Effectiveness of Myofascial Manual Therapies in Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis

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.

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.

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.

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. Similar content being viewed by others

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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. Corresponding author Ethics declarations Submission this research has not been published previously, and it is not under consideration for publication elsewhere. Conflicts of Interest The authors declare that they have no conflict of interest. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Appendix Appendix Search strategy (((((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]))) Rights and permissions About this article Cite this article 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 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00192-022-05173-x