Two-pronged approach relieves refractory CPPS pain

Combining physical and psychological therapy for chronic pelvic pain syndrome (CPPS, or chronic nonbacterial prostatitis) can provide relief for many patients who have pain refractory to conventional treatments, according Stanford (CA) University researchers.

Lead author Rodney Anderson, MD, assisted by a psychologist, a physical therapist, and a clinical research coordinator, saw moderate to marked improvement in nearly three-quarters of the 138 men they treated who had CPPS refractory to traditional therapy.

This combined physical therapy and psychological approach, said Dr. Anderson, is "difficult, time consuming, and not well reimbursed," but it works.

The men had symptoms for a median of 31 months. Therapy included four weekly physical therapy sessions using massage and myofascial trigger point release in internal and external muscle groups that refer pain, followed by eight biweekly treatments. Patients concurrently underwent a form of cognitive behavioral therapy, paradoxical relaxation therapy, and they were instructed in self-trigger point release, skin rolling, self-massage, and stretching. Dr. Anderson said this therapy probably is the more important part of the protocol because genitourinary disorders are intimately related to the autonomic nervous system and to the balance of smooth and striated muscle, which are affected by acute and chronic stress.

Patients' perceptions of the overall effects of therapy, documented on a Global Response Assessment questionnaire, showed 72% of the men had moderate to marked improvement and a median 24% to 46% drop in total NIH-Chronic Prostatitis Symptom Index scores, respectively.

The Stanford Pelvic Pain Syndrome Survey, including a pain visual analog scale, was used to rate patients' progress. In those who showed clinical improvement, median scores decreased 69% and 80% for pain and urinary symptoms, respectively. One-fifth (21%) showed a 27% increase in pain scores.

Findings were presented at the AUA annual meeting.