herbal medicine retention enema combined with perineal massage (THREM) in managing refractory CP/CPPS. Methods A total of 20 patients with refractory CP/CPPS, who did not show significant improvement despite receiving multiple conventional treatments, including oral medications, were included in this study. Following THREM therapy, the International Prostate Symptom Score (IPSS), visual analogue scale (VAS), and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) quality of life (QoL) score were used to assess treatment efficacy. Results Six months after THREM therapy, a significant decrease in IPSS, VAS, and QoL scores was observed (P<0.01). Importantly, 85% of the patients experienced a reduction in symptoms of ≥60%, with an average degree of alleviation reaching 70.25%±24.20%. Conclusions THREM treatment demonstrated excellent efficacy in managing refractory CP/CPPS at least for 6 months. It has promising clinical application prospects. Further research is warranted to validate these results and explore the underlying mechanisms of THREM therapy.
Collapse
Affiliation(s)
- Zhiyong Wu
- Department of Urology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Urology, the 2nd Hospital of Heilongjiang Province, Harbin, China
- Yubao Clinic, Shanghai, China
| | - Caiyue Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yubing Peng
- Department of Urology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Andrology, Shanghai, China
| | - Feng Zhou
- Department of Plastic and Aesthetic Surgery, Shanghai Tongji Hospital, Tongji University, Shanghai, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingfan Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongliang Hu
- Department of Urology, the 2nd Hospital of Heilongjiang Province, Harbin, China
| | - Mujun Lu
- Department of Urology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Andrology, Shanghai, China
| |
Collapse
|
3
|
Lee JK, Law TY, Shen L, Pek GX, Lim QY, Tan YQ, Chia JY, Li MK. Extracorporeal shockwave therapy of the perineum for male patients with chronic pelvic pain syndrome: a pilot study. Prostate Int 2024; 12:27-34. [PMID: 38523905 PMCID: PMC10960085 DOI: 10.1016/j.prnil.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/22/2023] [Accepted: 11/02/2023] [Indexed: 03/26/2024] Open
Abstract
Background Chronic pelvic pain syndrome (CPPS) is a complex condition that is often difficult to treat and may sometimes require a multidisciplinary team. Among the wide array of treatment options is extracorporeal shockwave therapy (ESWT). However, its role in CPPS remains controversial. The purpose of our study is to assess the efficacy and safety of ESWT of the perineum in male patients with CPPS. Methods Fourteen patients aged between 21 and 85 years were recruited in this single-center, single-arm prospective trial from October 2018 to October 2020. ESWT was delivered to the perineum weekly for up to 8 weeks. Assessment was done via International Index for Erectile Function, International Prostate Symptom Score, King's Health Questionnaire, National Institutes of Health - Chronic Prostatitis Symptom Index, Visual Analogue Scale, Analgesic Questionnaire, and UPOINT (urinary symptoms [U], psychosocial dysfunction [P], organ-specific symptoms [O], infection-related symptoms [I], neurological/systemic conditions [N], tenderness of skeletal muscles [T]) phenotype system. The parameters are assessed before the start and end of treatment as well as at regular time points on follow-up appointments up to 20 weeks. Results Thirteen patients completed the study. There was improvement in the Visual Analogue Scale pain score, Tenderness domain on UPOINT, King's Health Questionnaire, and National Institutes of Health - Chronic Prostatitis Symptom Index scores. In terms of erectile function, improvement in the erectile function domain of International Index for Erectile Function was observed. There was also significant improvement in lower urinary tract symptoms assessed on International Prostate Symptom Score. There were no adverse events reported post treatment and during the follow-up period. Conclusions ESWT improved pain and quality of life of male patients with CPPS. It can be a safe and effective treatment modality in the armamentarium of CPPS.
Collapse
Affiliation(s)
- Joe K.C. Lee
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Terence Y.X. Law
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gregory X.W. Pek
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Qi Y. Lim
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Yi Q. Tan
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Jun Y. Chia
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Man K. Li
- Department of Urology, National University Hospital, Singapore, Singapore
- Li Man Kay Urology Associates Mount Elizabeth Novena Hospital, Singapore, Singapore
| |
Collapse
|
4
|
Diaz-Mohedo E, Hita-Contreras F, Castro-Martin E, Pilat A, Perez-Dominguez B, Valenza-Peña G. Using Myofascial Therapy to Improve Psychological Outcomes, Quality of Life, and Sexual Function in Women with Chronic Pelvic Pain-A Case Series. Healthcare (Basel) 2024; 12:304. [PMID: 38338190 PMCID: PMC10855135 DOI: 10.3390/healthcare12030304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Chronic pelvic pain represents a prevalent condition afflicting women. Research has highlighted the presence of psychological distress and sexual dysfunction in these individuals. Regrettably, myofascial pelvic pain often goes unnoticed and untreated despite its integral role in chronic pelvic pain. (2) Methods: By employing a longitudinal case series design, we studied eighteen women afflicted with chronic pelvic pain. Over a 12-week period, these participants underwent 15 sessions of myofascial therapy. Data encompassing sociodemographic particulars, the Hospital Anxiety and Depression Scale, the Medical Outcomes Study Short Form 12 questionnaire, and the Female Sexual Function Index were collected at baseline, 12 weeks post-intervention, and again at the 24-week mark. (3) Results: After a span of 12 weeks subsequent to the intervention, the participants demonstrated noteworthy enhancements (p < 0.001) in their depression and anxiety scores, their overall Mental Component scores in the Medical Outcomes Study Short Form 12, as well as sexual function. Importantly, these gains were sustained at the 24-week juncture post-therapy. (4) Conclusions: The findings stemming from our prospective case study underscore the potential utility of myofascial therapy for women grappling with chronic pelvic pain. This form of intervention yields significant advancements in alleviating anxiety, depression, health-related quality of life, and sexual function.
Collapse
Affiliation(s)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaen, 23071 Jaen, Spain;
| | - Eduardo Castro-Martin
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (E.C.-M.); (G.V.-P.)
| | - Andrzej Pilat
- Myofascial Therapy School “Tupimek”, Physiotherapy School ONCE, Universidad Autonoma, 28049 Madrid, Spain;
| | | | - Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (E.C.-M.); (G.V.-P.)
| |
Collapse
|
5
|
Santangelo G, Ruggiero G, Murina F, Di Donato V, Perniola G, Palaia I, Fischetti M, Casorelli A, Giannini A, Di Dio C, Muzii L, Benedetti Panici P, Bogani G. Vulvodynia: A practical guide in treatment strategies. Int J Gynaecol Obstet 2023; 163:510-520. [PMID: 37154479 DOI: 10.1002/ijgo.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/20/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
Vulvodynia is a debilitating condition characterized by chronic vulvar pain, with a detrimental impact on the patient's overall quality of life. Its etiology is multifactorial, but still in the process of being clearly outlined. Vulvodynia is not a single entity. It is a heterogeneous condition characterized by multiple triggers, making it challenging to define a reference standard for its treatment. In this manuscript we selected all articles including the following key criteria: "vulvodynia". The primary outcomes observed included the resolution of chronic pelvic pain, dyspareunia and sexual satisfaction, psychological well-being, and overall quality of life. Most pharmacologic treatments require further evidence to be recommended. On the other hand, non-pharmacologic approaches such as psychotherapy, physical therapy, and surgery have received stronger support. This review summarizes pros and cons of adopting available treatments. Multimodal approaches should be introduced to improve patient outcomes. Further investigations are warranted to improve patients' quality of life.
Collapse
Affiliation(s)
- Giusi Santangelo
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gianfilippo Ruggiero
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Filippo Murina
- Lower Genital Tract Disease Unit, Obstetrics and Gynecology Department, V. Buzzi Hospital, University of Milan, Milan, Italy
| | - Violante Di Donato
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giorgia Perniola
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Innocenza Palaia
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Margherita Fischetti
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Assunta Casorelli
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Giannini
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Camilla Di Dio
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Bogani
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| |
Collapse
|
6
|
Huang N, Qin Z, Sun W, Bao K, Zha J, Zhang P, Feng P, Zhao X, Liu M, Shi J, Ma M. Comparing the effectiveness of extracorporeal shockwave therapy and myofascial release therapy in chronic pelvic pain syndrome: study protocol for a randomized controlled trial. Trials 2023; 24:675. [PMID: 37853420 PMCID: PMC10583345 DOI: 10.1186/s13063-023-07633-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome is a highly prevalent syndrome. Previous studies showed that extracorporeal shockwave therapy and myofascial release therapy could improve the quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Theoretically, combined therapy with extracorporeal shockwave therapy and myofascial release therapy will likely have significant advantages in treating CP/CPPS. We, therefore, present a protocol for conducting a well-designed randomized controlled trial to compare the efficacy and safety of each therapy. METHODS The proposed study will be a three-group randomized control trial (RCT) design that includes 150 participants from Zhongda Hospital Affiliated to Southeast University, with equal allocation of participants to the three intervention groups. The study duration will be 8 weeks, which includes a 4-week treatment period and a 4-week follow-up period. The primary outcome will be the changes in surface electromyography (sEMG) assessment and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). The secondary outcomes will include the changes in three-dimensional quantification, shear wave elastography (SWE), and sympathetic skin response (SSR) testing. Assessments will be conducted before the intervention (T0), before the 5th intervention (T1), immediately after the 8th intervention (T2), and the 4th week after the end of the 8th intervention (T3). DISCUSSION This trial will compare the differences in efficacy between single extracorporeal shockwave therapy, single myofascial release therapy, and combined therapy to select the most appropriate treatment option for patients with CP/CPPS. The possible pathogenesis of CP/CPPS would also be analyzed by comparing the intercorrelation between each objective and subjective measurement (NIH-CPSI score, sEMG, SWE, SSR). TRIAL REGISTRATION The name of the registry: Extracorporeal Shockwave and Myofascial Release Therapy in Chronic Pelvic Pain Syndrome. REGISTRATION NUMBER NCT05659199. Date of registration: December 2022.
Collapse
Affiliation(s)
- Ningqing Huang
- Department of Physical Medicine and Rehabilitation, Southeast University, Nanjing, Jiangsu Province, People's Republic of China
| | - Zhi Qin
- Department of Radiology, Southeast University Zhongda Hospital, Nanjing, Jiangsu Province, People's Republic of China
| | - Wudong Sun
- Department of Rehabilitation, Southeast University Zhongda Hospital, No. 87, Dingjiaqiao, Gulou District, Nanjing, Jiangsu Province, People's Republic of China
| | - Kaiming Bao
- Division of Biokinesiology and Physical Therapy, University of Southern California, Nanjing, Jiangsu Province, People's Republic of China
| | - Jingxian Zha
- Department of Obstetrics, Southeast University Zhongda Hospital, Nanjing, Jiangsu Province, People's Republic of China
| | - Peng Zhang
- Department of Rehabilitation, Southeast University Zhongda Hospital, No. 87, Dingjiaqiao, Gulou District, Nanjing, Jiangsu Province, People's Republic of China
| | - Panpan Feng
- Nanjing Institute of Physical Education, Nanjing, Jiangsu Province, People's Republic of China
| | - Xiaojun Zhao
- Nanjing Institute of Physical Education, Nanjing, Jiangsu Province, People's Republic of China
| | - Mengqian Liu
- Department of Physical Medicine and Rehabilitation, Southeast University, Nanjing, Jiangsu Province, People's Republic of China
| | - Jinjun Shi
- Southeast University Zhongda Hospital, Nanjing, Jiangsu Province, People's Republic of China
| | - Ming Ma
- Department of Rehabilitation, Southeast University Zhongda Hospital, No. 87, Dingjiaqiao, Gulou District, Nanjing, Jiangsu Province, People's Republic of China.
| |
Collapse
|
7
|
Dune TJ, Griffin A, Hoffman EG, Joyce C, Taege S, Brubaker L, Fitzgerald CM. Importance of internal vaginal pelvic floor muscle exams for women with external lumbar/hip/pelvic girdle pain. Int Urogynecol J 2023; 34:1471-1476. [PMID: 36308537 DOI: 10.1007/s00192-022-05390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The relationship between external lumbar, hip, and/or pelvic girdle pain and internal vaginal pelvic floor myofascial pain is not well described. We assessed this relationship in a cohort of adult women. METHODS The cohort included women ≥ 18 years old who received care for external lumbar, hip, and/or pelvic girdle pain (reported or elicited on physical examination) who then underwent internal vaginal myofascial levator ani pain assessments, in a tertiary care Female Pelvic Medicine and Reconstructive Surgery pelvic pain clinic over a 2-year period (2013 and 2014). RESULTS The cohort of 177 women had an average age of 44.9±16.0 years, an average body mass index of 27.2±7.0 kg/m2, and the majority (79.2%) were white. Most patients presented with a chief complaint of pelvic (51.4%), vulvovaginal (18.6%), and/or lumbar (15.3%) pain. Women who reported symptoms of lumbar, hip, or pelvic girdle pain were more likely to have pain on vaginal pelvic floor muscle examination than women without this history (OR, 7.24; 95% CI, 1.95-26.93, p=0.003). The majority (85.9%) of women had bilateral internal vaginal pelvic floor myofascial pain on examination. CONCLUSIONS Although participants did not describe "vaginal pelvic floor myofascial pain," the high detection rate for internal vaginal pelvic floor myofascial pain on clinical examination highlights an opportunity to improve treatment planning. These findings suggest that the vaginal pelvic floor muscle examination should be part of the assessment of all women with lumbar, hip, and/or pelvic girdle pain. The relationship between this finding and clinical outcomes following directed treatment warrants additional study.
Collapse
Affiliation(s)
- Tanaka J Dune
- Department of Obstetrics and Gynaecology, Pelvic Floor Unit, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Arianna Griffin
- Department of Pediatrics, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Elizabeth Gunnar Hoffman
- Departments of Medicine and Psychiatry and Behavioral Sciences, Duke University Hospital, Durham, NC, USA
| | - Cara Joyce
- Department of Health Informatics and Data Science, Loyola University Parkinson School of Health Sciences and Public Health, Maywood, IL, USA
| | - Susanne Taege
- Urogynecology and Pelvic Floor, Mount Carmel Medical Group, Westerville, OH, USA
| | - Linda Brubaker
- Departments of Obstetrics & Gynecology, Reproductive Medicine, University of California-San Diego, San Diego, CA, USA
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| |
Collapse
|
8
|
Kaftan BT. [Somatoform disorders-chronic pelvic pain in women]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02087-4. [PMID: 37145155 DOI: 10.1007/s00120-023-02087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/06/2023]
Abstract
Pelvic pain in women is a clinically common symptom and a frequent finding in general practitioner, urological, gynecological, and pediatric practice. The list of possible differential diagnoses is long and the clarification ranges from a visual diagnosis to technical and surgical examinations to complex interdisciplinary consultations. But when do we talk about chronic lower abdominal pain? What can be the cause of this and how can we approach it diagnostically and therapeutically? What should we pay attention to? The difficulty begins with the definition. If we look at the national and international guidelines and publications, we find different definitions for chronic pelvic pain. There are various causes of chronic pelvic pain. There is often a combination of physical and psychological factors, which is why it is often not possible to identify a single diagnosis behind chronic pelvic pain syndrome. The clarification of these complaints requires a biopsychosocial approach. Multimodal approaches should be considered in assessment and treatment, and experts from other disciplines should be consulted.
Collapse
Affiliation(s)
- Björn Theodor Kaftan
- Zentrum für Interstitielle Zystitis und Beckenschmerz (IC/BPS), Städtisches Klinikum Lüneburg gGmbH, Bögelstr. 1, 21335, Lüneburg, Deutschland.
| |
Collapse
|
9
|
Kadah S, Soh SE, Morin M, Schneider M, Heron E, Frawley H. Is there a difference in pelvic floor muscle tone between women with and without pelvic pain? A systematic review and meta-analysis. J Sex Med 2023; 20:65-96. [PMID: 36897234 DOI: 10.1093/jsxmed/qdac002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alterations in pelvic floor muscle (PFM) function have been observed in women with persistent noncancer pelvic pain (PNCPP) as compared with women without PNCPP; however, the literature presents conflicting findings regarding differences in PFM tone between women with and without PNCPP. AIM To systematically review the literature comparing PFM tone in women with and without PNCPP. METHODS MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Scopus were searched from inception to June 2021 for relevant studies. Studies were included that reported PFM tone data in women aged ≥18 years with and without PNCPP. The risk of bias was assessed with the National Heart, Lung, and Blood Institute Quality Assessment Tool. Standardized mean differences (SMDs) for PFM tone measures were calculated via random effects models. OUTCOMES Resting PFM tone parameters, including myoelectrical activity, resistance, morphometry, stiffness, flexibility, relaxation, and intravaginal pressure, measured by any clinical examination method or tool. RESULTS Twenty-one studies met the inclusion criteria. Seven PFM tone parameters were measured. Meta-analyses were conducted for myoelectrical activity, resistance, and anterior-posterior diameter of the levator hiatus. Myoelectrical activity and resistance were higher in women with PNCPP than in women without (SMD = 1.32 [95% CI, 0.36-2.29] and SMD = 2.05 [95% CI, 1.03-3.06], respectively). Women with PNCPP also had a smaller anterior-posterior diameter of the levator hiatus as compared with women without (SMD = -0.34 [95% CI, -0.51 to -0.16]). Meta-analyses were not performed for the remaining PFM tone parameters due to an insufficient number of studies; however, results of these studies suggested greater PFM stiffness and reduced PFM flexibility in women with PNCPP than in women without. CLINICAL IMPLICATIONS Available evidence suggests that women with PNCPP have increased PFM tone, which could be targeted by treatments. STRENGTHS AND LIMITATIONS A comprehensive search strategy was used with no restriction on language or date to review studies evaluating PFM tone parameters between women with and without PNCPP. However, meta-analyses were not undertaken for all parameters because few included studies measured the same PFM tone properties. There was variability in the methods used to assess PFM tone, all of which have some limitations. CONCLUSION Women with PNCPP have higher PFM tone than women without PNCPP; therefore, future research is required to understand the strength of the relationship between pelvic pain and PFM tone and to investigate the effect of treatment modalities to reduce PFM tone on pelvic pain in this population.
Collapse
Affiliation(s)
- Shaza Kadah
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia.,Department of Physical Therapy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University, Melbourne, Victoria 3199, Australia
| | - Melanie Morin
- School of Rehabilitation Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec J1K 2R1, Canada
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria 3800, Australia
| | - Emma Heron
- School of Allied Health, Curtin University, Bentley, Western Australia 6102, Australia
| | - Helena Frawley
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia.,Allied Health Research, Royal Women's Hospital, Melbourne, Victoria 3052, Australia.,Allied Health Research, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
| |
Collapse
|
10
|
Wei Y, Chen X, Wang T, Dong X, Zhu Z. Effects of Du Meridian Moxibustion Combined with Mild Moxibustion on Female Pelvic Floor Myofascial Pain Syndrome: A Retrospective Cohort Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:7388864. [PMID: 36425258 PMCID: PMC9681563 DOI: 10.1155/2022/7388864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 12/10/2023]
Abstract
OBJECTIVE This study aimed to investigate the efficacy and safety of moxibustion in the treatment of pelvic floor myofascial pain syndrome. METHODS A total of 80 women with pelvic floor myofascial pain syndrome (cold coagulation and blood stasis type) were included in this retrospective study and divided into a moxibustion group and a drug treatment group. Patients who received Celebrex oral analgesia, health education, and lifestyle improvement were included in the drug treatment group. The patients that received Du meridian moxibustion combined with mild moxibustion, health education, and lifestyle improvement were included in the moxibustion group. The comparison of pelvic pain, the TCM clinical symptom score, and the curative effect was made between the two groups before treatment and after 1-3 weeks of treatment, respectively. RESULTS An intragroup comparison showed a stepwise decrease in the VAS score and the TCM clinical symptom score of the two groups during the treatment. An intergroup comparison revealed that the VAS score of the moxibustion group was lower than that of the drug treatment group, while TCM clinical symptoms and clinical efficacy significantly improved in the moxibustion group compared to those in the drug treatment group (P < 0.05). CONCLUSION Du meridian moxibustion combined with mild moxibustion alleviates pelvic floor myofascial pain syndrome, thus helping improve women's quality of life and providing patients with a more effective and safer treatment plan.
Collapse
Affiliation(s)
- Yehong Wei
- Nursing Department, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, China
| | - Xufeng Chen
- Department of Obstetrics and Gynecology, Hangzhou TCM Hospital, Hangzhou 310005, China
| | - Tianyu Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, China
| | - Xianna Dong
- TCM Nursing Clinic, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, China
| | - Zheng Zhu
- Department of Urologic Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, China
| |
Collapse
|
11
|
Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study. Diagnostics (Basel) 2022; 12:diagnostics12112723. [PMID: 36359567 PMCID: PMC9689409 DOI: 10.3390/diagnostics12112723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.
Collapse
|
12
|
Thomas EB, Stegall MS, Farley KE, Pawlak SA. A Multidisciplinary Pelvic Pain Clinic: Integrated Health Psychology in a Specialty Care Setting. J Womens Health (Larchmt) 2022; 31:1639-1644. [PMID: 35704283 PMCID: PMC9836695 DOI: 10.1089/jwh.2022.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Chronic pelvic pain (CPP) is a relatively common health problem, impacting around 25 million women globally. This study details the development of a multidisciplinary women's CPP clinic at a major U.S. academic medical center, and examines associations between mood, pain symptoms, and trauma history. Materials and Methods: Data were collected from 96 subjects, including self-report measures (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Brief Trauma Questionnaire), pain intensity ratings, psychiatric diagnoses, and relevant medical history. Results: Most subjects reported at least one traumatic experience. Nearly half of subjects met criteria for an anxiety disorder and/or a depressive disorder. Most subjects were diagnosed with pelvic floor dysfunction, and more than half were referred to physical therapy. Women with abdominal/pelvic surgery history reported more traumatic experiences than women without surgical history. Women with a history of sexual abuse reported trying more medications and seeking care from a greater number of providers. Many reported pain duration of >2 years. Conclusions: Study findings related to mental health and trauma support a multidisciplinary CPP approach that includes a clinical health psychology component. Future research may investigate the therapeutic processes that apply to this population to identify targeted efficacious interventions.
Collapse
Affiliation(s)
- Emily B.K. Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Manny S. Stegall
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Kathryn E. Farley
- Department of Physical Medicine and Rehabilitation, UnityPoint Health, St. Luke's Hospital, Cedar Rapids, Iowa, USA
| | - Stacey A. Pawlak
- Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
13
|
Tracey A. Pelvic Floor Physical Therapy and Its Merit in the Treatment of Female Urogenital Pain. Curr Pain Headache Rep 2022; 26:775-782. [DOI: 10.1007/s11916-022-01076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
|
14
|
Lackner JM, Jaccard J, Quigley BM, Ablove TS, Danforth TL, Firth RS, Gudleski GD, Krasner SS, Radziwon CD, Vargovich AM, Clemens JQ, Naliboff BD. Study protocol and methods for Easing Pelvic Pain Interventions Clinical Research Program (EPPIC): a randomized clinical trial of brief, low-intensity, transdiagnostic cognitive behavioral therapy vs education/support for urologic chronic pelvic pain syndrome (UCPPS). Trials 2022; 23:651. [PMID: 35964133 PMCID: PMC9375413 DOI: 10.1186/s13063-022-06554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response. Methods UCPPS patients (240) ages 18–70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief. Discussion Empirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine. Trial Registration Clinicaltrials.gov NCT05127616. Registered on 9/19/21. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06554-9.
Collapse
Affiliation(s)
- Jeffrey M Lackner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA.
| | - James Jaccard
- School of Social Work, New York University, New York, NY, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brian M Quigley
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Tova S Ablove
- Department of Obstetrics and Gynecology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Teresa L Danforth
- Department of Urology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Rebecca S Firth
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Gregory D Gudleski
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Susan S Krasner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Christopher D Radziwon
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Alison M Vargovich
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Bruce D Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| |
Collapse
|
15
|
Yani MS, Eckel SP, Kirages DJ, Rodriguez LV, Corcos DM, Kutch JJ. Impaired Ability to Relax Pelvic Floor Muscles in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Phys Ther 2022; 102:6585840. [PMID: 35576002 PMCID: PMC9618172 DOI: 10.1093/ptj/pzac059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Excessive pelvic floor muscle activity has been suggested as a source of pain in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Our objective was to determine whether men with CP/CPPS have changes in neural drive that impair their ability to relax pelvic floor muscles. METHODS We recruited 90 men (42 with CP/CPPS and 48 in the control group [without a history of pelvic pain]). All completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). We quantified the ability to relax by comparing resting pelvic floor muscle activity under 2 conditions: a "rest-only" condition, in which participants were instructed to simply relax, and a "rest-between-contraction" condition, in which participants were instructed to rest for several seconds between voluntary pelvic floor muscle contractions. We used multivariate mixed-effects models to examine differences between the groups (men with CP/CPPS and men in the control group) as well as the effect of 6 symptoms captured by the NIH-CPSI: pain related to location (perineum, testicles, penis, suprapubic region) and activity (urination, ejaculation). RESULTS Men with CP/CPPS were significantly different from men in the control group; men with CP/CPPS had higher resting activity in the rest-between-contraction condition than in the rest-only condition, whereas men in the control group had similar resting activities in both conditions. This effect was strongest in men who reported ejaculation-related pain, which was 70% of the CP/CPPS group. CONCLUSION Men without a history of pelvic pain were able to relax their pelvic floor muscles back to baseline after performing voluntary pelvic floor muscle contractions. In contrast, men with CP/CPPS, particularly those with ejaculation-related pain, had an impaired ability to relax their pelvic floor muscles. IMPACT This study may support the investigation of more personalized physical therapist approaches for CP/CPPS that enhance the ability to relax pelvic floor muscles as a mechanism for pain reduction.
Collapse
Affiliation(s)
- Moheb S Yani
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Sandrah P Eckel
- Division of Biostatistics, Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel J Kirages
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Daniel M Corcos
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
16
|
Rabal Conesa C, Cao Avellaneda E, López Cubillana P, Prieto Merino D, Khalus Plish A, Martínez Franco A, López Abad A. Manual Therapy Intervention in Men With Chronic Pelvic Pain Syndrome or Chronic Prostatitis: An Exploratory Prospective Case-Series. Cureus 2022; 14:e24481. [PMID: 35497084 PMCID: PMC9041646 DOI: 10.7759/cureus.24481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Chronic pelvic pain syndrome (CPPS) is permanent pelvic pain of unknown etiology. Current theories suggest a multifactorial origin for CPPS, including urinary pathologies, psychosocial factors, prostate inflammation, infection, central sensitization of the nervous system, and muscular contractures or fibrosis. As there are no defined treatment protocols for CPPS, a multimodal approach is recommended. The objective of this study was to evaluate the impact of a manual therapy treatment protocol on pain, urinary symptoms, and overall quality of life. Materials and Methods Twenty-three men aged 47.36 ± 10.11 years were recruited consecutively by urologists practicing at two hospitals. All men presented prostatic tenderness with no other positive clinical history, urine cultures, or echography studies. Patients underwent six manual therapy sessions (three during the first week and three every two weeks after that) performed by a single osteopath or physiotherapist. The intervention protocol addressed the treatment of muscle structures, fascial mechanics, vascularization, innervation, emotional factors, and the need for information. The questionnaires used to evaluate outcomes included the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptoms Score (IPSS), and a Visual Analog Scale (VAS) for pain, and the Hospital Anxiety and Depression Scale (HADS). Data were evaluated using Chi-squared or paired difference tests by an external researcher. Results The mean NIH-CPSI scores recorded for our study cohort decreased by 7.69 points (30.92%; p<0.0005; 95% CI 4.02-10.52). IPSS measurements decreased by 3.20 points (22.18%; p=0.009; 95% CI 1.00-6.09), although the item addressing quality of life decreased by 1.67 points only (31.99%; p<0.0005; 95% CI 0.94-2.33). The VAS score also decreased by 2.20 points (38.6%; p<0.0005; 95% CI 1.45-2.73). Changes in HADS scores were not statistically significant. Conclusions Based on patient responses, this case series revealed that manual therapy improved urinary symptoms, pain, and quality of life.
Collapse
|
17
|
Effectiveness of Myofascial Manual Therapies in Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis. Int Urogynecol J 2022; 33:2963-2976. [PMID: 35389057 DOI: 10.1007/s00192-022-05173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Chronic pelvic pain syndrome (CPPS) is defined as the occurrence of chronic pelvic pain (CPP) in the absence of a specific cause. People typically refer to pain associated with urological, gynaecological, and sexual dysfunction, affecting the quality of life. Therefore, we assessed the effectiveness of myofascial manual therapies (MMT) for pain and symptom impact. METHODS A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement. Five databases were searched for RCTs. Studies were independently assessed through a standardized form, and their internal validity was evaluated using the Cochrane risk of bias (RoB) tool. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria. RESULTS Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: -0.54 (-1.16; 0.08); p = 0.09], for symptom impact [ES: -0.37 (-0.87; 0.13); p = 0.15], and for quality of life [ES: -0.44 (-1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was "very low". Other results were presented in a qualitative synthesis. CONCLUSIONS In patients with CPP/CPPS, MMT is not considered superior to other interventions for pain reduction and symptom impact improvements. However, a positive trend was detected, and we should find confirmation in the future. Further high-quality, double-blinded, sham-controlled RCTs are first necessary to confirm these positive effects and to improve the quality of evidence.
Collapse
|
18
|
Pena VN, Engel N, Gabrielson AT, Rabinowitz MJ, Herati AS. Diagnostic and Management Strategies for Patients with Chronic Prostatitis and Chronic Pelvic Pain Syndrome. Drugs Aging 2021; 38:845-886. [PMID: 34586623 DOI: 10.1007/s40266-021-00890-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 01/29/2023]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and often heterogenous condition that can have severe consequences on patient quality of life. In this review, we describe the pathophysiology, diagnostic work-up, and treatment of patients with CP/CPPS incorporating the most recent literature. Studies have demonstrated that CP/CPPS involves a complex pathophysiology, including infectious, immunologic, neurologic, endocrinologic, and psychologic etiologies, with frequent intersections between the different entities. Despite robust research assessing a variety of therapeutics targeting these etiologies, clinical trials have failed to identify an empiric treatment strategy applicable specifically to older adult male patients with CP/CPPS. As such, it can be challenging to manage older male patients with this condition. The advent of clinical phenotyping of patients with CP/CPPS has led to advances in tailored management strategies. Monomodal therapy has been largely unsuccessful because of the unclear and complex etiology of CPPS. As a result, CP/CPPS therapy has transitioned to a multimodal approach, including both pharmacologic and non-pharmacologic therapies. The best studied pharmacologic therapies include antibiotics, alpha-blockers, anti-inflammatory and immunomodulatory agents, phytotherapies, phosphodiesterase inhibitors, hormonal agents, neuromodulatory agents, and antidepressants. The best studied non-pharmacological therapies include pelvic floor physical therapy, myofascial trigger point release, acupuncture and electroacupuncture, psychological support and biofeedback, and electrocorporeal shockwave therapy and local thermotherapy.
Collapse
Affiliation(s)
- Vanessa N Pena
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Noah Engel
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Andrew T Gabrielson
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Matthew J Rabinowitz
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Amin S Herati
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| |
Collapse
|
19
|
Ajimsha MS, Ismail LA, Al-Mudahka N, Majzoub A. Effectiveness of external myofascial mobilisation in the management of male chronic pelvic pain of muscle spastic type: A retrospective study. Arab J Urol 2021; 19:394-400. [PMID: 34552791 PMCID: PMC8451701 DOI: 10.1080/2090598x.2021.1954414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective To evaluate the outcome of men with muscle spastic chronic pelvic pain syndrome (CPPS) who underwent a comprehensive five-session fascial connectivity based external myofascial mobilisation (EMM) approach. Patients and methods A retrospective chart review of patients who underwent EMM for CPPS at the Pelvic Pain Unit of Hamad Medical Corporation, Qatar between January 2019 and October 2020 was conducted. Patient's symptoms were measured with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scale and the numerical rating scale (NRS) before and after the completion of the sessions. The patients were given five EMM sessions as a 'once-a-week' programme. Results A total of 31 patients who completed all the EMM sessions were included. The mean (range) age of patients was 38 (20-54) years. The mean (SD) NIH-CPSI score at initial evaluation was 29.41 (8.3) and decreased to 9.14 (3.45) after the fifth visit. All the patients in the study group had a reduction of >6 points in the NIH-CPSI score, indicating a robust treatment response. The NRS reading also revealed significant improvement in pain (P < 0.001). Conclusions : An EMM approach based on fascial connectivity led to significant symptom improvement in all the studied patients. EMM may be an effective treatment option for muscle spastic type of CPPS. Future high-quality studies with control groups are needed to confirm the present findings. Durability and long-term results are yet to be determined. ABBREVIATIONS CP/CPPS: chronic prostatitis/chronic pelvic pain syndrome; EMM: external myofascial mobilisation; EO: external oblique; FM: fascial manipulation; GMx: gluteus maximus; HAC: hip adductor complex; HMC: Hamad Medical Corporation; IO: internal oblique; LD: latissimus dorsi; MFR: myofascial release; MM: myofascial mobilisation; NIH-CPSI: National Institute of Health-Chronic Prostatitis Symptom Index; NRS: numerical rating scale; PFPT: pelvic floor physical therapy; QoL, quality of life; TLF: thoracolumbar fascia; UPOINT: urinary (U), psychosocial (P), organ-specific (O), infection (I), neurological/systemic (N) and tenderness of pelvic floor skeletal muscles (T).
Collapse
Affiliation(s)
- M S Ajimsha
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | | | - Noora Al-Mudahka
- Department of Physiotherapy, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine - Qatar, Doha, Qatar
| |
Collapse
|
20
|
Srinivasan M, Torres JE, McGeary D, Nagpal AS. Complementary and Alternative (CAM) Treatment Options for Women with Pelvic pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 8:240-248. [PMID: 33585075 DOI: 10.1007/s40141-020-00264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose of review I.To provide an overview of the current complementary and alternative (CAM) treatment options for women with chronic pelvic pain (CPP). Recent findings II.Recent studies on chronic pain at cellular, molecular and network level and their interaction with the immune system has unfolded several mechanisms for pain making it promising to explore the alternative paradigm to manage the incredibly complex chronic pelvic pain condition where multifactorial etiology often limits successful outcomes. Summary III.The multifactorial nature and complexity in establishing the underlying diagnosis in CPP limits predictable response to traditional medical and interventional options. Complementary and alternative options have been studied to improve outcomes. Incorporation of exercise-based CAM, pelvic floor physical therapy, acupuncture and cognitive behavioral therapy are suggested to show promising results but well powered randomized studies are needed to draw conclusions on their efficacy. Evidence for non-opioid alternatives such as oral cannabinoids are preliminary and may emerge to be safe and effective.
Collapse
Affiliation(s)
- Malathy Srinivasan
- Department of Physical Medicine and Rehabilitation, Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Donald McGeary
- Associate Professor and Vice Chair for Research, Rehabilitation Medicine; Associate Professor, Psychiatry, UT Health San Antonio
| | - Ameet S Nagpal
- UT Health San Antonio, Department of Anesthesiology, Associate Professor, Department of Anesthesiology, Medical Director, UT Health San Antonio Pain Consultants, Associate Program Director, UT Health San Antonio Pain Medicine Fellowship
| |
Collapse
|
21
|
Badillo SA. Evidence-Based Women’s Health Physical Therapy Across the Lifespan. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
22
|
Imamura M, Scott NW, Wallace SA, Ogah JA, Ford AA, Dubos YA, Brazzelli M. Interventions for treating people with symptoms of bladder pain syndrome: a network meta-analysis. Cochrane Database Syst Rev 2020; 7:CD013325. [PMID: 32734597 PMCID: PMC8094454 DOI: 10.1002/14651858.cd013325.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bladder pain syndrome (BPS), which includes the condition of interstitial cystitis, is a poorly understood clinical condition for which patients present with varying symptoms. Management of BPS is challenging for both patients and practitioners. At present, there is no universally accepted diagnosis and diverse causes have been proposed. This is reflected in wide-ranging treatment options, used alone or in combination, with limited evidence. A network meta-analysis (NMA) simultaneously comparing multiple treatments may help to determine the best treatment options for patients with BPS. OBJECTIVES To conduct a network meta-analysis to assess the effects of interventions for treating people with symptoms of bladder pain syndrome (BPS). SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL, in the Cochrane Library), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and handsearched journals and conference proceedings (searched 11 May 2018) and the reference lists of relevant articles. We conducted a further search on 5 June 2019, which yielded four small studies that were screened for eligibility but were not incorporated into the review. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of interventions for treating adults with BPS. All types of interventions (including conservative, pharmacological and surgical) were eligible. DATA COLLECTION AND ANALYSIS We assessed the risk of bias of included studies using Cochrane's 'Risk of bias' tool. Primary outcomes were the number of people cured or improved, pain, frequency and nocturia. For each outcome, random-effects NMA models were fitted using WinBUGS 1.4. We monitored median odds ratios (ORs) for binary outcomes and mean differences (MDs) for continuous outcomes with 95% credible intervals (Crls). We compared results of the NMA with direct evidence from pairwise meta-analysis of head-to-head trials. We used the CINeMA tool to assess the certainty of evidence for selected treatment categories. MAIN RESULTS We included 81 RCTs involving 4674 people with a median of 38 participants (range 10 to 369) per RCT. Most trials compared treatment against control; few trials compared two active treatments. There were 65 different active treatments, and some comparisons were informed by direct evidence from only one trial. To simplify, treatments were grouped into 31 treatment categories by mode of action. Most studies were judged to have unclear or high risk of bias for most domains, particularly for selection and detection bias. Overall, the NMA suggested that six (proportion cured/improved), one (pain), one (frequency) and zero (nocturia) treatment categories were effective compared with control, but there was great uncertainty around estimates of effect. Due to the large number of intervention comparisons in this review, we focus on three interventions: antidepressants, pentosan polysulfate (PPS) and neuromuscular blockade. We selected these interventions on the basis that they are given 'strong recommendations' in the EAU Guidelines for management of BPS (EAU Guidelines 2019). We found very low-certainty evidence suggesting that antidepressants were associated with greater likelihood of cure or improvement compared with control (OR 5.91, 95% CrI 1.12 to 37.56), but it was uncertain whether they reduced pain (MD -1.27, 95% CrI -3.25 to 0.71; low-certainty evidence), daytime frequency (MD -2.41, 95% CrI -6.85 to 2.05; very low-certainty evidence) or nocturia (MD 0.01, 95% CrI -2.53 to 2.50; very low-certainty evidence). There was no evidence that PPS had improved cure/improvement rates (OR 0.14, 95% CrI 0.40 to 3.35; very low-certainty evidence) or reduced pain (MD 0.42, 95% CrI -1.04 to 1.91; low-certainty evidence), frequency (MD -0.37, 95% CrI -5.00 to 3.44; very low-certainty evidence) or nocturia (MD -1.20, 95% CrI -3.62 to 1.28; very low-certainty evidence). There was evidence that neuromuscular blockade resulted in greater cure or improvement (OR 5.80, 95% CrI 2.08 to 18.30) but no evidence that it improved pain (MD -0.33, 95% CrI -1.71 to 1.03), frequency (MD -0.91, 95% CrI -3.24, 1.29) or nocturia (MD -0.04, 95% CrI -1.35 to 1.27). The certainty of this evidence was always very low. AUTHORS' CONCLUSIONS We are uncertain whether some treatments may be effective in treating patients with BPS because the certainty of evidence was generally low or very low. Data were available for a relatively large number of trials, but most had small sample sizes and effects of treatments often could not be estimated with precision. An NMA was successfully conducted, but limited numbers of small trials for each treatment category hampered our ability to fully exploit the advantages of this analysis. Larger, more focused trials are needed to improve the current evidence base.
Collapse
Affiliation(s)
- Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Neil W Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Sheila A Wallace
- Evidence Synthesis Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Joseph A Ogah
- Obstetrics and Gynaecology, University Hospitals of Morecambe Bay NHS Foundation Trust, Barrow in Furness, UK
| | - Abigail A Ford
- Department of Urogynaecology, Imperial Healthcare Trust, St Mary's Hospital, London, UK
| | - Yann A Dubos
- c/o Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
23
|
Hughes C, May S. A directional preference approach for chronic pelvic pain, bladder dysfunction and concurrent musculoskeletal symptoms: a case series. J Man Manip Ther 2020; 28:170-180. [PMID: 31702976 PMCID: PMC7480605 DOI: 10.1080/10669817.2019.1668994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic pelvic pain (CPP) with concurrent musculoskeletal and bladder symptoms is a complex and challenging problem. However, clinically the co-existence of these symptoms is not routinely questioned, and their musculoskeletal source is not investigated thoroughly. The purpose of this case series is to present the use of Mechanical Diagnosis and Therapy (MDT) principles in seven patients with concurrent chronic pelvic pain, bladder dysfunction and musculoskeletal symptoms. CASE DESCRIPTIONS Seven patients with coexisting pelvic health and musculoskeletal signs and symptoms were retrospectively reviewed. Most common symptoms were urinary frequency, incontinence, pelvic pain, nocturia, dyspareunia, bladder dyssynergia, and lumbar, pelvic or hip pain. All patients failed to recognize the possible interconnectedness of the two sets of symptoms. Each exhibited a directional preference (DP) and subsequent MDT provisional classification of derangement was established; the use of DP forces abolished or dramatically improved both symptoms and mobility impairments. In all cases DP was for sustained sagittal forces initially, but ultimately lateral forces and mobilization were indicated. OUTCOMES Changes in Pelvic Floor Impact Questionnaire, Care Connections Pelvic Floor and Lumbar spine were all clinically significant and exceeded minimally Clinical Important Differences several times. Average of 5.8 sessions per patient was noted. Follow-up at an average of 3.3 years revealed ongoing satisfaction and confidence in independent self-management. DISCUSSION These case studies highlight the importance of ensuring expansion of intake questions for possible co-existence of symptoms in both pelvic and musculoskeletal patients, possibly suggesting a mechanical intervention is indicated. Provisional subclassification into 'Mechanical Pelvic Syndrome' is proposed. Level of Evidence: 4.
Collapse
Affiliation(s)
| | - Stephen May
- Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
24
|
Rodríguez-Torres J, López-López L, Cabrera-Martos I, Prados-Román E, Granados-Santiago M, Valenza MC. Effects of an Individualized Comprehensive Rehabilitation Program on Impaired Postural Control in Women With Chronic Pelvic Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:1304-1312. [PMID: 32325162 DOI: 10.1016/j.apmr.2020.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of an individualized comprehensive rehabilitation program (ICPR) on impaired postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain. DESIGN Randomized controlled trial. SETTING Women with chronic pelvic pain were recruited from the Gynecology Department of the University Hospital San Cecilio in Granada, Spain. PARTICIPANTS Participants (N=38) who were randomly divided into 2 groups. INTERVENTIONS The intervention group received an 8-week ICRP, and the control group received a leaflet with ergonomic information. MAIN OUTCOME MEASURES The main outcomes included were postural control (Mini Balance Evaluation Systems [Mini BESTest] and timed Up and Go [TUG]), pain (Brief Pain Inventory), self-perceived health status (EuroQol 5 dimensions [EQ-5D]), and functionality (Oswestry Disability Index [ODI]). RESULTS Significant differences were found between groups in the Mini BESTest and TUG scores with large effect sizes. The Brief Pain Inventory, EQ-5D, and ODI also presented significant differences in the between-groups analysis, with better scores in the intervention group after treatment. In the follow-up analysis, significant differences were found between groups in the Mini BESTest (P<.001), the cognitive TUG subscale (P=.032), interference of pain (P<.001), anxiety and depression (P=.001), and visual analog scale EQ-5D (P=.026) subscales, as well as the ODI (P<.001). CONCLUSIONS Our results show significant improvements on postural control, pain, self-perceived health status, and functionality in women with chronic pelvic pain who received an 8-week ICRP.
Collapse
Affiliation(s)
- Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Esther Prados-Román
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - María Granados-Santiago
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie C Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.
| |
Collapse
|
25
|
Pelvic Floor Dysfunction in Women. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
26
|
Keizer A, Vandyken B, Vandyken C, Yardley D, Macedo L, Kuspinar A, Fagahani N, Forget MJ, Dufour S. Predictors of Pelvic Floor Muscle Dysfunction Among Women With Lumbopelvic Pain. Phys Ther 2019; 99:1703-1711. [PMID: 31504926 DOI: 10.1093/ptj/pzz124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/25/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is evidence to suggest that a large proportion of individuals seeking care for lumbopelvic pain also have pelvic floor muscle dysfunction (PFMD). Because the majority of physical therapists do not have the requisite training to adequately assess pelvic floor musculature, determining predictors of PFMD could be clinically useful. OBJECTIVE The objective was to establish a combination of factors (self-report and physical) predictive of PFMD in women with lumbopelvic pain. DESIGN This was a cross-sectional study. METHODS Participants completed a battery of self-report and physical assessments (masked assessors). Three clinical findings characterized PFMD: weakness of the pelvic floor, lack of coordination of the pelvic floor, and pelvic floor muscle tenderness on palpation (bilateral obturator internus). Univariate and multivariate logistic regression analyses were used to determine the extent to which different predictors were associated with PFMD. RESULTS One hundred eight women with self-reported lumbopelvic pain (within the past week) were included in the study (mean age = 40.4 years; SD = 12.6 years). None of the examined factors predicted pelvic floor muscle weakness. Two factors independently predicted pelvic floor muscle tenderness on palpation: very strong and/or uncontrollable urinary urges (odds ratio [OR] = 2.93; 95% confidence interval [CI] = 1.13-7.59) and Central Sensitization Inventory scores of 40 or greater (OR = 3.13; 95% CI = 1.08-9.10). LIMITATIONS The sample consisted of young women, some of whom were not actively seeking care. Additionally, the technique for assessing pelvic floor muscle tenderness on palpation requires further validation. CONCLUSIONS Women who have lumbopelvic pain, uncontrollable urinary urgency, and central sensitization were, on average, 2 times more likely to test positive for pelvic floor muscle tenderness on palpation. Further studies are needed to validate and extend these findings.
Collapse
Affiliation(s)
- Alexzandra Keizer
- Department of Physiotherapy, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Brittany Vandyken
- Department of Physiotherapy, Faculty of Health Sciences, McMaster University
| | | | - Darryl Yardley
- Department of Physiotherapy, Western University, London, Ontario, Canada; and West End Physiotherapy, Hamilton, Ontario, Canada
| | - Luciana Macedo
- Department of Physiotherapy, Faculty of Health Sciences, McMaster University
| | - Ayse Kuspinar
- Department of Physiotherapy, Faculty of Health Sciences, McMaster University
| | | | | | - Sinéad Dufour
- Department of Physiotherapy, Faculty of Health Sciences, McMaster University, 1400 Main St W, IAHS Room 304, Hamilton, Ontario L8S 4L8, Canada; and The World of My Baby, Milton, Ontario, Canada
| |
Collapse
|
27
|
Manage vulvodynia using a multimodal and individualized approach. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
28
|
Abstract
Vulvodynia is a common, recurrent, vulvar pain condition with debilitating consequences for affected women's health and quality of life. The heterogeneity of women suffering from vulvodynia as well as its uncertain and likely multifactorial etiology pose a significant challenge to identifying any kind of "gold standard" treatment. Thus, treatment providers must be well versed in the various options and the evidence for each. In this review, we begin with pharmacological treatments, followed by non-pharmacological treatments, surgery, and finally multimodal treatments. For each approach, we briefly discuss the method, mechanism of action, and empirical support for the treatment. In sum, pharmacological treatments that may be beneficial but require further research include antinociceptive agents (lidocaine, capsaicin), anti-inflammatory agents (corticosteroids, interferon), neuromodulating medications (anticonvulsants and antidepressants), hormonal agents, and muscle relaxants (e.g., botulinum toxin). There is strong evidence to support and recommend non-pharmacological interventions including psychological therapy, pelvic floor physical therapy, as well as surgery (i.e., vestibulectomy for provoked vestibulodynia) for the treatment of vulvodynia. We conclude this review with a discussion of issues that may have hindered progress of treatment efficacy and effectiveness, and recommendations for moving the field forward.
Collapse
|
29
|
Franco JVA, Turk T, Jung JH, Xiao Y, Iakhno S, Tirapegui FI, Garrote V, Vietto V. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2019; 10:CD012552. [PMID: 31587256 PMCID: PMC6778620 DOI: 10.1002/14651858.cd012552.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. We considered a 25% decrease of NIH-CPSI baseline score or a six-point reduction as MCID. OBJECTIVES To assess the effects of pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome. SEARCH METHODS We performed a comprehensive search using CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, trial registries, grey literature and conference proceedings, with no restrictions on the language of publication or publication status. The date of the latest search of all databases was July 2019. SELECTION CRITERIA We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available pharmacological interventions compared to placebo or in head-to-head comparisons. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed the risks of bias of included studies. We assessed the quality of the evidence (QoE) using the GRADE approach. MAIN RESULTS We included 99 unique studies in 9119 men with CP/CPPS, with assessments of 16 types of pharmacological interventions. Unless stated otherwise, our comparisons were based on short-term follow-up (less than 12 months). Most studies did not specify their funding sources; 21 studies reported funding from pharmaceutical companies.1. Alpha blockers: (24 studies, 2061 participants). We are uncertain about the effects of these drugs on prostatitis symptoms when compared to placebo at short-term follow-up (mean difference (MD) in total NIH-CPSI score -5.01, 95% confidence interval (CI) -7.41 to -2.61; 18 studies, 1524 participants, very low QoE) and at long-term follow-up (MD -5.60, 95% CI -10.89 to -0.32; 4 studies, 235 participants, very low QoE). Alpha blockers may be associated with an increased incidence of adverse events, such as dizziness and postural hypotension (risk ratio (RR) 1.60, 95% CI 1.09 to 2.34; 19 studies, 1588 participants; low QoE). Alpha blockers probably result in little to no difference in sexual dysfunction, quality of life and anxiety and depression (moderate to low QoE).2. 5-alpha reductase inhibitors (5-ARI): (2 studies, 177 participants). Finasteride probably reduces prostatitis symptoms compared to placebo (NIH-CPSI score MD -4.60, 95% CI -5.43 to -3.77; 1 study, 64 participants; moderate QoE) and may not be associated with an increased incidence of adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.3. Antibiotics: (6 studies, 693 participants). Antibiotics (quinolones) may reduce prostatitis symptoms compared to placebo (NIH-CPSI score MD -2.43, 95% CI -4.72 to -0.15; 5 studies, 372 participants; low QoE) and are probably not associated with an increased incidence in adverse events (moderate QoE). Antibiotics probably result in little to no difference in sexual dysfunction and quality of life (moderate QoE). There was no information on anxiety or depression.4. Anti-inflammatories: (7 studies, 585 participants). Anti-inflammatories may reduce prostatitis symptoms compared to placebo (NIH-CPSI scores MD -2.50, 95% CI -3.74 to -1.26; 7 studies, 585 participants; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.5. Phytotherapy: (7 studies, 551 participants). Phytotherapy may reduce prostatitis symptoms compared to placebo (NIH-CPSI scores MD -5.02, 95% CI -6.81 to -3.23; 5 studies, 320 participants; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). Phytotherapy may not improve sexual dysfunction (low QoE). There was no information on quality of life or anxiety and depression.6. Botulinum toxin A (BTA): Intraprostatic BTA injection (1 study, 60 participants) may cause a large reduction in prostatitis symptom (NIH-CPSI scores MD -25.80, 95% CI -30.15 to -21.45), whereas pelvic floor muscle BTA injection (1 study, 29 participants) may not reduce prostatitis symptoms (low QoE). Both comparisons used a placebo injection. These interventions may not be associated with an increased incidence in adverse events (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.7. Allopurinol: (2 studies, 110 participants). Allopurinol may result in little to no difference in prostatitis symptoms and adverse events when compared to placebo (low QoE). There was no information on sexual dysfunction, quality of life or anxiety and depression.8. Traditional Chinese medicine (TCM): (7 studies, 835 participants); TCM may reduce prostatitis symptoms (NIH-CPSI score, MD -3.13, 95% CI -4.99 to -1.28; low QoE) and may not be associated with an increased incidence in adverse events (low QoE). TCM probably does not improve sexual dysfunction (moderate QoE) and may not improve symptoms of anxiety and depression (low QoE). There was no information on quality of life.The most frequent reasons for downgrading the QoE were study limitations, inconsistency and imprecision. We found few trials with active comparators. AUTHORS' CONCLUSIONS We found low- to very low-quality evidence that alpha blockers, antibiotics, 5-ARI, anti-inflammatories, phytotherapy, intraprostatic BTA injection, and traditional Chinese medicine may cause a reduction in prostatitis symptoms without an increased incidence of adverse events in the short term, except for alpha blockers which may be associated with an increase in mild adverse events. We found few trials with active comparators and little evidence of the effects of these drugs on sexual dysfunction, quality of life or anxiety and depression. Future clinical trials should include a full report of their methods, including adequate masking, consistent assessment of all patient-important outcomes, including potential treatment-related adverse events, and appropriate sample sizes.
Collapse
Affiliation(s)
- Juan VA Franco
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosí 4234Buenos AiresBuenos AiresArgentinaC1199ACL
| | - Tarek Turk
- Damascus UniversityFaculty of MedicineMazzeh StreetDamascusSyrian Arab Republic
| | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Yu‐Tian Xiao
- Changhai Hospital, Second Military Medical UniversityDepartment of Urology168 Changhai RoadShanghaiChina
| | | | - Federico Ignacio Tirapegui
- Hospital Italiano de Buenos AiresUrology DivisionJuan D. Peron 4190Ciudad Autónoma de Buenos AiresBuenos AiresArgentinaC1181ACH
| | - Virginia Garrote
- Instituto Universitario Hospital ItalianoBiblioteca CentralJ.D. Perón 4190Buenos AiresArgentinaC1199ABB
| | - Valeria Vietto
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceBuenos AiresArgentina
| | | |
Collapse
|
30
|
Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clin Obstet Gynecol 2019; 62:22-36. [PMID: 30383545 DOI: 10.1097/grf.0000000000000412] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.
Collapse
|
31
|
Aguirre F, Heft J, Yunker A. Factors Associated With Nonadherence to Pelvic Floor Physical Therapy Referral for the Treatment of Pelvic Pain in Women. Phys Ther 2019; 99:946-952. [PMID: 30916754 PMCID: PMC6602154 DOI: 10.1093/ptj/pzz050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 09/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with pelvic pain due to pelvic floor myofascial pain syndrome are often referred for pelvic floor physical therapy, the primary treatment option. However, many patients do not adhere to the treatment. OBJECTIVE The purpose of this study was to examine the adherence rate and outcomes of patients referred for physical therapy for pelvic floor myofascial pain syndrome and identify risk factors associated with nonadherence. DESIGN This was a retrospective cohort study. METHODS ICD-9 codes were used to identify a cohort of patients with pelvic floor myofascial pain syndrome during a 2-year time period within a single provider's clinical practice. Medical records were abstracted to obtain information on referral to physical therapy, associated comorbidities and demographics, and clinical outcomes. "Primary outcomes" was defined as attendance of at least 1 visit. Secondary outcomes included attendance of at least 6 physical therapist visits and overall improvement in pain. Statistical analysis was performed using chi-square, Fisher exact, and independent t tests. Nonparametric comparisons were performed using Wilcoxon signed rank test. Multivariate analysis was completed to adjust for confounders. RESULTS Of the 205 patients, 140 (68%) attended at least 1 session with physical therapy. At least 6 visits were attended by 68 (33%) patients. Factors associated with poor adherence included parity and a preexisting psychiatric diagnosis. The odds of attending at least 1 visit were 0.75 (95% confidence interval = 0.62-0.90) and 0.44 (95% confidence interval = 0.21-0.90), respectively. Patients who attended ≥ 6 visits were more likely to have private insurance (78%) and travel shorter distances to a therapist (mean = 16 miles vs 22). Patients with an improvement in pain (compared with those who were unchanged) attended an average of 3 extra physical therapist visits (mean = 6.9 vs 3.1). LIMITATIONS Limitations include reliance on medical records for data integrity; a patient population derived from a single clinic, reducing the generalizability of the results; the age of the data (2010-2012); and the likely interrelatedness of many of the variables. It is possible that maternal parity and psychiatric diagnoses are partial surrogates for social, logistic, or economic constraints and patient confidence. CONCLUSIONS Initial adherence to pelvic floor physical therapy was less likely for multiparous women and women with a history of psychiatric diagnosis. Persistent adherence was more likely with private insurance or if the physical therapist location was closer. Pain improvement correlated with increased number of physical therapist sessions.
Collapse
Affiliation(s)
- Frank Aguirre
- Department of Obstetrics and Gynecology, University of South Carolina Medical School, Columbia, South Carolina
| | - Jessica Heft
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amanda Yunker
- Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, 1161 21st Ave, MCN B-1100, Nashville, TN 37232 (USA),Address all correspondence to Dr Yunker at:
| |
Collapse
|
32
|
Pirola GM, Verdacchi T, Rosadi S, Annino F, De Angelis M. Chronic prostatitis: current treatment options. Res Rep Urol 2019; 11:165-174. [PMID: 31240202 PMCID: PMC6556531 DOI: 10.2147/rru.s194679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/03/2019] [Indexed: 12/28/2022] Open
Abstract
Male chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is represented by a heterogeneous group of symptoms that can cause an important impairment of daily quality of life for patients. Diagnosis of CP/CPPS is often not clear and treatment can be challenging, as it varies according to the different causative factors and derived symptoms. Differently from approaches used in the past, the diagnosis and subsequent treatment rely on separating this entity from chronic bacterial prostatitis and considering it as a multifactorial disease. Autoimmunity and inflammation, myofascial tenderness, neuroinflammation, and psychological causes have been clearly related to this disease, and therefore CPPS should not only be considered as related to benign prostatic enlargement. A multitude of different symptoms related to urinary, genital, rectal, and perineal areas can be attributed to this condition and therefore should be routinely investigated in patients, as well as possible differential diagnoses which can cause the same symptoms, such as pudendal nerve entrapment syndrome. The aim of this narrative review is to focus on CPPS after an infectious cause has been excluded.
Collapse
Affiliation(s)
| | - Tiziano Verdacchi
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Stefano Rosadi
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Filippo Annino
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Michele De Angelis
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| |
Collapse
|
33
|
Denneny D, Frawley HC, Petersen K, McLoughlin R, Brook S, Hassan S, Williams AC. Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 100:562-577. [DOI: 10.1016/j.apmr.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
|
34
|
Franco JVA, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int 2019; 124:197-208. [PMID: 30019814 DOI: 10.1111/bju.14492] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. We included randomized controlled trials in men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the Grading of Recommendations Assessment, Development and Evaluation methods. The primary outcomes were prostatitis symptoms and adverse events. The secondary outcomes were sexual dysfunction, urinary symptoms, quality of life, anxiety and depression. RESULTS We included 38 unique studies in 3290 men with CP/CPPS across 23 comparisons, reporting outcomes mostly at short-term follow-up. Our analysis showed that acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with a sham procedure (mean difference [MD] in total National Institutes of Health - Chronic Prostatitis Symptom Index [NIH-CPSI] score -5.79, 95% confidence interval [CI] -7.32 to -4.26, moderate QoE). Acupuncture may result in little or no difference in adverse events (low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, low QoE). Lifestyle modifications may be associated with a reduction in prostatitis symptoms compared with control (risk ratio for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE), but we found no information regarding adverse events. A physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE), but we found no information regarding adverse events. It was uncertain whether prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE) and we found no information regarding adverse events. Extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE), but these results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE). Transrectal thermotherapy, alone or in combination with medical therapy, may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events. CONCLUSIONS Based on the findings with moderate to high QoE, this review found that some non-pharmacological interventions, such as acupuncture and extracorporeal shockwave therapy, are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse events. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods, including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.
Collapse
Affiliation(s)
- Juan V A Franco
- Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina.,Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Tarek Turk
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.,Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yu-Tian Xiao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Stanislav Iakhno
- Food Safety and Infection Biology (Matinf), Norwegian University of Life Sciences, Oslo, Norway
| | - Virginia Garrote
- Biblioteca Central, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
| | - Valeria Vietto
- Argentine Cochrane Centre, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina.,Family and Community Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
35
|
The Efficacy of Manual Therapy for Treatment of Dyspareunia in Females: A Systematic Review. ACTA ACUST UNITED AC 2019; 43:28-35. [PMID: 34135723 DOI: 10.1097/jwh.0000000000000117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Pelvic floor physical therapy is a noninvasive option for relieving pain associated with dyspareunia, genital pain associated with sexual intercourse. Manual therapy is a clinical approach used by physical therapists to mobilize soft tissues, reduce pain, and improve function. To date, the systematic efficacy of manual therapy for treating dyspareunia has not been investigated. Objective To examine the efficacy of manual therapy in reducing pelvic pain among females with dyspareunia. Study Design Systematic review. Methods A systematic literature search was conducted in MEDLINE, EMBASE, and CINAHL databases for articles published between June 1997 and June 2018. Articles were reviewed and selected on the basis of defined inclusion and exclusion criteria. The articles were assessed for quality using the PEDro and Modified Downs and Black scales. Results Three observational studies and 1 randomized clinical trial met inclusion criteria. The primary outcome measured was the pain subscale of the Female Sexual Function Index. All studies showed significant improvements in the pain domain of the Female Sexual Function Index (P < .5), corroborating manual therapy as a viable treatment in relieving pain associated with dyspareunia. However, the quality across studies ranged from poor to good. Conclusions Although these findings support the use of manual therapy for alleviating pain with intercourse, few studies exist to authenticate this claim. Moreover, the available studies were characterized by small sample sizes and were variable in methodological quality. More extensive research is needed to establish the efficacy of manual therapy for dyspareunia and the specific mechanisms by which manual therapy is beneficial.
Collapse
|
36
|
Pudendal Neuralgia: Making Sense of a Complex Condition. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
37
|
Jarvi KA, Wu C, Nickel JC, Domes T, Grantmyre J, Zini A. Canadian Urological Association best practice report on chronic scrotal pain. Can Urol Assoc J 2018; 12:161-172. [PMID: 29485040 PMCID: PMC5994986 DOI: 10.5489/cuaj.5238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Keith A Jarvi
- Sinai Health System, University of Toronto, Toronto, ON; Canada
| | - Christopher Wu
- Sinai Health System, University of Toronto, Toronto, ON; Canada
| | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Chronic scrotal pain (CSP) is a common yet poorly understood condition, with significant impacts on overall quality of life. Many patients will have sought evaluation and management from multiple providers in an attempt to find a solution for their pain. RECENT FINDINGS Despite many emerging treatments for CSP and further understanding of the potential etiologies and pathophysiological basis of the condition, its natural history is poorly understood. It is also important to recognize the psychosocial impact of CSP and consider formal referral for psychological evaluation and treatment if the patient endorses significant psychiatric responses to pain. It is important to also recognize the neuropathic component of pain that may arise in patients with CSP. Neuropathic medications show promise as a narcotic-sparing pharmacological intervention. There are promising surgical options for CSP including microsurgical denervation of the spermatic cord. This article highlights the current best practice recommendations on the evaluation and management of chronic scrotal pain.
Collapse
Affiliation(s)
- Christopher Wu
- Mount Sinai Hospital-Toronto, 60 Murray Street, 6th Floor, Toronto, ON, M5T 3L9, Canada
| | - Keith Jarvi
- Mount Sinai Hospital-Toronto, 60 Murray Street, 6th Floor, Toronto, ON, M5T 3L9, Canada.
| |
Collapse
|
39
|
Fuentes-Márquez P, Cabrera-Martos I, Valenza MC. Physiotherapy interventions for patients with chronic pelvic pain: A systematic review of the literature. Physiother Theory Pract 2018; 35:1131-1138. [PMID: 29757068 DOI: 10.1080/09593985.2018.1472687] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: To summarize the available scientific evidence on physiotherapy interventions in the management of chronic pelvic pain (CPP). Data Sources: A systematic review of randomized controlled trials was performed. An electronic search of MEDLINE, CINAHL, and Web of Science databases was performed to identify relevant randomized trials from 2010-2016. Study Selection: Manuscripts were included if at least one of the comparison groups received a physiotherapy intervention. Studies were assessed in duplicate for data extraction and risk of bias using the Physiotherapy Evidence Database scale PEDro. Data Extraction and Synthesis: Eight of the studies screened met the inclusion criteria. Four manuscripts studied the effects of electrotherapy including intravaginal electrical stimulation, short wave diathermy, respiratory-gated auricular vagal afferent nerve stimulation, percutaneous tibial nerve stimulation, and sono-electro-magnetic therapy with positive results. Three studies focused on manual assessing the efficacy of myofascial versus massage therapy in two of them and ischemic compression for trigger points. Conclusions: Although physiotherapy interventions show some beneficial effects, evidence cannot support the results. Heterogeneity in terms of population phenotype, methodological quality, interpretation of results, and operational definition result in little overall evidence to guide treatment.
Collapse
Affiliation(s)
- Pedro Fuentes-Márquez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| |
Collapse
|
40
|
Franco JVA, Turk T, Jung JH, Xiao Y, Iakhno S, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2018; 5:CD012551. [PMID: 29757454 PMCID: PMC6494451 DOI: 10.1002/14651858.cd012551.pub3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. OBJECTIVES To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). SEARCH METHODS We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. SELECTION CRITERIA We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods. MAIN RESULTS We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture probably leads to clinically meaningful reduction in prostatitis symptoms compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture may result in little to no difference in adverse events (low QoE). Acupuncture may not reduce sexual dysfunction when compared with sham procedure (MD in the International Index of Erectile Function (IIEF) Scale -0.50, 95% CI -3.46 to 2.46, low QoE). Acupuncture may also lead to a clinically meaningful reduction in prostatitis symptoms compared with standard medical therapy (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, low QoE). We found no information regarding quality of life, depression or anxiety.2. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a reduction in prostatitis symptoms compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.3. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). This programme may not reduce anxiety or depression (low QoE). We found no information regarding adverse events, sexual dysfunction or quality of life.4. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events, sexual dysfunction, quality of life, depression or anxiety.5. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE). This treatment probably improves sexual dysfunction (MD in the IIEF Scale MD 3.34, 95% CI 2.68 to 4.00, one study, 60 participants, moderate QoE). We found no information regarding quality of life, depression or anxiety.6. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events. We found no information regarding sexual dysfunction, quality of life, depression or anxiety.7. Other interventions: there is uncertainty about the effects of most of the other interventions included in this review. We found no information regarding psychological support or prostatic surgery. AUTHORS' CONCLUSIONS Based on the findings of moderate quality evidence, this review found that some non-pharmacological interventions such as acupuncture and extracorporeal shockwave therapy are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse event. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.
Collapse
Affiliation(s)
- Juan VA Franco
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosí 4234Buenos AiresBuenos AiresArgentinaC1199ACL
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceTte. Gral. Juan Domingo Perón 4190Buenos AiresBuenos AiresArgentinaC1199ABB
| | - Tarek Turk
- Damascus UniversityFaculty of MedicineMazzeh StreetDamascusSyrian Arab Republic
| | - Jae Hung Jung
- Yonsei University Wonju College of MedicineDepartment of Urology20 Ilsan‐roWonjuGangwonKorea, South26426
- Yonsei University Wonju College of MedicineInstitute of Evidence Based Medicine20 Ilsan‐roWonjuGangwonKorea, South26426
| | - Yu‐Tian Xiao
- Changhai Hospital, Second Military Medical UniversityDepartment of Urology168 Changhai RoadShanghaiChina
| | | | - Virginia Garrote
- Instituto Universitario Hospital ItalianoBiblioteca CentralJ.D. Perón 4190Buenos AiresArgentinaC1199ABB
| | - Valeria Vietto
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosí 4234Buenos AiresBuenos AiresArgentinaC1199ACL
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceTte. Gral. Juan Domingo Perón 4190Buenos AiresBuenos AiresArgentinaC1199ABB
| | | |
Collapse
|
41
|
Klotz SGR, Schön M, Ketels G, Löwe B, Brünahl CA. Physiotherapy management of patients with chronic pelvic pain (CPP): A systematic review. Physiother Theory Pract 2018; 35:516-532. [PMID: 29589778 DOI: 10.1080/09593985.2018.1455251] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Chronic pelvic pain (CPP) is a common pain condition. However, treatment remains challenging. Musculoskeletal findings are frequent; therefore physiotherapy might be helpful. The purpose of this review was to evaluate the current evidence on physiotherapy in patients with CPP (PROSPERO registration number CRD42016037516). METHODS Six databases were searched and additional hand searches were performed. Two reviewers independently conducted the database search and selected studies using a two-step approach. The methodological quality was assessed applying the Critical Review Form - Quantitative Studies. RESULTS A total of eight studies were included. Trigger point therapy was examined in four studies; two of which were randomized controlled trials. All studies indicate a significant change in pain measurement. The other four studies evaluated the effect of biofeedback, Thiele massage, Mensendieck somatocognitive therapy and aerobic exercises, whereas the last two were tested in controlled trials. All studies showed significant improvements in pain assessment. CONCLUSIONS The evidence currently available is sparse with methodological flaws, making it difficult to recommend a specific physiotherapy option. There is an urgent need for high-quality randomized controlled trials to identify the most effective physiotherapy management strategy for patients with CPP.
Collapse
Affiliation(s)
- Susanne G R Klotz
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Centre Hamburg-Eppendorf, Hamburg, Germany and Schön Klinik Hamburg Eilbek , Hamburg , Germany.,b Department of Physiotherapy , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Mila Schön
- b Department of Physiotherapy , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Gesche Ketels
- b Department of Physiotherapy , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany
| | - Bernd Löwe
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Centre Hamburg-Eppendorf, Hamburg, Germany and Schön Klinik Hamburg Eilbek , Hamburg , Germany
| | - Christian A Brünahl
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Centre Hamburg-Eppendorf, Hamburg, Germany and Schön Klinik Hamburg Eilbek , Hamburg , Germany
| |
Collapse
|
42
|
Franco JVA, Turk T, Jung JH, Xiao Y, Iakhno S, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev 2018; 1:CD012551. [PMID: 29372565 PMCID: PMC6491290 DOI: 10.1002/14651858.cd012551.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. OBJECTIVES To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). SEARCH METHODS We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. SELECTION CRITERIA We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods. MAIN RESULTS We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture reduces prostatitis symptoms in an appreciable number of participants compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture likely results in little to no difference in adverse events (moderate QoE). It probably also decreases prostatitis symptoms compared with standard medical therapy in an appreciable number of participants (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, moderate QoE).2. Circumcision: (one study, 713 participants) based on short-term follow-up, early circumcision probably decreases prostatitis symptoms slightly (NIH-CPSI score MD -3.00, 95% CI -3.82 to -2.18, moderate QoE) and may not be associated with a greater incidence of adverse events compared with control (a waiting list to be circumcised, low QoE).3. Electromagnetic chair: (two studies, 57 participants) based on short-term follow-up, we are uncertain of the effects of the use of an electromagnetic chair on prostatitis symptoms. It may be associated with a greater incidence of adverse events compared with sham procedure (low to very low QoE).4. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a greater improvement in prostatitis symptoms in an appreciable number of participants compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events.5. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). We found no information regarding adverse events.6. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events.7. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE).8. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events.9. Other interventions: there is uncertainty about the effects of other interventions included in this review. We found no information regarding psychological support or prostatic surgery. AUTHORS' CONCLUSIONS Some of the interventions can decrease prostatitis symptoms in an appreciable number without a greater incidence of adverse events. The QoE was mostly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.
Collapse
Affiliation(s)
| | - Tarek Turk
- Damascus UniversityFaculty of MedicineMazzeh StreetDamascusSyrian Arab Republic
| | | | - Yu‐Tian Xiao
- Changhai Hospital, Second Military Medical UniversityDepartment of Urology168 Changhai RoadShanghaiChina
| | - Stanislav Iakhno
- Norwegian University of Life SciencesFood Safety and Infection Biology (Matinf)OsloNorway
| | - Virginia Garrote
- Instituto Universitario Hospital ItalianoBiblioteca CentralJ.D. Perón 4190Buenos AiresArgentinaC1199ABB
| | | |
Collapse
|
43
|
Brünahl CA, Klotz SGR, Dybowski C, Riegel B, Gregorzik S, Tripp DA, Ketels G, Löwe B. Combined Cognitive-Behavioural and Physiotherapeutic Therapy for Patients with Chronic Pelvic Pain Syndrome (COMBI-CPPS): study protocol for a controlled feasibility trial. Trials 2018; 19:20. [PMID: 29316946 PMCID: PMC5759202 DOI: 10.1186/s13063-017-2387-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/29/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic pelvic pain syndrome (CPPS) is a pain condition perceived in the pelvic area for at least 6 months. While evidence of the aetiology and maintenance of CPPS is still unclear and therapy options are rare, there is preliminary evidence for the efficacy of cognitive behavioural therapy and physiotherapy. However, an integrated treatment has not yet been studied. The primary aim of this study is therefore to test the feasibility of combined psychotherapy and physiotherapy for female and male patients with CPPS. The secondary aim is to explore changes in patient-relevant and economic outcomes compared to a control group. METHODS A feasibility study with a crossover design based on the principles of a 'cohort multiple randomized controlled trial' will be conducted to test a combined therapy for patients with CPPS. The study will consist of two consecutive treatment modules (cognitive behavioural group psychotherapy and physiotherapy as individual and group sessions), which will be applied in varying order. The modules will consist of nine weekly sessions with a 4-week break between the modules. The control group will undergo treatment as usual. Study subjects will be recruited from the interdisciplinary outpatient clinic for CPPS at the University Medical Center Hamburg-Eppendorf. Thirty-six patients will be assigned to the intervention, and 18 patients will be assigned to the control group. The treatment groups will be gender homogeneous. Feasibility as the primary outcome will be analysed in terms of the demand, acceptability, and practicality. Secondary study outcomes will be measured using validated self-rating-scales and physical examinations. DISCUSSION To the best of our knowledge, this study is the first to investigate the feasibility of combined psychotherapy and physiotherapy for patients with CPPS. In addition to testing feasibility, the results can be used for the preliminary estimation of therapeutic effects. The results from this study will be used to generate an enhanced therapeutic approach, which might be subject to further testing in a larger study. TRIAL REGISTRATION German Clinical Trials Register, DRKS00009976 . Registered on 15 March 2016. ISRCTN, ISRCTN43221600 . Registered on 10 May 2016.
Collapse
Affiliation(s)
- Christian A. Brünahl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Susanne G. R. Klotz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christoph Dybowski
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Björn Riegel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Sonja Gregorzik
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| | - Dean A. Tripp
- Department of Psychology, Queen’s University, Kingston, Ontario K7L 3 N6 Canada
- Department of Anaesthesia, Queen’s University, Kingston, Ontario K7L 3 N6 Canada
- Department of Urology, Queen’s University, Kingston, Ontario K7L 3 N6 Canada
| | - Gesche Ketels
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081 Hamburg, Germany
| |
Collapse
|
44
|
Does Patient Education Augment Pelvic Floor Physical Therapy Preparedness and Attendance? A Randomized Controlled Trial. Female Pelvic Med Reconstr Surg 2018; 24:155-160. [DOI: 10.1097/spv.0000000000000516] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Lusty A, Kavaler E, Zakariasen K, Tolls V, Nickel JC. Treatment effectiveness in interstitial cystitis/bladder pain syndrome: Do patient perceptions align with efficacy-based guidelines? Can Urol Assoc J 2018; 12:E1-E5. [PMID: 29173267 PMCID: PMC5783700 DOI: 10.5489/cuaj.4505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to determine if patients' perceptions of success or failure of interstitial cystitis/bladder pain syndrome (IC/BPS) therapies proposed in treatment guidelines align with the evidence from available clinical trial treatment data. METHODS A total of 1628 adult females with a self-reported diagnosis of IC completed a web-based survey in which patients described their perceived outcomes with the therapies they were exposed to. Previously published literature, used in part to develop IC/BPS guidelines, provided the clinical trial data outcomes. Patient-reported outcomes were compared to available clinical trial outcomes and published treatment guidelines. RESULTS Based on patient perceived outcomes (benefit:risk ratio), the most effective treatments were opioids, phenazopyridine, and alkalizing agents, with amitriptyline and antihistamines reported as moderately effective. The only surgical procedure with any effectiveness was electrocautery of Hunner's lesions. In order of efficacy reported in the literature, the therapies for IC/BPS with predicted superior outcomes should be: cyclosporine A, amitriptyline, hyperbaric oxygen, pentosan polysulfate plus subcutaneous heparin, botulinum toxin A plus hydrodistension, and L-arginine. While some of the guideline recommendations aligned with patient-reported effectiveness data, there was a general disconnect between guidelines and effectiveness reported in clinical practice. CONCLUSIONS There is a disconnect between real-world patient perceived effectiveness of IC/BPS treatments compared to the efficacy reported from clinical trial data and subsequent guidelines developed from this efficacy data. Optimal therapy must include the best evidence from clinical research, but should also include real-life clinical practice implementation and effectiveness.
Collapse
Affiliation(s)
- Avril Lusty
- Department of Urology, Queen’s University, Kingston, ON, Canada
| | | | - Kay Zakariasen
- Department of Urology, Queen’s University, Kingston, ON, Canada
| | - Victoria Tolls
- Department of Urology, Queen’s University, Kingston, ON, Canada
| | | |
Collapse
|
46
|
Abstract
OBJECTIVE To determine the feasibility of a detailed pain sensitivity assessment using body-wide musculoskeletal tender points (TPs) in women with different types of chronic pelvic pain (CPP) and compare phenotypic differences. MATERIALS AND METHODS Seventy women with CPP and 35 pain-free women underwent musculoskeletal evaluation of TPs in the pelvic floor, abdomen, groin, inner thigh, and all 18 fibromyalgia TPs. Patients scored elicited pain on a numeric rating scale. TP pain scores were used for intergroup comparison and intragroup correlation. RESULTS Women with CPP were grouped as having either bladder pain syndrome (BPS, n=24) or myofascial pelvic pain (MPP, n=11) singularly or both concomitantly (BPS+MPP, n=35). TP pain scores for all evaluations were higher in women with CPP compared with healthy women (P<0.001). Women with BPS+MPP had elevated TP pain for each evaluation compared with women with BPS alone. Pelvic floor and fibromyalgia TP scores correlated strongly in the MPP group, moderately in the BPS+MPP group, and weakly in the BPS alone group. Although some moderate and strong correlations between different body locations were present in all 3 groups, only the BPS+MPP group showed moderate to strong correlations between all body TPs. CONCLUSIONS Detailed musculoskeletal evaluation of women with CPP is feasible and well tolerated. Careful phenotyping differentiated BPS, MPP, and BPS+MPP groups. Attending to the differences between these groups clinically may lead to more effective treatment strategies and improved outcomes for patients with CPP.
Collapse
|
47
|
Evaluation and Management of Voiding Dysfunction Following Surgery for Mesh Excision. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0427-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
48
|
Pinto RA, Costa D, Morgado A, Pereira P, Charrua A, Silva J, Cruz F. Intratrigonal OnabotulinumtoxinA Improves Bladder Symptoms and Quality of Life in Patients with Bladder Pain Syndrome/Interstitial Cystitis: A Pilot, Single Center, Randomized, Double-Blind, Placebo Controlled Trial. J Urol 2017; 199:998-1003. [PMID: 29031769 DOI: 10.1016/j.juro.2017.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We compared the efficacy and safety of trigonal injections of onabotulinumtoxinA and saline in patients with bladder pain syndrome/interstitial cystitis. MATERIALS AND METHODS This phase II study enrolled women who had had bladder pain syndrome/interstitial cystitis for more than 6 months and pain for 4 months or longer on a visual analogue scale of 0 to 10, which were refractory to common treatment. OnabotulinumtoxinA 100 U in 10 or saline as placebo in 9 was administered as 10 trigonal injections of 1 ml. The primary study end point was the change from baseline pain intensity reported at week 12. Additional end points included O'Leary-Sant scores, micturition frequency, quality of life at week 4, 8 and 12, and the treatment benefit scale at week 12. Safety assessments included urinary tract infection, post-void residual urine and the initiation of clean intermittent catheterization. RESULTS At week 12 onabotulinumtoxinA had significantly reduced pain compared with saline (mean ± SD -3.8 ± 2.5 vs -1.6 ± 2.1, p <0.05). The proportion of patients who achieved a 50% or greater reduction in the pain visual analog scale was 60% for onabotulinumtoxinA vs 22% for placebo. OnabotulinumtoxinA significantly improved O'Leary-Sant scores and quality of life over placebo at weeks 4, 8 and 12. Important numerical reductions in voiding frequency were also observed with the toxin. OnabotulinumtoxinA was well tolerated. Urinary tract infections developed in 3 patients who received onabotulinumtoxinA vs 2 who received saline. Mean post-void residual urine at week 12 was 5 ± 13 ml for onabotulinumtoxinA vs 0 ml with saline. This study had the limitations inherent to a single center trial with a small number of patients enrolled. CONCLUSIONS OnabotulinumtoxinA 100 U caused significant and clinically relevant improvements in bladder pain and quality of life in patients with bladder pain syndrome/interstitial cystitis refractory to common therapy. It was also well tolerated.
Collapse
Affiliation(s)
- Rui Almeida Pinto
- Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.
| | - Daniel Costa
- Department of Urology, Hospital de São João, Porto, Portugal
| | - Afonso Morgado
- Department of Urology, Hospital de São João, Porto, Portugal; Faculty of Medicine of Porto, Porto, Portugal
| | - Pedro Pereira
- Department of Urology, Hospital de São João, Porto, Portugal
| | - Ana Charrua
- Faculty of Medicine of Porto, Porto, Portugal
| | - João Silva
- Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal
| | - Francisco Cruz
- Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal
| |
Collapse
|
49
|
Masterson TA, Masterson JM, Azzinaro J, Manderson L, Swain S, Ramasamy R. Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study. Transl Androl Urol 2017; 6:910-915. [PMID: 29184791 PMCID: PMC5673826 DOI: 10.21037/tau.2017.08.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Male chronic pelvic pain syndrome (CPPS) is a heterogeneous constellation of symptoms that causes significant impairment and is often challenging to treat. In this prospective study, we evaluated men with CPPS who underwent comprehensive pelvic floor physical therapy (PFPT) program. We used the previously validated Genitourinary Pain Index (GUPI) to measure outcomes. Methods We included 14 men who underwent physical therapy for idiopathic CPPS from October 2015 to October 2016. Men with clearly identifiable causes of pelvic pain, such as previous surgery, chronic infection, trauma, prostatitis and epididymitis were excluded. Treatment included: (I) manual therapy (internal and external) of pelvic floor and abdominal musculature to facilitate relaxation of muscles; (II) therapeutic exercises to promote range of motion, improve mobility/flexibility and strengthen weak muscles; (III) biofeedback to facilitate strengthening and relaxation of pelvic floor musculature; (IV) neuromodulation for pelvic floor muscle relaxation and pain relief. GUPI questionnaires were collected at initial evaluation and after the 10th visit. Higher scores reflect worse symptoms. Previous validation of the GUPI calculated a reduction of 7 points to robustly predict being a treatment responder (sensitivity 100%, specificity 76%) and a change in 4 points to predict modest response. Data are presented as medians (ranges). Results A total of 10 patients completed 10 visits, and the remaining four patients completed between 5 and 9 visits. The median National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score at initial evaluation was 30.8 [16–39] and decreased to 22.2 [7–37] at the tenth visit. Five of the 10 patients (50%) in the study had a reduction of greater than 7 points indicating a robust treatment response, and two (20%) had a change of greater than 4 indicating moderate response. Three patients (30%) did not have any meaningful change in NIH-CPSI and the remaining four are in the process of completing 10 sessions. Duration of therapy appears to predict treatment response. Longer duration has better response. Conclusions Male CPPS is difficult to treat and often requires a multimodal approach. Based on the results of our pilot study, pelvic floor rehabilitation may be an effective treatment option for select patients. A larger study with a control group is needed to validate the routine use of pelvic floor rehabilitation in men with CPPS and predict characteristics of men who would respond to therapy.
Collapse
Affiliation(s)
| | | | - Jessica Azzinaro
- Department of Physical Therapy, University of Miami, Miami, Florida, USA
| | - Lattoya Manderson
- Department of Physical Therapy, University of Miami, Miami, Florida, USA
| | - Sanjaya Swain
- Department of Urology, University of Miami, Miami, Florida, USA
| | | |
Collapse
|
50
|
Franco JVA, Tirapegui FI, Turk T, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Hippokratia 2017. [DOI: 10.1002/14651858.cd012551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Juan VA Franco
- Instituto Universitario del Hospital Italiano; Argentine Cochrane Centre; Potosí 4234 Buenos Aires Buenos Aires Buenos Aires Argentina C1199ACL
| | - Federico Ignacio Tirapegui
- Hospital Italiano de Buenos Aires; Urology Division; Juan D. Peron 4190 Ciudad Autónoma de Buenos Aires Buenos Aires Argentina C1181ACH
| | - Tarek Turk
- Damascus University; Faculty of Medicine; Mazzeh Street Damascus Syrian Arab Republic
| | - Virginia Garrote
- Instituto Universitario Hospital Italiano; Biblioteca Central; J.D. Perón 4190 Buenos Aires Argentina C1199ABB
| | - Valeria Vietto
- Hospital Italiano de Buenos Aires; Family and Community Medicine Service; Buenos Aires Argentina
| |
Collapse
|