Free
The Somatic Connection  |   July 2015
Feasibility Study Shows Promising Efficacy of Myofascial Therapy for Urologic Chronic Pelvic Pain
Author Affiliations
  • Brain Gould, OMS IV
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   July 2015
Feasibility Study Shows Promising Efficacy of Myofascial Therapy for Urologic Chronic Pelvic Pain
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 459-460. doi:10.7556/jaoa.2015.093
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 459-460. doi:10.7556/jaoa.2015.093
FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2013:189(1 suppl):S75-S85. doi: 10.1016/j.juro.2012.11.018. 
Few randomized controlled trials involving physical therapy to manage urologic chronic pelvic pain syndrome (UCPPS) have been completed. To determine whether physical therapy for the management of UCPPS is feasible, the authors conducted a multicenter, single-blinded randomized controlled trial comparing the effects of myofascial physical therapy (MPT) and global therapeutic massage (GTM) in patients with UCPPS or interstitial cystitis. Patients (23 men [49%], 24 women [51%]; median age [range], 43 [22-76] years) from 6 clinical centers were randomly assigned to a GTM group or an MPT group. The GTM group received a full-body Western massage that was applied to the upper and lower limbs, trunk, buttocks, abdomen, head, and neck. The MPT group received connective tissue manipulation of the abdominal wall, back, buttocks, and thighs as well as myofascial trigger point release to painful myofascial trigger points. The MPT group was permitted to use approved home exercises between weekly therapy sessions. Each group received 10 hour-long weekly sessions of manual therapy with a physical therapist. 
Inclusion criteria were clinical diagnosis of a UCPPS, a pelvic pain score of 3 or higher on a 10-point scale, symptoms of abnormal urinary frequency, a National Institutes of Health Chronic Prostatitis Symptom index for men, pelvic pain for at least a 3-month period within the past 6 months, symptoms of UCPPS for less than 3 years, and tenderness to palpation of the pelvic floor on examination. Exclusion criteria were the presence of scars that would likely not respond to manual treatment; positive urine culture within 1 month of initiation of therapy; inability to tolerate vaginal or rectal examination; prior manual treatment for same symptoms of UCPPS; neurologic disorder affecting the bladder; active urethral or ureteral calculi or urethral diverticulum; history of pelvic radiation therapy, tuberculous cystitis, bladder cancer, carcinoma in situ, prostate cancer, or urethral cancer; other debilitating medical conditions; or other potentially severe pelvic abnormalities. 
The parameters of measurement were taken at baseline and week 12, which included pain score, urinary urgency, urinary frequency, O'Leary-Sant Interstitial Cystitis Symptom Index, O'Leary-Sant Interstitial Cystitis Problem Index, a 12-Item Short-Form Health Survey, and Female Sexual Function Index. 
The global response assessment in the MPT group was higher (P=.03) than in the GTM group, and the MPT group showed a decrease in patient-reported symptom scores (P=.05). Physician assessment of internal pain or tenderness to palpation showed a similar decrease in tenderness of anterior and posterior pelvic musculature among both groups; however, the MPT group showed more notable relief of internal muscle groups when compared with the GTM group (P<.05). 
The authors concluded that it is indeed feasible to study the effectiveness of myofascial therapy and massage in patients with urologic chronic pelvic pain, and there may be a greater efficacy of myofascial therapy in certain urologic conditions. The authors are conducting a similar study to determine if their findings could be replicated.