Department of Urology, School of Medicine, Stanford University, Stanford, California 94305-5118, USA.
J Urol. 2011 Apr;185(4):1294-9. doi: 10.1016/j.juro.2010.11.076. Epub 2011 Feb 22.
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.
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.
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).
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.
慢性前列腺炎/慢性骨盆疼痛综合征仍然难以通过常规治疗方法治愈。有证据支持这样一种概念，即骨盆肌肉触痛点和心理社会困扰的表型对触发点释放和特定的放松训练有反应。本病例系列报告了对难治性病例进行为期 6 天的强化综合治疗的长期结果。
共有 200 名疼痛中位数为 4.8 年的男性患者自行到斯坦福大学泌尿科就诊，参加一项既定的方案。每天 3 至 5 小时的课程包括盆腔内/盆腔外物理治疗、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。患者在开始治疗后的不同时间间隔（包括国家卫生研究院慢性前列腺炎症状指数、总体反应评估和心理查询）回答基线和随访问卷。
我们随访了 116 名男性患者，中位数为 6 个月。基线总症状指数为 43 分中的 26 分。随访时评分下降了 30%（p<0.001），60%的患者下降了 6 分或更多（范围 6 至 30）。疼痛、排尿功能障碍和生活质量等领域均有显著改善（p<0.001）。总体反应评估显示，82%的患者报告有改善（59%为明显至中度，23%为轻度）。
对传统治疗方法有反应的慢性骨盆疼痛男性患者受益于强化触发点治疗和伴随的矛盾放松训练。自我管理触发点释放技术的教育和持续的骨盆肌肉放松有助于患者减轻疼痛和功能障碍。对临床表型的精细化和对具有骨盆肌肉触痛点的患者的选择，应能提高这种治疗方式的成功率。
