Possibilities of non-drug methods of treatment for chronic pelvic pain syndrome in men (systematic review)

Abstract

Introduction. According to the classification of the USA National Institutes of Health (NIH), chronic abacterial prostatitis/chronic pelvic pain syndrome (CPPS) is characterized by a symptom complex of pelvic pain, urinary disorders and sexual dysfunction in the absence of uropathogens and infl ammation signs. This is a heterogeneous syndrome. There is no universal therapy for it; and there is a low effectiveness of drug treatment. Among publications about this problem, the articles devoted to the results of the non-drug methods of CPPS treatment have become increasingly common, and it makes possible to summarize these works within the framework of a systematic review.The aim: to study according to the literature data the results of the non-drug treatment methods, including osteopathic correction, in patients with CPPS. Materials and methods. A literary search was performed on Russian and foreign databases of scientific medical literature (PubMed, De bruiter, The International Journal of Osteopathic Medicine, Journal of Bodywork and Movement Therapies, Journal of Osteopathic Medicine, CyberLeninka, Russian Osteopathic Journal, etc.). The main search was carried out from 2017 to 2022. According to the keywords chronic prostatitis, chronic pelvic pain syndrome, treatment, the 252 studies have been found since 2017, including 15 meta-analyses, 17 randomized controlled trials (RCTs). There was a high level of evidence in 47 studies, including 8 meta-analyses and 11 RCTs. To search for articles describing the results of manual therapy and osteopathic correction of CPPS in men, the time range was expanded from 2010 to 2022. There were found 6 articles, including 2 RCTs. Results. The complexity of the CPPS pathogenesis in men causes difficulties in treatment. Currently, preference is given to non-drug methods, among which acupuncture has shown the best results in terms of pain relief, reducing the lower urinary tract symptoms, improving the patients′ life quality, and full absence of side effects. In addition, good results were obtained with the use of low-frequency extracorporeal shock wave therapy, pelvic fl oor physiotherapy, local cryotherapy. There is a minimum of side effects for all these treatment methods. According to the studies of Russian and foreign specialists, there has been shown the greater effectiveness of osteopathic treatment of chronic prostatitis/CPPS in comparison with individual drug treatment, gymnastics, physiotherapy, prostate massage, general therapeutic massage. Adverse events are not described. Only acupuncture and osteopathic correction showed long-term (several years) preservation of the achieved positive results among the considered treatment methods. Conclusion. Among all the found studies of the osteopathic correction (OC) or manual therapy results, there were small samples of involved patients, and different criteria of the treatment results assessment were used. There were often no comparison groups, as a result only 2 RCTs could potentially be included in the meta-analysis. Judging by the described results, OC can affect several links in the pathogenesis of CPPS in men. Therefore it is expedient to conduct studies on large patients groups with mandatory random formation of control groups for better evidence.