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Intensive treatment protocol may help patients with CP/CPPS

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) — Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) may benefit from an intensive treatment involving trigger point release and cognitive behavioral therapy, according to a new study published in the April edition of The Journal of Urology.

CP/CPPS often persists despite treatment with conventional therapy, and research has shown that men with CP/CPPS may be more likely to suffer from anxiety and depression than those without the condition. Previous studies suggest that patients may respond to non-traditional therapies such as relaxation training or myofascial trigger point release.

“The traditional therapy has been so incomplete and dissatisfying,” Dr. Rodney Anderson, the lead author on the study from the Stanford University School of Medicine, told Reuters Health. Many patients with the condition, he said, try antibiotics, analgesics, and herbal remedies, but “nothing really gets rid of it.”

In the current study, 116 men suffering from CP/CPPS underwent an intensive 6-day treatment program with daily 3 to 5-hour sessions that included intrapelvic/extrapelvic physiotherapy, paradoxical relaxation training with cognitive behavioral therapy, and instruction for continued self-treatment and self-management of pain. Following the intensive treatment, patients were also given a recording of relaxation instruction to use independently and taught how to perform trigger point release using a personal wand. There was no control group.

The median age of participants was 48 years, and men had been experiencing symptoms for a median of 4.8 years prior to the current treatment. All participants were self-referred to Stanford University Urology and treated between 2004 and 2009. All but 8 of the participants had severely refractory CPPS and had been previous treated with multiple different modalities.

After a median 6 months of follow-up, patients had improved significantly on measures of pain, quality of life, and urinary and sexual function.

Median scores on the National Institutes of Health Chronic Prostatitis Symptom Index decreased from 26 (out of a possible 43) before treatment to 19 at follow-up (P < 0.001), with 82% of patients reporting some improvement and 60% experiencing a decrease of 6 points or more.

Median pain score measured with a visual analog scale decreased from 4 (out of 10) to 3 at follow-up, urinary domain scores decreased from 10.5 (out of 28) to 6, and sexual health domain scores decreased from 5 (out of 20) to 3 (P < 0.001 for all; higher scores represent greater severity.)

Improvements were sustained in patients with a long-term follow-up of 23 months.

Dr. Anderson said that the average cost of the treatment program was about $3,600 per patient. However, with physician training and a relaxation program based around video and audio components, “I think you could do this for half that much,” he said.

Dr. Anderson also said that improvement rates might be higher still in a group of patients that is targeted specifically for this treatment. “It really depends on a careful evaluation and then selecting the kind of therapy that’s going to work the best,” he said. “If you select those that would be the best responders, those rates will improve.”

The treatment is fundamentally about teaching patients to take care of themselves and prepare them to address their own symptoms, Dr. Anderson said. “Education of patients in techniques for self-administered (trigger point) massage and encouragement of continued pelvic muscle relaxation are assets in helping them to participate in the management of this chronic disorder,” Dr. Anderson and his colleagues write.

J Urol 2011;185:1294-1299.