Efficacy of Cognitive Behavior Therapy, Pelvic Floor Therapy, Integrated Therapy, and Pharmacotherapy in the Treatment of Chronic Pelvic Pain in Women: A Randomized Controlled Trial

Bushra Akram, Ahmad Bilal
In: Pakistan Journal of Medical Sciences · 2026 · vol. 42(9) , pp. 2487–2496 · doi:10.12669/pjms.42.9.16890 · W7204927030
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This randomized controlled trial found that integrated cognitive behavior and pelvic floor therapy significantly reduced chronic pelvic pain scores in women more effectively than individual therapies, pharmacotherapy, or placebo.

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This randomized controlled trial evaluated the efficacy of cognitive behavior therapy, pelvic floor therapy, integrated therapy, and pharmacotherapy for chronic pelvic pain in 175 women. Participants were assigned to one of four intervention arms or a placebo group, with outcomes measured using the Impact of Female Chronic Pelvic Pain Questionnaire over a three-month period. The results indicated that while all interventions significantly reduced pain scores at posttest compared to baseline, only the integrated therapy combining cognitive behavior and pelvic floor therapies demonstrated statistically significant superiority over the other treatment modalities and placebo. Relevance to endometriosis: listed as a general treatment modality for chronic pelvic pain, though the paper does not specifically isolate patients with endometriosis or adenomyosis.

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Abstract

Objective: The objective of the current study was to determine the efficacy of Cognitive Behavior Therapy (CBT-cp), Pelvic Floor Therapy (PFT), Integrated Therapy (Combination of CBT-cp and PFT), and Pharmacotherapy in the Treatment of Chronic Pelvic Pain in women, compared with the placebo group. Methodology: A five-arm (four intervention arms and one placebo arm), Randomized Controlled Trial (RCT) was conducted, to examine the effectiveness of CBT-cp, PFT, and Pharmacotherapy in the treatment of Chronic Pelvic Pain in women, compared with the placebo group. The sample comprised 175 female patients with CPP; 141 patients completed the study. They were presented to the Outpatient Department of the Department of Obstetrics & Gynecology, and the Department of Physiotherapy at Nishtar Hospital, Multan, Pakistan, from April to June, 2025. The Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ), Urdu version was used as primary outcome measure. The intervention lasted three months. Results: Results showed that the mean CPP scores significantly decreased at the Posttest (p < 0.001) on IF-CPPQ, although they did not maintain at follow-up. It demonstrated that posttest and follow-up scores were significantly different from pretest scores in all the intervention groups. The Integrated therapy group differed considerably from the CBT-cp, PFT, Pharmacotherapy, and Placebo groups in CPP reduction. Conclusion: The Integrated therapy is the most effective and statistically significant in reducing CPP compared with CBT-cp, PFT, Pharmacotherapy, and Placebo.
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Objective

The objective of the current study was to determine the efficacy of Cognitive Behavior Therapy (CBT-cp), Pelvic Floor Therapy (PFT), Integrated Therapy (Combination of CBT-cp and PFT), and Pharmacotherapy in the Treatment of Chronic Pelvic Pain in women, compared with the placebo group. Methodology: A five-arm (four intervention arms and one placebo arm), Randomized Controlled Trial (RCT) was conducted, to examine the effectiveness of CBT-cp, PFT, and Pharmacotherapy in the treatment of Chronic Pelvic Pain in women, compared with the placebo group. The sample comprised 175 female patients with CPP; 141 patients completed the study. They were presented to the Outpatient Department of the Department of Obstetrics & Gynecology, and the Department of Physiotherapy at Nishtar Hospital, Multan, Pakistan, from April to June, 2025. The Impact of Female Chronic Pelvic Pain Questionnaire (IF-CPPQ), Urdu version was used as primary outcome measure. The intervention lasted three months.

Results

Results showed that the mean CPP scores significantly decreased at the Posttest (p < 0.001) on IF-CPPQ, although they did not maintain at follow-up. It demonstrated that posttest and follow-up scores were significantly different from pretest scores in all the intervention groups. The Integrated therapy group differed considerably from the CBT-cp, PFT, Pharmacotherapy, and Placebo groups in CPP reduction.

Conclusion

The Integrated therapy is the most effective and statistically significant in reducing CPP compared with CBT-cp, PFT, Pharmacotherapy, and Placebo.

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