Results of NIH myofascial physical therapy trial

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kevin
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Results of NIH myofascial physical therapy trial

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Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for the Treatment of Urological Chronic Pelvic Pain Syndromes.

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; Urological Pelvic Pain Collaborative Research Network. Loyola University Medical Center, Maywood (MPF, RK, CF), Illinois.

PURPOSE: We determined the feasibility of conducting a randomized clinical trial designed to compare 2 methods of manual therapy (myofascial physical therapy and global therapeutic massage) in patients with urological chronic pelvic pain syndromes.

MATERIALS AND METHODS: We recruited 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at 6 clinical centers. 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 during study treatment and rate of response to therapy as assessed by the patient global response assessment. Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods.

RESULTS: There were 23 (49%) men and 24 (51%) women randomized during a 6-month period. Of the patients 24 (51%) were randomized to global therapeutic massage, 23 (49%) to myofascial physical therapy and 44 (94%) completed the study. Therapist adherence to the treatment protocols was excellent. The global response assessment response rate of 57% in the myofascial physical therapy group was significantly higher than the rate of 21% in the global therapeutic massage treatment group (p = 0.03).

CONCLUSIONS: We judged the feasibility of conducting a full-scale trial of physical therapy methods and the preliminary findings of a beneficial effect of myofascial physical therapy warrants further study.
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy; pubic/prostate/perineal discomfort; Helped by: trigger point therapy, Afrin nasal spray, Cymbalta, hydrocodone (small doses), distraction. Makes worse: sex.

Not medical advice. Consult your doctor.
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webslave
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Re: Results of NIH myofascial physical therapy trial

Post by webslave »

Very suggestive results. :smile:
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alprost
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Re: Results of NIH myofascial physical therapy trial

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webslave wrote:Very suggestive results. :smile:
Agreed. The problem is that trigger-point release is such a difficult treatment to standardise, as it depends largely on the skill and experience or the PT in locating and treating trigger points. Also, it requires adherence to quite a demanding self-treatment protocol for best results, and is enhanced by lessening the neural drive to the muscles via lowering arousal levels in the CNS (specifically in the limbic system) via relaxation/meditation protocols. Comparing this to a clinical trial of a drug, where treatment is standardised and adherence relativity easily evaluated, it is easy to see just how challenging conducting these studies can be.

The fact that, in spite of these caveats, the results of this study are very encouraging just underlines how robust the rationale and treatment protocol of trigger-point release is for CPPS. I know this from personal experience (now about 90% better from a very severe case thanks to Dr Wise and his team), but it is nice to see the evidence starting to accumulate with larger scale clinical trials in the pipeline :-D
This is not Medical advice - Consult your Doctor!

Age:39. Age at onset:31. Symptoms prior to treatment: Golf ball in rectum, severe urinary frequency (2-3x/hr; 5-10x/night); weak stream; painful ejaculation; coccygeal pain; tip of penis pain; general pelvic pain on left; testicular pain; supra-pubic pain. Current | Symptoms: Urinary frequency 1x every 2-3 hrs and 1-2 x a night; mild pelvic pain on left hand side (all symptoms still improving!)
Helped by: Trigger point release; avoiding exercise; pelvic floor relaxation; Neurontin decreased bladder sensitivity somewhat. Worsened by: Exercise; frequent ejaculation; ibuprofen irritates bladder. Made no difference: Diet; biofeedback; quercetin; Steroid anti-inflammatories; Elavil.

****UPDATE*** I am now able to sit again at work all day, and can perform moderate aerobic exersise again for the first time in 8 years!!!

Please read:
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viewtopic.php?f=7&t=239&p=1158
viewtopic.php?f=37&t=248&p=1214
Dimdem
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Re: Results of NIH myofascial physical therapy trial

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The results are suggestive, but one thing to bear in mind is that the 57% vs. 21% numbers in the abstract combine subjects with CPPS and IC. For CPPS specifically, the difference between myofascial PT and massage was not as marked. 4 out of 10 men with CPPS who got massage responded (were at least moderately improved), while 7 out of 11 who got myofascial therapy responded. What really pulled the response rate down for regular massage was that only 1 of 14 IC patients responded to it (versus 6 out of 12 for myofascial therapy). Not that this is what is most likely to interest people here in the study anyway, but they caution that this was not meant as a comparison of massage and myofascial PT. For one thing, they used the same PTs for both therapies, and not only were they much more experienced with myofascial therapy than with massage but they may have had higher expectations for the myofascial therapy. Obviously there is no way to do this kind of study "double blind."
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Re: Results of NIH myofascial physical therapy trial

Post by webslave »

Not sure what actual massage was done, but if the global massage included massaging the pelvic area, then trigger points may have been treated, at least to a degree.
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Re: Results of NIH myofascial physical therapy trial

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This may not answer the question, but:
Techniques used include effleurage, petrissage, friction, tapotement, vibration and kneading. These techniques were applied in upper and lower limbs, trunk, buttocks, abdomen, head and neck each for prescribed time periods (eg 10 minutes massage to head and neck). . . . The GTM treatment was not similar to the MPT treatment with respect to the manual methods administered to the body tissues, ie there was no methodological overlap between treatments.
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Re: Results of NIH myofascial physical therapy trial

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If you knead the abdomen and pelvis, you will treat trigger points to an extent. In addition, the global massage will have a generally relaxing effect on patients, lessening stress, so further complicating the comparison.
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