Chronic Prostatitis and/or Chronic Pelvic Pain as a Psychoneuromuscular Disorder—A Meta-analysis - 18/09/18

Doi : 10.1016/j.urology.2018.07.022

Rodney U. Anderson ^a,^⁎ , David Wise ^b, Brian H. Nathanson ^c
^a Stanford University School of Medicine Stanford, Stanford, CA
^b New Pelvic Pain Technologies, Inc., San Francisco, CA
^c OptiStatim, LLC, Longmeadow, MA

^⁎Address correspondence to: Rodney U. Anderson, M.D., Stanford University School of Medicine, 574 Junipero Serra, Stanford, CA 94305.Stanford University School of Medicine574 Junipero SerraStanfordCA94305

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 18 September 2018

Abstract

Objective

To evaluate effectiveness of physical therapy, biofeedback, and/or cognitive behavioral therapy for chronic prostatitis/chronic pelvic pain syndrome (CP and/or CPPS). This symptom complex has resisted resolution from conventional urologic treatment of the prostate, which includes antibiotics, alpha-blockers, and analgesics. Beginning in 1995, a new paradigm was introduced viewing CP and/or CPPS as a psychoneuromuscular disorder driven by protective pelvic floor guarding and psychosocial stress.

Methods

A literature search (PubMed, Google Scholar, and the Cochran Library) was conducted from inception through December 2017 using key words related to CP and/or CPPS (eg, prostatitis and pelvic pain) with physical therapy (eg, myofascial trigger point release) and/or biofeedback or cognitive behavioral treatment. Studies were required to include pre- and post-treatment with the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI) scores.

Results

Eight studies inclusive of 280 patients met primary inclusion criteria. Study sample sizes ranged from 8 to 116 men (mean = 35); treatment duration ranged from 8 to 26 weeks (mean = 14). Pretreatment mean CPSI scores ranged from 21.7 to 33.5. The nonstandardized weighted mean reduction of CPSI score from baseline was 8.8 points; 95% confidence interval (7.5, 11.1); P <.001. The I² statistic = 18.5% indicating little heterogeneity between studies. A sensitivity analysis including an additional multimodal intervention study of with 100 patients produced similar findings.

Conclusion

Conventional medical treatment often fails to resolve CP and/or CPPS. A 6-point reduction in CPSI score is considered a clinically meaningful improvement of symptoms. This meta-analysis shows that treating CP and/or CPPS as a psychoneuromuscular disorder can significantly exceed this clinical threshold.

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Plan

Methods

Literature Search Strategy

Financial Disclosure: Rodney U Anderson acted as consultant to New Pelvic Pain Technologies, Inc. Brian H. Nathanson's company, OptiStatim, LLC, was paid a consulting fee for data analysis by New Pelvic Pain Technologies, Inc. Study sponsor New Pelvic Pain Technologies, Inc had no role in the study design, collection, analysis or interpretation of data and only approval of manuscript and decision to submit for publication.