Chronic Prostatitis/Chronic Pelvic Pain as a Psycho-Neuromuscular Disorder-A Meta-analysis

To evaluate effectiveness of physical therapy, biofeedback, and/or cognitive behavioral therapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/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/CPPS as a psycho-neuromuscular disorder driven by protective pelvic floor guarding and psychosocial stress.

A literature search (PubMed, Google Scholar, and the Cochran Library) was conducted from inception through December 2017 using key words related to CP/CPPS (e.g., prostatitis, pelvic pain) with physical therapy (e.g., 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 (NIH-CPSI) scores.

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). Pre-treatment mean CPSI scores ranged from 21.7 to 33.5. The non- standardized weighted mean reduction of CPSI score from baseline was 8.8 points; 95% CI (7.5, 11.1); p<0.001. 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.

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

Urology. 2018 Jul 27 [Epub ahead of print]

Rodney U Anderson, David Wise, Brian H Nathanson

Stanford University School of Medicine Stanford, CA 94305. Electronic address: ., New Pelvic Pain Technologies, Inc. San Francisco, CA., OptiStatim, LLC, Longmeadow, MA.