Aug. 23, 2009– — Myofascial Physical Therapy Shows Promise in Urologic Chronic Pelvic Pain Syndromes (UCPPS). Estimates of the national prevalence of the urologic chronic pelvic pain syndromes (bladder pain syndrome/interstitial cystitis and chronic prostatitis NIH type IIIA/IIIB) vary between 0.2 percent and 3.4 percent of the population.

On examination, tension and tenderness of the pelvic floor musculature and other somatic tissues are commonly present. It is thought that these myofascial abnormalities contribute significantly to the pain of UCPPS. It is not known whether these musculoskeletal abnormalities are a consequence of lower urinary tract symptoms or are a primary disorder which gives rise to secondary urinary symptoms.

Frequently found abnormalities include myofascial trigger points defined as taut bands or tender nodules that evoke twitch responses or reproduce the character and location of symptoms during careful physical palpation.

Mary Pat FitzGerald and the Urological Pelvic Pain Collaborative Research Network (UPPCRN) of the National Institute of Diabetes Digestive and Kidney Disorders designed a randomized, single-blind clinical trial in which 8 participants each were to be recruited by a subset of 6 of the UPPCRN clinical centers for a total sample size of 48. Eligible patients were randomized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each. Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment, adverse events, and rate of response to therapy as determined by the patient global response assessment (GRA).

The overall GRA response – moderately or markedly improved – was 57 percent in the physical therapy group and 21 percent in the massage group. Of interest, a difference between treatment arms was present only in the interstitial cystitis subjects. Global massage was effective for both groups of patients, but only myofascial physical therapy was effective for BPS/IC.

This is the first published randomized trial comparing myofascial physical therapy with global therapeutic massage for urologic chronic pelvic pain. The centers succeeded in showing that such a trial is feasible and worthy of repeating on a larger scale to better define possible benefits of these therapies. Such a study is now in its final stages in 11 UPPCRN centers and should yield important data in the next year.

Fitzgerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, Kotarinos R, Fraser L, Cosby A, Fortman C, Neville C, Badillo S, Odabachian L, Sanfield A, O’Dougherty B, Halle-Podell R, Cen L, Chuai S, Landis JR, Mickelberg K, Barrell T, Kusek JW, Nyberg LM
J Urol. 2009 Aug;182(2):570-80

Written by Contributing Editor Philip M. Hanno, MD, MPH

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