Physical therapy effective for pelvic pain relief

September 1, 2008

Investigators compared specific physical therapy against general, full-body, Western-style massage in men and women with interstitial cystitis/chronic pelvic pain syndrome and men with chronic prostatitis/chronic pelvic pain syndrome.

Key Points

But it was a success on both counts. The study by the National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Urologic Pelvic Pain Collaborative Research Network pitted targeted physical therapy techniques against general body massage for men and women with interstitial cystitis/chronic pelvic pain syndrome and men with chronic prostatitis/chronic pelvic pain syndrome. Kenneth M. Peters, MD, chair of the department of urology at William Beaumont Hospital in Royal Oak, MI, presented the results at the AUA annual meeting.

Likewise, the doctors' skills were tested. The physical therapists verified whether the physicians had identified patients appropriate for the study, namely those with pelvic floor tenderness.

Gender-specific responses

Of the 126 patients approached, 47 (23 men and 24 women) ultimately were randomized to one treatment or the other at six participating centers. Of those randomized, 44 completed the study. Patients underwent 1-hour treatment sessions weekly. The median number of visits was 10 over a 12-week period.

The primary outcome measurement, taken within 2 weeks of the end of therapy, was moderate or marked improvement on a global response assessment, which asks patients whether they feel better, the same, or worse, and by how much. Overall, 57% of patients responded to the physical therapy, compared with 21% who responded to general massage, a significant difference. Few adverse events were reported, and these complaints were transient incidents of pain reported during the treatments.

The difference in response to treatment between men and women was striking. Among women, 45% responded to physical therapy and 0 to general massage.

"Those initial encouraging results suggest that myofascial physical therapy methods offer meaningful clinical benefit to patients," Dr. Peters said.

But that's an understatement, given the statistical significance of the results.

In the men, however, the difference between those who responded to physical therapy and those who responded to massage wasn't statistically significant. But interestingly, their response rates were higher than the women's. Sixty-seven percent of the men responded to physical therapy; 45% responded to general massage.

"Limitations of the pilot study were that the number of study participants randomized was insufficient to conclusively evaluate the efficacy of physical therapy, and it really wasn't powered to seek statistical significance, but the fact that we showed that was very impressive," Dr. Peters concluded.