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Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand

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Abstract

This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1–10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient’s discretion. Changes in medication use were assessed by McNemar’s test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

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Abbreviations

CP/CPPS:

Chronic prostatitis/chronic pelvic pain syndrome

CPPS:

Urologic chronic pelvic pain syndrome

NIH-CPSI:

National Institutes of Health Chronic Prostatitis Symptoms

TrP:

Trigger point

References

  • Anderson, R. U., & Nathanson, B. H. (2011). Pain: Drug therapies for CP/CPPS: Help or hype? Nature Reviews Urology, 8(5), 236–237.

    Article  PubMed  Google Scholar 

  • Anderson, R. U., Wise, D., Sawyer, T., & Chan, C. (2005). Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. The Journal of Urology, 174(1), 155–160.

    Article  PubMed  Google Scholar 

  • Anderson, R. U., Wise, D., Sawyer, T., Glowe, P., & Orenberg, E. K. (2011a). 6-Day intensive treatment protocol for refractory chronic prostatitis/chronic pelvic pain syndrome using myofascial release and paradoxical relaxation training. The Journal of Urology, 185(4), 1294–1299.

    Article  PubMed  Google Scholar 

  • Anderson, R., Wise, D., Sawyer, T., & Nathanson, B. H. (2011b). Safety and effectiveness of an internal pelvic myofascial trigger point wand for urologic chronic pelvic pain syndrome. The Clinical Journal of Pain, 27(9), 764–768.

    Article  PubMed  Google Scholar 

  • Anothaisintawee, T., Attia, J., Nickel, J. C., Thammakraisorn, S., Numthavaj, P., McEvoy, M., & Thakkinstian, A. (2011). Management of chronic prostatitis/chronic pelvic pain syndrome: A systematic review and network meta-analysis. JAMA, 305(1), 78–86.

    Article  PubMed  Google Scholar 

  • Calhoun, E. A., & Chronic Prostatitis Collaborative Research Network. (2004). The economic impact of chronic prostatitis. Archives of Internal Medicine, 164(11), 1231.

    Article  PubMed  Google Scholar 

  • Clemens, J. Q., Markossian, T., & Calhoun, E. A. (2009). Comparison of economic impact of chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis/painful bladder syndrome. Urology, 73(4), 743–746.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cornel, E. B., van Haarst, E. P., Schaarsberg, R. W., & Geels, J. (2005). The effect of biofeedback physical therapy in men with chronic pelvic pain syndrome type III. European Urology, 47(5), 607–611.

    Article  PubMed  Google Scholar 

  • Dellit, T. H., Owens, R. C., McGowan, J. E., Gerding, D. N., Weinstein, R. A., Burke, J. P., & Hooton, T. M. (2007). Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases, 44(2), 159–177.

    Article  PubMed  Google Scholar 

  • Duclos, A. J., Lee, C. T., & Shoskes, D. A. (2007). Current treatment options in the management of chronic prostatitis. Therapeutics and Clinical Risk Management, 3(4), 507.

    PubMed Central  PubMed  Google Scholar 

  • FitzGerald, M. P., Anderson, R. U., Potts, J., Payne, C. K., Peters, K. M., Clemens, J. Q., & Nyberg, L. M. (2009). Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. The Journal of Urology, 182(2), 570–580.

    Article  PubMed Central  PubMed  Google Scholar 

  • FitzGerald, M. P., Payne, C. K., Lukacz, E. S., Yang, C. C., Peters, K. M., Chai, T. C., & Nyberg, L. M. (2012). Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. The Journal of Urology, 187(6), 2113–2118.

    Article  PubMed Central  PubMed  Google Scholar 

  • Habermacher, G. M., Chason, J. T., & Schaeffer, A. J. (2006). Prostatitis/chronic pelvic pain syndrome. Annual Review of Medicine, 57, 195–206.

    Article  PubMed  Google Scholar 

  • Hanno, P. M., Burks, D. A., Clemens, J. Q., Dmochowski, R. R., Erickson, D., FitzGerald, M. P., & Faraday, M. M. (2011). AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. The Journal of Urology, 185(6), 2162–2170.

    Article  PubMed  Google Scholar 

  • Khorasani, B., Arab, A. M., Sedighi Gilani, M. A., Samadi, V., & Assadi, H. (2012). Transabdominal ultrasound measurement of pelvic floor muscle mobility in men with and without chronic prostatitis/chronic pelvic pain syndrome. Urology, 80(3), 673–677.

    Article  PubMed  Google Scholar 

  • Latthe, P., Latthe, M., Say, L., Gülmezoglu, M., & Khan, K. S. (2006). WHO systematic review of prevalence of chronic pelvic pain: A neglected reproductive health morbidity. BMC Public Health, 6(1), 177.

    Article  PubMed Central  PubMed  Google Scholar 

  • McNaughton Collins, M., MacDonald, R., & Wilt, T. (2000). Diagnosis and treatment of chronic abacterial prostatitis: A systematic review. Annals of Internal Medicine, 133(5), 367–381.

    Article  PubMed  Google Scholar 

  • Nickel, J. C., Downey, J., Hunter, D., & Clark, J. (2001). Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. The Journal of Urology, 165(3), 842–845.

    Article  PubMed  Google Scholar 

  • Nickel, J. C., Krieger, J. N., McNaughton-Collins, M., Anderson, R. U., Pontari, M., Shoskes, D. A., & Schaeffer, A. J. (2008). Alfuzosin and symptoms of chronic prostatitis–chronic pelvic pain syndrome. New England Journal of Medicine, 359(25), 2663–2673.

    Article  PubMed Central  PubMed  Google Scholar 

  • Nickel, J. C., & Shoskes, D. A. (2010). Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome. BJU International, 106(9), 1252–1263.

    Article  PubMed  Google Scholar 

  • Nickel, J. C., & Touma, N. (2012). α-blockers for the treatment of chronic prostatitis/chronic pelvic pain syndrome: An update on current clinical evidence. Reviews in Urology, 14(3–4), 56.

    PubMed Central  PubMed  Google Scholar 

  • Pontari, M. A. (2008). Chronic prostatitis/chronic pelvic pain syndrome. Urologic Clinics of North America, 35(1), 81–89.

    Article  PubMed  Google Scholar 

  • Samplaski, M. K., Li, J., & Shoskes, D. A. (2012). Clustering of UPOINT domains and subdomains in men with chronic prostatitis/chronic pelvic pain syndrome and contribution to symptom severity. The Journal of Urology, 188(5), 1788–1793.

    Article  PubMed  Google Scholar 

  • Shoskes, D. A., Berger, R., Elmi, A., Landis, J. R., Propert, K. J., & Zeitlin, S. (2008a). Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: The chronic prostatitis cohort study. The Journal of Urology, 179(2), 556–560.

    Article  PubMed Central  PubMed  Google Scholar 

  • Shoskes, D. A., Nickel, J. C., Dolinga, R., & Prots, D. (2009). Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology, 73(3), 538–542.

    Article  PubMed  Google Scholar 

  • Shoskes, D. A., Nickel, J. C., Rackley, R. R., & Pontari, M. A. (2008b). Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: A management strategy for urologic chronic pelvic pain syndromes. Prostate cancer and prostatic diseases, 12(2), 177–183.

    Article  PubMed  Google Scholar 

  • Temple, R., & Ellenberg, S. S. (2000). Placebo-controlled trials and active-control trials in the evaluation of new treatments. Part 1: Ethical and scientific issues. Annals of Internal Medicine, 133(6), 455–463.

    Article  PubMed  Google Scholar 

  • Weiss, J. M. (2001). Pelvic floor myofascial trigger points: Manual therapy for interstitial cystitis and the urgency-frequency syndrome. The Journal of Urology, 166(6), 2226–2231.

    Article  PubMed  Google Scholar 

  • Westesson, K. E., & Shoskes, D. A. (2010). Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: Can we diagnose and treat? Current Urology Reports, 11(4), 261–264.

    Article  PubMed  Google Scholar 

  • Wise, D., & Anderson, R. U. (2012). A headache in the pelvis: A new understanding and treatment for prostatitis and chronic pelvic pain syndromes (6th ed.). Occidental, CA: National Center for Pelvic Pain.

    Google Scholar 

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Conflict of interest

R. U. Anderson is a consultant to New Pelvic Pain Technologies, Inc. and holds intellectual property royalty relationship. D. Wise is founder and owner of New Pelvic Pain Technologies, Inc. T. Sawyer is a consultant and holds stock relationship with New Pelvic Pain Technologies, Inc. Brian H. Nathanson, through his company OptiStatim, LLC, has received consulting fees from New Pelvic Pain Technologies, Inc.

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Authors and Affiliations

  1. Stanford University School of Medicine, 574 Junipero Serra Blvd, Stanford, CA, 94305, USA

    Rodney U. Anderson

  2. Department of Health Education, San Francisco State University, San Francisco, CA, USA

    Richard H. Harvey

  3. National Center for Pelvic Pain Research, Sebastopol, CA, USA

    David Wise & Tim Sawyer

  4. Sonoma, CA, USA

    J. Nevin Smith

  5. OptiStatim, LLC, Longmeadow, MA, USA

    Brian H. Nathanson

Authors
  1. Rodney U. Anderson
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  2. Richard H. Harvey
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  3. David Wise
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  4. J. Nevin Smith
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  5. Brian H. Nathanson
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  6. Tim Sawyer
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Corresponding author

Correspondence to Rodney U. Anderson.

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Anderson, R.U., Harvey, R.H., Wise, D. et al. Chronic Pelvic Pain Syndrome: Reduction of Medication Use After Pelvic Floor Physical Therapy with an Internal Myofascial Trigger Point Wand. Appl Psychophysiol Biofeedback 40, 45–52 (2015). https://doi.org/10.1007/s10484-015-9273-1

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  • DOI: https://doi.org/10.1007/s10484-015-9273-1

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