UroToday.com, Berkeley, Calif, reports on the first published, randomized trial comparing myofascial physical therapy with global therapeutic massage for urologic chronic pelvic pain, according to a statement posted on the Web site.

Mary Pat FitzGerald and the Urological Pelvic Pain Collaborative Research Network (UPPCRN) of the National Institute of Diabetes Digestive and Kidney Disorders designed a randomized, single-blind clinical trial in which eight participants each were to be recruited by a subset of six of the UPPCRN clinical centers for a total sample size of 48. Eligible patients were randomized to myofascial physical therapy or global therapeutic massage and were scheduled to receive up to 10 weekly treatments of 1 hour each. Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment, adverse events, and rate of response to therapy as determined by the patient global response assessment (GRA), according to the statement.

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The centers succeeded in showing that such a trial is feasible and worthy of repeating on a larger scale to better define possible benefits of these therapies—and, such a study is now in its final stages in 11 UPPCRN centers and should yield important data in the next year, says the statement.

Estimates of the national prevalence of the urologic chronic pelvic pain syndromes (bladder pain syndrome/interstitial cystitis, and chronic prostatitis NIH type IIIA/IIIB) vary between 0.2% and 3.4% of the population, according to the statement.

On examination, tension and tenderness of the pelvic floor musculature and other somatic tissues are commonly present, and it is thought that these myofascial abnormalities contribute significantly to the pain of UCPPS, says the statement. It is not known whether these musculoskeletal abnormalities are a consequence of lower urinary tract symptoms or are a primary disorder that gives rise to secondary urinary symptoms, it says.

Frequently found abnormalities include myofascial trigger points defined as taut bands or tender nodules that evoke twitch responses or reproduce the character and location of symptoms during careful physical palpation, says the statement.

The overall GRA response—moderately or markedly improved—was 57% in the physical therapy group and 21% in the massage group, according to the statement. Of interest, a difference between treatment arms was present only in the interstitial cystitis subjects, it says. Global massage was effective for both groups of patients, but only myofascial physical therapy was effective for BPS/IC, says the statement.

Fitzgerald MP, Anderson RU, Potts J, Payne CK, et al. J Urol. 2009 Aug;182(2):570-80 

Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

Copyright © 2009 – UroToday

[Source: UroToday.com]