Treating Chronic Prostatitis/Chronic Pelvic Pain as a Psychoneuromuscular Disorder Shows Benefits

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In studies selected for the analysis, one or more interventions that included physical therapy, myofascial trigger point release, and biofeedback were used.
In studies selected for the analysis, one or more interventions that included physical therapy, myofascial trigger point release, and biofeedback were used.

Treating chronic prostatitis/chronic pelvic pain (CP/CPPS) as a psychoneuromuscular disorder may improve related symptoms significantly, according to a study published in Urology.

For this meta-analysis, investigators searched studies published from inception of medical databases (PubMed, Google Scholar, Cochrane Library) to 2017 in which the efficacy of physical therapy, biofeedback, and/or cognitive behavioral therapy was examined for the treatment CP/CPPS. A total of 8 studies were selected in which one or more of the following interventions was used: physical therapy, myofascial trigger point release, biofeedback and/or electromyography, cognitive behavioral therapy, or other counseling. Average treatment duration over the 8 studies (n=280) was 14.4 weeks.

Inclusion criteria for studies were data on pretreatment and posttreatment with National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores. A 6-point reduction in NIH-CPSI score was considered clinically significant improvement of symptoms.

Among the studies included in the analysis, mean NIH-CPSI scores ranged from 21.7 to 33.5 pretreatment, and most patients were deemed to have “severe” symptoms. The nonstandardized weighted mean reduction of CPSI score from baseline was 8.8 points (95% CI, 7.5-11.1; P <.001). The I2 was 18.5%, indicating little heterogeneity among studies. A sensitivity analysis of an additional multimodal intervention study of 100 patients yielded similar findings.

Study limitations include the inability to establish causality between treatment and a reduction of NIH-CPSI score.

“Aside from the harm of exposing patients with no evidence of infection to extended regimens of antibiotic therapy, it is a disservice to continue to treat [patients with] refractory CP/CPPS [for whom] conventional therapies with long-term regimens of antibiotics, alpha-blockers, opioids, and/or anti-inflammatory medications [failed] when a nonpharmaceutical approach can provide effective relief of symptoms,” emphasized the study authors.

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Reference

Anderson R, Wise D, Nathanson BH. Chronic prostatitis/chronic pelvic pain as a psycho-neuromuscular disorder--A meta-analysis [published online July 27, 2018] Urology. doi: 10.1016/j.urology.2018.07.022

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