Editorial - Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes
Written by Philip M. Hanno, MD
Thursday, 20 August 2009
BERKELEY, CA (UroToday.com) -
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% and 3.4% 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% in the physical therapy group and 21% 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
10.1016/j.juro.2009.04.022
PubMed Abstract
PMID: 19535099
Myofascial Physical Therapy Shows Promise in UCPPS
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Re: Myofascial Physical Therapy Shows Promise in UCPPS
Great news! It's always promising to see this approach featured in a broadly viewed source. Lots of familiar names in the credits, too. I look forward to hearing the results from the larger trial in progress.
My only concern is the availability of truly qualified physical therapists. You know there will be some hardliner urologists who'll only accept ginormous studies, for which we might not have enough adequately qualified PTs to provide credible, fair results.
My only concern is the availability of truly qualified physical therapists. You know there will be some hardliner urologists who'll only accept ginormous studies, for which we might not have enough adequately qualified PTs to provide credible, fair results.
I am not a physician. This is not medical advice. Consult your doctor!
Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
Re: Myofascial Physical Therapy Shows Promise in UCPPS
Good news and long awaited...
We have known that PT is useful and it's great to see a clinical trial that proves this.
We have known that PT is useful and it's great to see a clinical trial that proves this.
I am not a medical doctor. Please fill out your signature (click here) ☼ ☼ My Starter List for new members
I encourage anxiety prone UCPPS people to consider L-Theanine
Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
I encourage anxiety prone UCPPS people to consider L-Theanine
Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.