6-Day Intensive Treatment Protocol for Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome Using Myofascial Release and Paradoxical Relaxation Training
6-Day Intensive Treatment Protocol for Refractory Chronic Prostatitis/Chronic Pelvic Pain Syndrome Using Myofascial Release and Paradoxical Relaxation Training
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DOI：
10.1016/j.juro.2010.11.076
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发表时间：
2011-04-01
影响因子：
6.6
通讯作者：
Orenberg, Elaine K.
中科院分区：
文献类型：
--
作者：
Anderson, Rodney U.;Wise, David;Orenberg, Elaine K.
目的：慢性前列腺炎/慢性骨盆疼痛综合征仍然无法得到常规治疗。证据支持的概念，骨盆肌肉压痛和心理社会困扰的表型肌筋膜触发点释放和特定的放松训练。这一病例系列报告的长期结果，6天的密集组合，这些疗法在难治cases.Materials和方法：共200名男性疼痛的中位数为4.8年提到自己的斯坦福大学泌尿外科参与一个既定的协议。每天3至5小时的疗程，包括骨盆内/骨盆外物理治疗、自我治疗训练和矛盾放松训练，为促进自我管理提供了坚实的基础。受试者回答基线和随访问卷调查，在开始治疗后的可变间隔，包括美国国立卫生研究院慢性前列腺炎症状指数，全球反应评估和心理querion.Results：我们遵循了116名男子的中位数为6个月。基线总症状指数为26分，最高为43分。随访时，评分下降30%（p < 0.001），60%的受试者表现出6分或以上的下降（范围6 - 30）。疼痛、排尿功能障碍和生活质量方面均有显著改善（P < 0.001）。全球反应评估显示，82%的受试者报告改善（59%显着至中度，23%轻微）。结论：男性慢性盆腔疼痛难治性传统治疗受益于强化肌筋膜触发点治疗和伴随的矛盾放松训练。自我管理触发点释放和持续骨盆肌肉放松技术的教育有助于患者减轻疼痛和功能障碍。临床表型的精细化和骨盆肌肉压痛患者的选择应该提高这种治疗方式的成功率。
Purpose: Chronic prostatitis/chronic pelvic pain syndrome continues to elude conventional therapy. Evidence supports the concept that phenotypes of pelvic muscular tenderness and psychosocial distress respond to myofascial trigger point release and specific relaxation training. This case series reports long-term outcomes of a 6-day intensive combination of such therapies in refractory cases.Materials and Methods: A total of 200 men with pain for a median of 4.8 years referred themselves to Stanford University Urology for participation in an established protocol. Daily 3 to 5-hour sessions including intrapelvic/extrapelvic physiotherapy, self-treatment training and paradoxical relaxation training provided a solid introduction to facilitate self-management. Subjects answered baseline and followup questionnaires at variable intervals after initiation of therapy including the National Institutes of Health Chronic Prostatitis Symptom Index, global response assessment and a psychological query.Results: We followed 116 men for a median of 6 months. Baseline total symptom index was 26 out of a maximum 43 points. Scores decreased by 30% (p < 0.001) at followup with 60% of subjects demonstrating a 6-point or greater decrease (range 6 to 30). Domains of pain, urinary dysfunction and quality of life showed significant improvement (p < 0.001). Global response assessment revealed that 82% of subjects reported improvement (59% marked to moderate, 23% slight).Conclusions: Men with chronic pelvic pain refractory to traditional treatment benefit from intensive myofascial trigger point therapy and concomitant paradoxical relaxation training. Education in techniques for self-administered trigger point release and continued pelvic muscle relaxation help patients reduce pain and dysfunction. Refinement of clinical phenotyping and selection of patients with pelvic muscle tenderness should enhance the success rate with this treatment modality.