794 6-DAY INTENSIVE PHYSIOTHERAPY AND COGNITIVE BEHAVIOR CLINIC TREATMENT FOR CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME

Article Outline

• INTRODUCTION AND OBJECTIVES
• METHODS
• RESULTS
• CONCLUSIONS
• Copyright

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INTRODUCTION AND OBJECTIVES 

Treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remains elusive. For patients exhibiting the phenotype of pelvic musculature tenderness, manual physiotherapy and cognitive behavior relaxation training appears to be helpful. The objective of this study was to show outcome benefits of an intensive 6-day immersion clinic in treating severely refractory patients.

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METHODS 

Men referred for treatment underwent physical examination, answered pain symptom questionnaires, and then spent several hours per day for 6 consecutive days undergoing myofascial trigger point release and training in paradoxical relaxation. Many patients were taught how to perform their own manipulations. Follow-up symptom scores, psychological status (5-point survey of feelings about disorder and coping with their symptoms) and global response assessments were performed from 3 to 42 months after the training/treatment program.

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RESULTS 

We analyzed 125 men who underwent the intensive therapy regimen. Their average age was 49 years (range 20-80); pelvic pain symptom duration average was 7.7±7.8 years with a median of 4.25 years. Follow-up of outcomes occurred after an average 11.8 ± 10.5 month with a median of 7 months. Differences in NIH-Chronic Prostatitis Symptom Index (CPSI) total and domain scores before and after treatment (paired t test) are presented in the Table. Fifty-two percent of the patients self-reported moderate or marked improvements in symptoms on the global response assessment; 14 (11%) indicated no change in their symptoms. Overall psychological benefits averaged 14.2 ± 4.9 (out of maximum score of 21); 25% of patients were exceedingly positive. Sixty-seven percent of patients indicated they continue to utilize cognitive training tapes and 47% continue physical therapy. Of the men completing the therapy, 68% perceived benefit and stated they would participate again or recommend this therapy to a friend.

Table 1. Changes in CPSI Symptom Scores Before and After Physiotherapy and Cognitive Behavior Training, Mean ± SD

CPSI Scores	Pre-treatment	Post-treatment	p-value
Total score	25.3±6.7	18.7±9.1	<0.001
Pain	11.8±3.7	8.8±4.4	<0.001
Urinary	4.4±2.8	3.2±2.8	<0.001
Quality of Life	9.6±2.3	6.9±3.5	<0.001

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CONCLUSIONS 

CP/CPPS patients with long-standing pain, which is refractory to traditional treatment, may benefit from focused myofascial trigger point therapy and cognitive behavior relaxation training. Refinement of phenotyping and selection of patients should enhance the success rate with this treatment modality.