Wise-Anderson publish major study in J Urology!

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Please note that the Journal of Urology is the most respected and prestigious journal in the field of urology. It is the Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field. Studies published in this journal enjoy the highest level of acceptance and credibility.

J Urol. 2011 Feb 18. [Epub ahead of print]

6-Day Intensive Treatment Protocol for Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome Using Myofascial Release and Paradoxical Relaxation Training.

Anderson RU, Wise D, Sawyer T, Glowe P, Orenberg EK.
Department of Urology, School of Medicine, Stanford University, Stanford.

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome continues to elude conventional therapy. Evidence supports the concept that phenotypes of pelvic muscular tenderness and psychosocial distress respond to myofascial trigger point release and specific relaxation training. This case series reports long-term outcomes of a 6-day intensive combination of such therapies in refractory cases.

MATERIALS AND METHODS: A total of 200 men with pain for a median of 4.8 years referred themselves to Stanford University Urology for participation in an established protocol. Daily 3 to 5-hour sessions including intrapelvic/extrapelvic physiotherapy, self-treatment training and paradoxical relaxation training provided a solid introduction to facilitate self-management. Subjects answered baseline and followup questionnaires at variable intervals after initiation of therapy including the National Institutes of Health Chronic Prostatitis Symptom Index, global response assessment and a psychological query.

RESULTS: We followed 116 men for a median of 6 months. Baseline total symptom index was 26 out of a maximum 43 points. Scores decreased by 30% (p <0.001) at followup with 60% of subjects demonstrating a 6-point or greater decrease (range 6 to 30). Domains of pain, urinary dysfunction and quality of life showed significant improvement (p <0.001). Global response assessment revealed that 82% of subjects reported improvement (59% marked to moderate, 23% slight).

CONCLUSIONS: Men with chronic pelvic pain refractory to traditional treatment benefit from intensive myofascial trigger point therapy and concomitant paradoxical relaxation training. Education in techniques for self-administered trigger point release and continued pelvic muscle relaxation help patients reduce pain and dysfunction. Refinement of clinical phenotyping and selection of patients with pelvic muscle tenderness should enhance the success rate with this treatment modality.

PMID: 21334027 [PubMed - as supplied by publisher]

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From Medscape

Intensive Therapy Regimen Helps Men With Chronic Pelvic Pain Syndrome

Jill Stein

June 1, 2010 (San Francisco, California) — A 6-day immersion program involving physiotherapy and cognitive behavioral therapy is showing promise in the treatment of severely refractory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), researchers reported here at the American Urological Association (AUA) 2010 Annual Scientific Meeting.

The study, by a group from Stanford University School of Medicine in Palo Alto, California, showed that men with longstanding pain refractory to traditional treatment benefited from an intensive program involving focused myofascial trigger-point therapy and cognitive behavior and relaxation training.

"Once you get patients to turn the corner, understand what's going on in their body, and learn how to control it mentally and with physical manipulations, this regimen works as well as any oral drug has ever worked," lead author and professor of urology Rodney Anderson, MD, told Medscape Urology in an interview.

The program is intended for patients exhibiting the phenotype of pelvic musculature tenderness, he pointed out.

Men referred for treatment underwent physical examination, answered pain-symptom questionnaires, and then spent several hours per day for 6 consecutive days undergoing myofascial trigger-point release and training in paradoxical relaxation. Many patients were taught how to perform their own manipulations. Cognitive behavioral therapy sessions were held daily to help patients manage the anxiety and catastrophic thinking associated with their symptoms.

In all, 125 men participated in follow-up assessments, which were performed from 3 to 42 months after the training/treatment program. The average age of the study population was 48 years, and the median duration of symptoms was 4.8 years.

The penis was the site of pain in 92% of men, the perineum in 78%, and the rectum in 71%.

Sustained Improvements Seen With Multimodal Therapy

Results showed that scores on the National Institutes of Health (NIH)-Chronic Prostatitis Symptom Index (CPSI) improved significantly (P < .001), with an average decrease of about 30% in total score after a median of 6 months. The NIH-CPSI is a widely validated tool for the symptomatic evaluation of men with CP/CPPS.

Overall, 70 of 116 patients (60%) had a decrease of 6 points or more in NIH-CPSI total score.

Symptomatic improvements after the immersion protocol were sustained even in patients who had longer-term follow-up.

Of 106 patients, 63 (59%) self-reported moderate or marked improvements in symptoms on the global response assessment; 14 (11%) patients indicated no change in their symptoms.

In all, 78% of patients indicated that they continue to use relaxation audiotapes — in many cases more than once weekly.

"We are really encouraged by the results, as there has really been no conventional treatment for the condition," Dr. Anderson said. "There is a whole gamut of oral agents that can be given to try to treat the condition but nothing really addresses the biophysiology of it because no one really knows what it is."

"I think this study addresses an important clinical problem. We see a lot of patients who have CP/CPPS who may not respond to the treatments usually used in this population," Tomas L. Griebling, MD, MPH, an AUA spokesperson and associate professor and vice-chair of the Department of Urology at the University of Kansas City Medical Center in Kansas City, Missouri, said in an interview with Medscape Urology.

"The results in this study were good and support the use of multimodal therapy and a type of therapy we might not have looked at in such a scientific way previously."

In the past, there has been some hesitation among practitioners to consider these types of therapies because we haven't had good scientific data to support them, and this study appears to be very well designed and has good outcomes," Dr. Griebling said.

American Urological Association (AUA) 2010 Annual Scientific Meeting: Abstract 794. Presented May 31, 2010.

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Followup comment from Dr Geo's blog

AUA confenrence: “Alternative” Therapy – Helps Men With Chronic Pelvic Pain Syndrome

A 6-day program, by a group from Stanford University School of Medicine involving physiotherapy and cognitive behavioral therapy is showing promise in the treatment of severe chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), researchers reported here at the American Urological Association (AUA) 2010 Annual Scientific Meeting.

The study, in Palo Alto, California, showed that men with longstanding pain refractory to traditional treatment benefited from an intensive program involving focused myofascial trigger-point therapy and cognitive behavior and relaxation training.

The program is intended for patients exhibiting the phenotype of pelvic musculature tenderness, Dr. Rodney Anderson, the lead investigator in the study, pointed out.

Men referred for treatment underwent physical examination, answered pain-symptom questionnaires, and then spent several hours per day for 6 consecutive days undergoing myofascial trigger-point release and training in paradoxical relaxation. Many patients were taught how to perform their own manipulations. Cognitive behavioral therapy sessions were held daily to help patients manage the anxiety and catastrophic thinking associated with their symptoms.

125 men participated in follow-up assessments, which were performed from 3 to 42 months after the training/treatment program. The average age of the study population was 48 years, and the median duration of symptoms was 4.8 years.

The penis was the site of pain in 92% of men, the perineum in 78%, and the rectum in 71%.

Sustained Improvements Seen With Multimodal Therapy

Results showed that scores on the National Institutes of Health (NIH)-Chronic Prostatitis Symptom Index (CPSI) improved significantly, with an average decrease of about 30% in total score after a median of 6 months.

The NIH-CPSI is a widely validated tool for the symptomatic evaluation of men with CP/CPPS.

Overall, 70 of 116 patients (60%) had a decrease of 6 points or more in NIH-CPSI total score.

Symptomatic improvements after the immersion protocol were sustained even in patients who had longer-term follow-up.

Of 106 patients, 63 (59%) self-reported moderate or marked improvements in symptoms on the global response assessment; 14 (11%) patients indicated no change in their symptoms.

In all, 78% of patients indicated that they continue to use relaxation audiotapes — in many cases more than once weekly.

My take on this

This program is written in a book called – A Headache in a Pelvis by Drs. David Wise and Rodney Anderson.

This study proves that alternative therapies are effective in treating this condition where so many men desperately suffer from.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a pelvic pain condition in men, and should be distinguished from other forms of prostatitis such as chronic bacterial prostatitis and acute bacterial prostatitis.

This group of men are forced to significantly adjust their lifestyle to accommodate for their symptoms.

Common symptoms include:

* Pain that can range from mild discomfort to debilitating.
* Pain may radiate to back and rectum, making sitting difficult.
* Pain while urinating (dysuria), muscular pelvic pain (myalgia), abdominal pain, constant burning pain in the penis, and frequency may all be present.
* Frequent urination and increased urgency may suggest interstitial cystitis (inflammation centred in bladder rather than prostate).
* Post-ejaculatory pain, mediated by nerves and muscles, is a hallmark of the condition and serves to distinguish CP/CPPS patients from men with BPH or normal men.
* Some patients report low libido, sexual dysfunction and erectile difficulties.

I am glad this research was presented considering that there is very little scientific interest in this condition. The main reason, I suspect, is because CPPS is not well understood so it is very difficult to create a medication or a procedure for it.

This study also proves that certain alternative approaches can be effective. Unfortunately, there are many such approaches that are effective and will not get adequately studied due to the high cost of running quality trials, the inability to properly randomize an “alternative” trial and the fact that there are multiple variables that work synergistically with alternative approaches. In our current scientific model, using too many possible therapeutic variables weakens the strength of a research study.

Other therapies that have shown effectiveness in the research include Acupuncture and quercetin ( a natural anti-inflammatory).

Natural therapies that “anecdotally” have shown to have some level of effectiveness include other natural inflammatories: bosweillia, fish oils, proteolytic enzymes, curcumin and resveratrol.

Finding if there is a dietary food that may be a culprit: often it is gluten ( a protein found in wheat and other grains) and /or dairy.

This group of people should never attempt to try just one thing. It takes multiple approaches at once to gain therapeutic benefit. The Stanford study proves that, by applying muscular trigger point release with cognitive behavioral therapies.

More to come from the AUA in SF

Geo

[webslave]

Another followup article in "The OB/GYN and INFERTILITY Nurse" journal:

Intensive Nonmedical Program Improves Chronic Pelvic Pain Syndrome in Men

[scotsman]

Great to read Mark

[carld]

Well deserved recognition to Dr. Wise and Dr. Anderson...Any one who comes here to argue that what we support is bogus can now look no further...The protocol is now recognized in the most respected urological published peer reviewed journal!

Best!!!!!!!!!!!

[webslave]

Full paper now available here
http://www.ucpps.men/1/

[Todd]

Maybe now we'll see other Uro's setting up clinics much like Anderson/Wise does.