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Non-Pharmacological Methods for Chronic Prostate and Pelvic Pain

Researchers consider eight therapies to treat these conditions in men.

A PPM Brief

Chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) are both common disorders that present with pelvic pain and lower urinary tract symptoms. While there are both pharmacological and non-pharmacological treatment interventions available, researchers1 recently assessed the effects of some non-pharmacological therapies for these disorders by performing a comprehensive review of randomized controlled trials.

The authors analyzed abstracted data from 38 studies, featuring 3,290 men with CP/CPPS across 23 comparisons, and rated the quality of evidence (QoE) using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. Of these,1 researchers found that the following non-pharmacological approaches, all based on short-term follow-up, may be effective:

  • Acupuncture (three studies, 204 participants). Acupuncture reduced prostatitis symptoms in an appreciable number of participants compared with a sham procedure. Acupuncture likely results in little to no difference in adverse events, reported the authors; and may also decrease prostatitis symptoms compared with standard medical therapy.
  • Circumcision (one study, 713 participants). Early circumcision probably decreases prostatitis symptoms slightly and may not be associated with a greater incidence of adverse events compared with control, concluded the authors.
  • Lifestyle modifications (one study, 100 participants). Lifestyle modifications may be associated with a greater improvement in prostatitis symptoms in an appreciable number of participants compared with control.
  • Physical activity (one study, 85 participants). A physical activity program may cause a small reduction in prostatitis symptoms compared with control.
  • Extracorporeal shockwave therapy (three studies, 157 participants). Extracorporeal shockwave therapy seems to reduce prostatitis symptoms when compared with a control. These results may not be sustained at medium-term follow-up, and may not be associated with a greater incidence of adverse events.
  • Transrectal thermotherapy compared to medical therapy (two studies, 237 participants). Transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone. One study reported that participants may experience transient adverse events, noted the authors.

A look at a few non-pharmacological options for the treatment of men with chronic pelvic pain.A look at a few non-pharmacological options for the treatment of men with chronic pelvic pain. (Source: 123RF)

The researchers were less optimistic about the following approaches for CP/CPPS:

  • Electromagnetic chair (two studies, 57 participants). In the review, it was unclear whether the use of an electromagnetic chair had any effect on prostatitis symptoms. Its usage may be associated with a greater incidence of adverse events compared with sham procedures.
  • Prostatic massage (two studies, 115 participants). Researchers were uncertain whether prostatic massage reduces or increases prostatitis symptoms compared with controls.

Of note, researchers found no information regarding psychological support or prostatic surgery. “Future clinical trials should include a full report of methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes,” they concluded.

Last updated on: January 23, 2019
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