Intrarectal pelvic PT a "meaningful treatment"

[webslave]

AUA 2008 - Randomized Multicenter Pilot Trial Shows Benefit of Manual Physical Therapies in Treatment of Chronic Pelvic Pain

ORLANDO, FL (UroToday.com) - Dr. Peters reported on a trial of physical therapy (PT) in CP/CPPS. This was a randomized trial to assess whether external and internal manual PT (MPT) vs. global therapeutic massage (GTM). Six sites each recruited and randomized 8 patients to MPT or GTM. All sites attended a workshop to standardize the therapies.

Patients had CPPS for 3 years or less and had tenderness and /or a muscular trigger point during baseline pelvic examination. A global survey was used to assess response. They also sought to determine the feasibility of doing a future large randomized trial.

47 patients were ultimately randomized and 2 withdrew during the study. Baseline characteristics were similar. Median treatment number was 10 and adherence to therapy protocol was excellent. Adverse events were 20-50% and were primarily pain. Response rates were 57% response in the MPT group vs. 21% in the GTM group. This suggests that MPT is a clinically meaningful treatment option. This pilot study supports a future randomized trial.

Presented by Kenneth Peters, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA

[garyholc]

It seems that more and more studies are now backing up the theory of CPPS being a muscular condition which can be treated by trigger point release using internal and external massage in the correct areas. However its still so frustrating that progress is very slow with regards urologists and doctors in the medical profession who still prescribe antibiotics and that there is not more people out there able to treat this potentially life changing condition.

[popburner]

I do think this is so important, though agree with Webslave and others that we have to be careful to claim this disease (or diseases) is simply just trigger points. There are those of us who have been examined by Tim Sawyer and others who have found some moderate trigger points, and some definite tightness, but who don't find those to be the only thing causing their pain (i.e. diet, inflammation, stress, adrenals) - most of my trigger points have resolved, yet most of my allodynia and other discomforts remain...it's a complicated picture that requires a multi-model investigation. This IS a great step forward though!

[Jay]

This is a very interesting study! I hope more of these come along. Every clinical trial which shows significant results increases the chances that some doctor will forward a sufferer to a more hopeful method of treatment than antibiotics.

57% is a great number, though still not as high as I'd have expected from success rates elsewhere (here, SP clinic, etc). I suppose the rest may be accounted for by diet, need for relaxation techniques, need for longer treatment, or possibly those participants just had a different condition entirely (i.e. neurological or structural involvement)?

Either way, great news and very encouraging. I am looking forward to trying PT myself and I have found a SP practitioner nearby.

[webslave]

Jay, the results are also affected by the investigators' training (or lack thereof) in finding and treating intrarectally-accessed trigger points.