Abstract
Introduction and hypothesis
Chronic pelvic pain syndrome (CPPS) is defined as the occurrence of chronic pelvic pain (CPP) in the absence of a specific cause. People typically refer to pain associated with urological, gynaecological, and sexual dysfunction, affecting the quality of life. Therefore, we assessed the effectiveness of myofascial manual therapies (MMT) for pain and symptom impact.
Methods
A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement. Five databases were searched for RCTs. Studies were independently assessed through a standardized form, and their internal validity was evaluated using the Cochrane risk of bias (RoB) tool. Effect sizes (ES) were calculated post-treatment, and the quality of evidence was assessed through GRADE criteria.
Results
Seven articles were included in the review, five of these in the meta-analysis. None of these studies were completely judged at low RoB. MMT was revealed to be not significantly superior for pain reduction [ES: –0.54 (–1.16; 0.08); p = 0.09], for symptom impact [ES: –0.37 (–0.87; 0.13); p = 0.15], and for quality of life [ES: –0.44 (–1.22, 0.33), p = 0.26] compared to standard care. The quality of evidence was “very low”. Other results were presented in a qualitative synthesis.
Conclusions
In patients with CPP/CPPS, MMT is not considered superior to other interventions for pain reduction and symptom impact improvements. However, a positive trend was detected, and we should find confirmation in the future. Further high-quality, double-blinded, sham-controlled RCTs are first necessary to confirm these positive effects and to improve the quality of evidence.
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References
Fall M, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2010. https://doi.org/10.1016/j.eururo.2009.08.020.
Engeler DS, et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol. 2013;64:431–9.
Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17:E141–7.
Suskind AM, et al. The prevalence and overlap of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome in men: results of the RAND Interstitial Cystitis Epidemiology male study. J Urol. 2013;189:141–5.
Fall M, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2004;46:681–9.
Bassaly R, et al. Myofascial pain and pelvic floor dysfunction in patients with interstitial cystitis. Int Urogynecol J. 2011;22:413–8.
Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am. 2009;36:707–22.
Cox A, et al. CUA guideline: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016;10:E136–55.
DiGiovanna EL, Schiowitz S, D. D. An Osteopathic Approach to Diagnosis & Treatment. 2005.
Laimi K, et al. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clin Rehabil. 2018. https://doi.org/10.1177/0269215517732820.
Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release: Systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015. https://doi.org/10.1016/j.jbmt.2014.06.001.
McKenney K, Elder AS, Elder C, Hutchins A. Myofascial release as a treatment for orthopaedic conditions: a systematic review. J Athl Train. 2013;48:522–7.
Dal Farra F, Risio RG, Vismara L, Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis. Complement Ther Med. 2021;56:102616.
Schulze NB, de Salemi MM, de Alencar GG, Moreira MC, de Siqueira GR. Efficacy of Manual Therapy on Pain, Impact of Disease, and Quality of Life in the Treatment of Fibromyalgia: A Systematic Review. Pain Physician. 2020;23:461–76.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021;134:178–89. https://doi.org/10.1016/j.jclinepi.2021.03.001.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. https://doi.org/10.1186/s13643-016-0384-4.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.
Higgins JPT, G. S, eds. Cochrane Handbook for Conducting Systematic Reviews. The Cochrane Collaboration; 2011.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. https://doi.org/10.1136/bmj.39489.470347.AD.
Ariza-Mateos MJ, Cabrera-Martos I, Ortiz-Rubio A, Torres-Sánchez I, Rodríguez-Torres J, Valenza MC. Effects of a Patient-Centered Graded Exposure Intervention Added to Manual Therapy for Women With Chronic Pelvic Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2019;100(1):9–16. https://doi.org/10.1016/j.apmr.2018.08.188.
Cristina D, Tullio G, Leo I, Tiziana D, Paolo DB, Luisa C, Laura M. Effect of two different rehabilitative treatments in women with chronic pelvic pain syndromes Neurourol Urodyn. 2012;31 SUPPL. 1 (S35-S36). https://doi.org/10.1002/nau.22259
Fitzgerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, Kotarinos R, Fraser L, Cosby A, Fortman C, Neville C, Badillo S, Odabachian L, Sanfield A, O'Dougherty B, Halle-Podell R, Cen L, Chuai S, Landis JR, et al. Urological Pelvic Pain Collaborative Research Network. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2013;189(1 Suppl):S75–85. https://doi.org/10.1016/j.juro.2012.11.018.
FitzGerald MP, Payne CK, Lukacz ES, Yang CC, Peters KM, Chai TC, Nickel JC, Hanno PM, Kreder KJ, Burks DA, Mayer R, Kotarinos R, Fortman C, Allen TM, Fraser L, Mason-Cover M, Furey C, Odabachian L, Sanfield A, et al. Interstitial Cystitis Collaborative Research Network. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187(6):2113–8. https://doi.org/10.1016/j.juro.2012.01.123.
Heyman J, Ohrvik J, Leppert J. Distension of painful structures in the treatment for chronic pelvic pain in women. Acta Obstet Gynecol Scand. 2006;85(5):599–603. https://doi.org/10.1080/00016340500495017.
Marx S, Cimniak U, Beckert R, Schwerla F, Resch KL. Chronische Prostatitis/chronisches Beckenschmerzsyndrom. Einfluss osteopathischer Behandlungen - eine randomisiert kontrollierte Studie [Chronic prostatitis/chronic pelvic pain syndrome. Influence of osteopathic treatment - a randomized controlled study]. Urologe A. 2009;48(11):1339-45. German. https://doi.org/10.1007/s00120-009-2088-z. Erratum in: Urologe A. 2010;49(1):55.
Montenegro ML, Braz CA, Rosa-e-Silva JC, Candido-dos-Reis FJ, Nogueira AA, Poli-Neto OB. Anaesthetic injection versus ischemic compression for the pain relief of abdominal wall trigger points in women with chronic pelvic pain. BMC Anesthesiol. 2015;15:175. https://doi.org/10.1186/s12871-015-0155-0.
Bergna A, Vismara L, Parravicini G, Dal Farra F. A new perspective for Somatic Dysfunction in Osteopathy: the Variability Model. J Bodyw Mov Ther. 2020;24(3):181–9. https://doi.org/10.1016/j.jbmt.2020.03.008.
Lunghi C, Consorti G, Tramontano M, Esteves JE, Cerritelli F. Perspectives on tissue adaptation related to allostatic load: Scoping review and integrative hypothesis with a focus on osteopathic palpation. J Bodyw Mov Ther. 2020;24(3):212–20. https://doi.org/10.1016/j.jbmt.2020.03.006.
Cox A, Golda N, Nadeau G, Curtis Nickel J, Carr L, Corcos J, Teichman J. CUA guideline: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016;10(5-6):E136–55. https://doi.org/10.5489/cuaj.3786.
Franco JV, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, Vietto V. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2018;5(5):CD012551. https://doi.org/10.1002/14651858.CD012551.pub3.
Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. J Obstet Gynecol Neonatal Nurs. 2012;41(5):680–91. https://doi.org/10.1111/j.1552-6909.2012.01404.x.
Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561753. https://doi.org/10.1155/2011/561753.ù.
Cathcart E, McSweeney T, Johnston R, Young H, Edwards DJ. Immediate biomechanical, systemic, and interoceptive effects of myofascial release on the thoracic spine: A randomised controlled trial. J Bodyw Mov Ther. 2019;23(1):74–81. https://doi.org/10.1016/j.jbmt.2018.10.006.
Shoskes DA, Berger R, Elmi A, Landis JR, Propert KJ, Zeitlin S. Chronic Prostatitis Collaborative Research Network Study Group. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008;179(2):556–60. https://doi.org/10.1016/j.juro.2007.09.088.
Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC. Prevalence of pelvic floor dysfunction in patients with interstitial cystitis. Urology. 2007;70(1):16–8. https://doi.org/10.1016/j.urology.2007.02.067.
Stecco C, Macchi V, Porzionato A, Duparc F, De Caro R. The fascia: the forgotten structure. Ital J Anat Embryol. 2011;116(3):127–38.
Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221(6):507–36. https://doi.org/10.1111/j.1469-7580.2012.01511.x.
Shafik A. Pudendal canal syndrome: a cause of chronic pelvic pain. Urology. 2002;60(1):199. https://doi.org/10.1016/s0090-4295(02)01604-7.
Origo D, Tarantino AG. Osteopathic manipulative treatment in pudendal neuralgia: A case report. J Bodyw Mov Ther. 2019;23(2):247–50. https://doi.org/10.1016/j.jbmt.2018.02.016.
Possover M, Forman A. Pelvic Neuralgias by Neuro-Vascular Entrapment: Anatomical Findings in a Series of 97 Consecutive Patients Treated by Laparoscopic Nerve Decompression. Pain Physician. 2015;18(6):E1139–43.
Tozzi P. Selected fascial aspects of osteopathic practice. J Bodyw Mov Ther. 2012;16(4):503–19. https://doi.org/10.1016/j.jbmt.2012.02.003.
Cerritelli F, Chiacchiaretta P, Gambi F, Perrucci MG, Barassi G, Visciano C, Bellomo RG, Saggini R, Ferretti A. Effect of manual approaches with osteopathic modality on brain correlates of interoception: an fMRI study. Sci Rep. 2020;10(1):3214. https://doi.org/10.1038/s41598-020-60253-6.
Tramontano M, Cerritelli F, Piras F, Spanò B, Tamburella F, Piras F, Caltagirone C, Gili T. Brain Connectivity Changes after Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial. Brain Sci. 2020;10(12):969. https://doi.org/10.3390/brainsci10120969.
Tamburella F, Piras F, Piras F, Spanò B, Tramontano M, Gili T. Cerebral Perfusion Changes After Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial. Front Physiol. 2019;(10):403. https://doi.org/10.3389/fphys.2019.00403.
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All authors contributed to the study conception and design. Material preparation and data collection were performed by Fulvio Dal Farra, Alessandro Aquino, Andrea Gianmaria Tarantino, and Daniele Origo. Data analysis was developed by Fulvio Dal Farra. The first draft of the manuscript was written by Fulvio Dal Farra and Andrea Gianmaria Tarantino, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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(((((chronic pelvic pain[Title]) OR (chronic pelvic pain syndrome*[Title])) OR (chronic prostatitis[Title])) OR (interstitial cystitis[Title])) OR (painful bladder[Title])) AND (((((((((myofascial release[Title]) OR (myofascial therapy[Title])) OR (myofascial treatment[Title])) OR (fascia* manipulation[Title])) OR (osteopathic manipulative treatment[Title])) OR (osteopathy[Title])) OR (manual therapy[Title])) OR (manipulation[Title])))
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Dal Farra, F., Aquino, A., Tarantino, A.G. et al. Effectiveness of Myofascial Manual Therapies in Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis. Int Urogynecol J 33, 2963–2976 (2022). https://doi.org/10.1007/s00192-022-05173-x
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DOI: https://doi.org/10.1007/s00192-022-05173-x