The Combination Of Myofascial Trigger Point Release And Paradoxical Relaxation Training Shows Promise In The Treatment Of Chronic Pelvic Pain In Men

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CPPS) in men continues to perplex and challenge the urologist in practice. Some estimate the prevalence to be between 5% and 16% of men. Most therapies to this point have focused in the empirical use of antibiotics although 95% of chronic prostatitis syndromes in men are nonbacterial and idiopathic and represent a nonspecific pain disorder. A neurobehavioral perspective to this chronic pain syndrome is starting to emerge.

The authors of a recent study believe that pelvic pain manifests as a myofascial pain syndrome, in which abnormal muscular tension could explain much of the discomfort and abnormal urinary dysfunction seen in men with CPPS. In the July, 2005 issue of the Journal of Urology, R. U. Anderson and colleagues from Stanford University report their experience using a team of a urologist, a physiotherapist and a psychologist to provide urological evaluation, physiotherapy with myofascial trigger point (TrP) release and autonomic and pelvic floor training (PRT) for CPPS.

In the study 138 men referred for chronic pelvic pain with a variety of manifestations were evaluated and treated with myofascial trigger assessment and release therapy with PRT (MRRT/PRT). The mean patient age was 40.5 years and mean symptom duration was 31 months. Treatment consisted of a traditional prostate massage and expressed secretions culture followed by assessment of myofascial trigger points. Tender points were noted and a physiotherapist focused on these spots during sessions of myofascial pressure and release and patient release/hold-relax/contract relax/reciprocal inhibition. Sessions occurred weekly for 4 weeks then bi-weekly for an additional 8 weeks. Patients also received 1 hour of individual verbal instructions and a supervised practice session at weekly intervals for 8 weeks by a psychologist which focused on specific breathing techniques to quiet anxiety and relaxation training sessions focused on directing patients to focus attention on the effortless acceptance of tension in specific areas of the body.

Symptoms were then assessed with a pelvic pain symptom survey (PPSS) and the National Institutes of Health-CP Symptom Index. Patients also reported perceptions of overall effects of therapy using a global response assessment questionnaire. Analysis of results showed that global response estimates of moderately improved or markedly improved, considered clinical successes, were reported by 72% of patients. More than half of the patients treated with the MFRT/PRT protocol had a 25% or greater decrease in pain and urinary symptom scores as assessed by the PPSS. In those at the 50% or greater improvement level (38% of all patients), median scores decreased 69% and 80% for pain and urinary symptom scores, respectively.

This case study analysis indicates that the MFRT/PRT protocol was successful in producing improvement in the majority of men with CPPS and it may be an effective treatment approach in these patients to provide both pain and urinary symptom relief. The treatment described in based on the new understanding that certain chronic pelvic pain reflects a self-feeding state of tension in the pelvic floor, perpetuated by cycles of tension, anxiety and pain. The treatment in this study aims to rehabilitate the pelvic floor, while simultaneously modifying the habit of focusing tension under stress.

From Uro Today.