Physiotherapy for chronic pelvic pain: a review of the latest evidence
Chronic pelvic pain (CPP) is a complex and debilitating condition that is prevalent worldwide. The symptoms of the condition fit a biopsychosocial model of pain, and can include bladder, bowel and sexual dysfunction. The cause of CPP is often unclear, as are the most effective interventions. There is a shortage of skilled physiotherapists in the UK, and patients often only access physiotherapy as a last resort. Multidisciplinary team (MDT) programmes are effective in managing chronic low back pain, and the same type of initiatives may be effective for CPP. The aim of this literature review was to identify and synthesize evidence from recent empirical quantitative studies in order to answer the following question: is physiotherapy effective in the management of CPP in men and women aged 18 years and older, and if so, which treatment protocols are best? Nine studies were assessed for methodological quality. The results from seven poor-and moderate-quality randomized controlled trials (RCTs) exhibited a trend: standalone physiotherapy interventions appeared to have only a small positive effect on pain scores and function. However, the sample sizes involved were small and larger trials are needed. Two studies were of such poor quality that these could not be included in the summary of the findings. The results from two larger samples in clinical case series demonstrated that MDT programmes may be effective in the treatment of both men and women. However, these studies were too varied in terms of intervention and design to allow any meaningful meta-analysis to be performed. One RCT showed that extracorporeal shockwave therapy may be effective for male CPP, but better placebos are required to establish this conclusively. Two RCTs that involved electroacupuncture reported efficacy in pain reduction, but both were of poor quality. Multidisciplinary team programmes showed the highest functional improvement. Future studies should consider a standardized MDT protocol for trial in a UK National Health Service setting, and continue to build on the evidence base that exists.
Keywords: chronic pelvic pain, physiotherapy, randomized controlled trials.