Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis - 25/09/24

Doi : 10.1016/j.ajog.2024.08.006

Małgorzata Starzec-Proserpio, PhD ^a,^b, Helena Frawley, PhD ^c,^d, Kari Bø, PhD ^e,^f, Mélanie Morin, PhD ^b,^⁎
^a Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
^b Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
^c Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
^d Allied Health Research, Royal Women's Hospital and Mercy Hospital for Women, Melbourne, Australia
^e Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
^f Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway

^∗Corresponding author: Mélanie Morin, PhD.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 25 September 2024

Abstract

Objective

To evaluate the effectiveness of nonpharmacological conservative therapies for women with CPP.

Data sources

A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023.

Study eligibility criteria

Randomized controlled trials comparing a nonpharmacological conservative therapy to inert (eg, placebo, usual care) or nonconservative (eg, surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (eg, electrophysical agents, manual stretching).

Study appraisal and synthesis methods

All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using postintervention scores for data that included similar interventions and outcomes. Standardized mean differences were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the Physiotherapy Evidence Database scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations criteria.

Results

Of 5776 retrieved studies, 38 randomized controlled trials including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or nonconservative treatments in both the short (standardized mean difference −1.69, 95% confidence interval −2.54, −0.85; high certainty) and intermediate-terms (standardized mean difference −1.82, 95% confidence interval −3.13, −0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (standardized mean difference −0.18, 95% confidence interval −0.56, 0.20; moderate certainty) and a slight difference in sexual function (standardized mean difference −0.28, 95% confidence interval −0.52, −0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (standardized mean difference 1.08, 95% confidence interval −1.38, 3.54, nonstatistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence.

Conclusion

This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with chronic pelvic pain with a high certainty of evidence.

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Key words : bladder pain syndrome, chronic pelvic pain, conservative management, dyspareunia, persistent pelvic pain, physical therapy, vulvodynia, women's health

Plan

	The authors report no conflict of interest.
	This research did not receive specific grants from any funding agency in the public, commercial, or not-for-profit sectors. The fellowship that supported M.S.-P. during the period in which she conducted this work was funded by Fonds de recherche du Québec-Santé.
	Selected results were presented during 26th Annual Scientific Meeting on Pelvic Pain by International Pelvic Pain Society, Denver, CO, October 19 to 22, 2023. Selected results were also submitted for presentation during International Continence Society meeting, Madrid, October 23 to 25, 2024.
	Systematic Review Registration: PROSPERO: CRD42022384450 (date registered: December 26, 2022).
	Data sharing statement: The raw data used to support the findings of this study are available from the respective corresponding author upon request.