Abstract
Objective
To evaluate effectiveness of physical therapy, biofeedback, and/or cognitive behavioral
therapy for chronic prostatitis/chronic pelvic pain syndrome (CP and/or CPPS). This
symptom complex has resisted resolution from conventional urologic treatment of the
prostate, which includes antibiotics, alpha-blockers, and analgesics. Beginning in
1995, a new paradigm was introduced viewing CP and/or CPPS as a psychoneuromuscular
disorder driven by protective pelvic floor guarding and psychosocial stress.
Methods
A literature search (PubMed, Google Scholar, and the Cochran Library) was conducted
from inception through December 2017 using key words related to CP and/or CPPS (eg,
prostatitis and pelvic pain) with physical therapy (eg, myofascial trigger point release)
and/or biofeedback or cognitive behavioral treatment. Studies were required to include
pre- and post-treatment with the National Institutes of Health Chronic Prostatitis
Symptom Index (CPSI) scores.
Results
Eight studies inclusive of 280 patients met primary inclusion criteria. Study sample
sizes ranged from 8 to 116 men (mean = 35); treatment duration ranged from 8 to 26
weeks (mean = 14). Pretreatment mean CPSI scores ranged from 21.7 to 33.5. The nonstandardized
weighted mean reduction of CPSI score from baseline was 8.8 points; 95% confidence
interval (7.5, 11.1); P <.001. The I2 statistic = 18.5% indicating little heterogeneity between studies. A sensitivity
analysis including an additional multimodal intervention study of with 100 patients
produced similar findings.
Conclusion
Conventional medical treatment often fails to resolve CP and/or CPPS. A 6-point reduction
in CPSI score is considered a clinically meaningful improvement of symptoms. This
meta-analysis shows that treating CP and/or CPPS as a psychoneuromuscular disorder
can significantly exceed this clinical threshold.
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Article info
Publication history
Published online: July 27, 2018
Accepted:
July 17,
2018
Received in revised form:
June 23,
2018
Received:
April 18,
2018
Footnotes
Financial Disclosure: Rodney U Anderson acted as consultant to New Pelvic Pain Technologies, Inc. Brian H. Nathanson's company, OptiStatim, LLC, was paid a consulting fee for data analysis by New Pelvic Pain Technologies, Inc. Study sponsor New Pelvic Pain Technologies, Inc had no role in the study design, collection, analysis or interpretation of data and only approval of manuscript and decision to submit for publication.
Identification
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© 2018 Elsevier Inc. All rights reserved.
