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The Somatic Connection  |   July 2015
Managing Pelvic Neuromusculoskeletal Dysfunction Relieves Chronic Pelvic Pain in Men
Author Affiliations
  • Ashley Garispe, OMS III
    Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California
  • 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
Managing Pelvic Neuromusculoskeletal Dysfunction Relieves Chronic Pelvic Pain in Men
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 460-461. doi:10.7556/jaoa.2015.094
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 460-461. doi:10.7556/jaoa.2015.094
Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-160. 
Chronic nonbacterial prostatitis (CP) and chronic pelvic pain syndrome (CPPS) can be challenging to manage, but manual therapy may help to provide symptom relief. The authors evaluated a multidisciplinary approach to the management of CP and CPPS in men using myofascial trigger point assessment and release therapy (MFRT) in conjunction with paradoxical relaxation therapy (PRT). A total of 138 men aged 16 to 79 years with CP or CPPS refractory to traditional therapy were treated for a minimum of 1 month with a MFRT/PRT protocol by a multidisciplinary team consisting of a urologist, a physical therapist, and a psychologist. 
For the MFRT protocol, the patients were examined by a urologist who identified myofasical trigger points by reproducing symptoms with palpation either at the site or at a nearby anatomic location. The physical therapist then applied therapy to the patients weekly by applying pressure to each location for 60 seconds until the myofascial trigger points were released. Therapy was performed once weekly for 4 weeks and biweekly for 8 weeks thereafter. 
For the PRT protocol, patients received 1 hour of relaxation exercises (eg, breathing techniques to relieve anxiety) to decrease their pelvic muscle tension each week for 8 weeks. The patients were encouraged to continue these 1-hour sessions daily at home for a minimum of 6 months. 
The patients’ symptoms were assessed before and after the interventions using a pelvic pain symptom survey and the National Institutes of Health Chronic Prostatitis Symptom Index, both of which evaluated for pain, urinary symptoms, and sexual dysfunction. A 7-point global response as sessment questionnaire was also used to monitor the patients’ perceptions of the overall effects of therapy. 
Of the 92 patients who completed the global response assessment questionnaire, 66 (72%) reported either marked improvement or moderate improvement in their total pain score, urinary symptoms score, and pain visual analog scale score. Total pain scores decreased a median of 8 points in patients with marked improvement (P<.001) and a median of 3.5 points in patients with moderate improvement (P=.001). Urinary symptom scores decreased a median of 3.5 points in patients with marked improvement (P=.001) and a median of 1 point in patients with moderate improvement (P=.67). Pain visual analog scale scores decreased a median of 2 points in patients with marked improvement (P=.001). 
This cross-sectional case series found that combined MFRT and PRT provided symptomatic relief of CPPS in patients refractory to traditional treatment. Although external validity is limited because of lack of patient standardization, randomization, and a control group, the results of this study demonstrated the potential benefit of managing neuromusculoskeletal components of CP or CPPS in men. We recommend including osteopathic manipulative treatment as an intervention in future randomized controlled trials in this patient population.