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

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Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

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Funding

this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. SOMA Istituto Osteopatia Milano, Research Department, Viale Sarca 336 F, 20126, Milan, Italy

    Fulvio Dal Farra, Andrea Gianmaria Tarantino & Daniele Origo

  2. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

    Fulvio Dal Farra

  3. Department of Health Science, University of Milan, Milan, Italy

    Alessandro Aquino

  4. Clinical-based Human Research Department, C.O.ME. Collaboration, Pescara, Italy

    Alessandro Aquino

  5. Italian Pelvic Floor Center, Bergamo, Italy

    Alessandro Aquino

  6. Manima Not-for-Profit Healthcare and Assistance, Milan, Italy

    Andrea Gianmaria Tarantino

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  1. Fulvio Dal Farra
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  4. Daniele Origo
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Contributions

All authors contributed to the study conception and design. 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.

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Correspondence to Andrea Gianmaria Tarantino.

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(((((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])))

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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

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