Physiotherapy and combined cognitive-behavioural therapy for patients with chronic pelvic pain syndrome: results of a non-randomised controlled feasibility trial

Abstract

ObjectiveTo explore feasibility in terms of delivering and evaluating a combination of physiotherapy and psychotherapy for patients with chronic pelvic pain syndrome (CPPS).DesignProspective non-randomised controlled pilot study.SettingTertiary care facility with a specialised interdisciplinary outpatient clinic for patients with CPPS.ParticipantsA total of 311 patients was approached; 60 participated. 36 patients were included in the intervention group (mean age ±SD 48.6 years±14.8; 52.8% female) and 24 in the control group (mean age ±SD 50.6 years±14.5; 58.3% female). Fourteen participants were lost to follow-up.InterventionsParticipants were non-randomly allocated to the intervention group with two consecutive treatment modules (physiotherapy and cognitive behavioural therapy) with a duration of 9 weeks each or to the control group (treatment as usual).Main outcome measuresFeasibility was operationalised in terms of delivering and evaluating the therapeutic combination. Regarding eligibility as the first aspect of feasibility, willingness to participate, dropout and satisfaction were assessed; for the second aspect, standardised self-report questionnaires measuring health-related quality of life, depression severity and pain were applied.ResultsAlthough eligibility and willingness-to-participate rates were low, satisfaction of the participants in the intervention group was high and dropout rates were low. Results indicated a small and non-significant intervention effect in health-related quality of life and significant effects regarding depression severity and pain.ConclusionsThe combination of physiotherapy and psychotherapy for patients with CPPS seems to be feasible and potentially promising with regard to effect. However, a subsequent fully powered randomised controlled trial is needed.Trial registration numberGerman Clinical Trials Register (DRKS00009976) and ISRCTN (ISRCTN43221600).

The role of psychosocial factors in the interprofessional management of women with chronic pelvic pain: A systematic review

“…In contrast, the changes in the manual therapy and the booklet control group were not significant 25 . Pain distress, pain perception, and pain interference were evaluated in one study each 25,26,28 . The measured pain‐related factor levels decreased after the intervention with statistical significance being reported only in Ariza‐Mateos et al 25 .…”

“…Of those reporting the number of and reasons for dropouts, Aboussouan et al 24 . reported six women dropping out due to incompletion of the program, Brünahl et al 26 . reported six dropouts (no information about their sex), and Katz et al 27 .…”

“…Pain catastrophizing was assessed in two studies resulting in decreased levels 26,27 with Katz et al reporting statistically significant changes. 27 Four studies [25][26][27][28] included measurements for either painrelated fear or anxiety or generalized anxiety. Statistical significance was only reported in the studies from Ariza-Mateos et al and Katz et al 25,27 Generalized anxiety was reduced in both the intervention and the control group after the intervention compared with the baseline; nonetheless, group differences were not reported.…”

Multimodal therapies and strategies for the treatment of interstitial cystitis/bladder pain syndrome in Taiwan

“…92 Results of most studies proved that BoNT-A can decrease the exocytosis of proinflammatory and excitatory neurotransmitters and neuropeptides, such as substance P, from primary afferent fibers that transmit nociceptive pain and participate in the development of peripheral and central sensitizations and decreases the insertion of pain-sensitive ion channels. 93 Seven studies discussed lifestyle and psychological therapies such as CBT or mindfulness, [94][95][96] hypnosis, 97 lifestyle modification, 98 yoga, 99 and e-health application. 100 Seven studies focused on treatment with oral medications, including Th2 cytokine inhibitor suplatast tosilate, 101 α1 adrenoceptor blocker silodosin, 102 SHIP1 of amino acid protein activator, 103 fatty acid amide hydrolase inhibitor ASP3652, 104 anti-TNF-α agent, 105 phosphodiesterase type 5 inhibitor tadalafil, 106 and pentosan polysulfate sodium.…”

Chronic pelvic pain; more than just the bladder

“…Female pelvic pain needs the same approach. A multidisciplinary approach combining both pelvic floor physiotherapy and mindfulness or Cognitive Behavioural Therapy (CBT) seems to be promising for treating women with CPPPS [31,32].…”