Myofascial Physical Therapy Beneficial in IC

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Myofascial Physical Therapy Beneficial in IC

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Myofascial Physical Therapy Appears Beneficial in Patients With Interstitial Cystitis

By: PATRICE WENDLING, Internal Medicine News Digital Network
11/11/10
FROM THE ANNUAL MEETING OF THE INTERNATIONAL PELVIC PAIN SOCIETY


CHICAGO – Results of a second randomized trial confirm that significantly more women with interstitial cystitis respond to myofascial physical therapy than traditional massage therapy.

Among 81 women with interstitial cystitis and moderate to severe pain or urgency, global response assessment (GRA) rates at 12 weeks were 59% with myofascial physical therapy versus 26% with global massage therapy consisting of full-body Western massage.

This is the second positive randomized controlled trial for a disorder in desperate need of new treatment options, Rhonda Kotarinos, a physical therapist in Oakbrook Terrace, Ill., said at the annual meeting of the International Pelvic Pain Society.

There is no cure for interstitial cystitis (IC), also referred to as painful bladder syndrome. Treatments include eliminating dietary triggers and reproductive organ triggers, anesthetic instillations, physical therapy, and use of pain medications such as opioids, nonsteroidal anti-inflammatory agents, and tricyclic antidepressants.

The prevalence of IC also varies greatly. A widely cited study reports that 1.1% of 1,218 women presenting for a routine primary care office visit had IC based on the O’Leary-Sant Interstitial Cystitis Symptom and Problem Index, while 12.6% had IC based on responses to the PUF (Pelvic Pain and Urgency/Frequency Patient Symptom Scale) questionnaire. The authors concluded that "the true prevalence of IC in women may be somewhere between these two extremes," (J. Urol. 2005;174:2231-4).

The feasibility of myofascial physical therapy (MPT) was evaluated by the same group of researchers in a pilot trial involving 44 men and women with urologic chronic pelvic pain syndrome, including IC. As in the current study, MPT consisted of connective tissue manipulation to all body wall tissues in the abdominal wall, thighs, back, and buttocks that clinically were found to contain connective tissue abnormalities or painful myofascial trigger points. Myofascial manipulation focused on trigger points and restrictive bands.

Patients also were assigned to 10 1-hour sessions of MPT or global massage therapy (GMT), and asked to rate their overall symptoms using the 7-point global response assessment (GRA), with 1 being "markedly worse" and 7 being "markedly improved."

GRA rates were significantly higher at 57% with MPT vs. 21% with massage therapy (J. Urol. 2009;182:570-80). Subgroup analyses revealed a striking difference in the response to standard massage therapy between the all-male patients with chronic pelvic pain syndrome (CPPS) and women with IC (40% vs. 7%), suggesting that patients with CPPS or men respond differently to massage therapy.

The pilot study was the first and only positive trial in 10 years of research in urologic CPPS funded by the National Institute of Diabetes and Digestive and Kidney Diseases, Ms. Kotarinos said.

The current trial was conducted at 11 centers in the United States and Canada, and included 81 women with IC for less than 3 years who had moderate to severe pelvic pain (95%) or moderate to severe urgency (93%). Their mean age was 43 years; 84% were white, 5% were black, and ethnicity for the remaining 11% was not provided.

The secondary end points did not confirm the primary results, Ms. Kotarinos said. The MPT arm had greater mean changes in symptom scores than did the GMT arm on the Interstitial Cystitis Symptom Index (-3.2 vs. -2.2), Interstitial Cystitis Problem Index (-3.6 vs. -2.4), Likert Pain scale (-2.2 vs. -1.5), and Likert Urge Scale (-2.1 vs. -1.4), but the differences did not reach statistical significance.

In all, 85% of patients in both arms completed therapy, which was well tolerated, she said. This is important as myofascial PT can be painful or seen as unduly invasive. Adverse events of any kind were reported in 64% of the MPT group and 60% of the GMT group, and serious adverse events in 15% vs. 14%, respectively. Serious adverse events among MPT patients included four cases of pain and one case each of dehydration, vomiting, and other genitourinary symptoms.

Ms. Kotarinos pointed out that the study included a small group of highly select patients, and that blinding was ineffective, as nearly all patients correctly guessed their treatment arm.

She suggests that future research is warranted to investigate the lack of response in secondary outcomes and to define the role of MPT in the broader IC population, the optimal patient selection criteria, and optimal treatment parameters.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Ms. Kotarinos disclosed no conflicts of interest.


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