Effectiveness of Myofascial Manual Therapies in Chronic Pelvic Pain Syndrome: A Systematic Review and Meta-Analysis
Fulvio Dal Farra12, Alessandro Aquino345, Andrea Gianmaria Tarantino67, Daniele Origo1
1SOMA Istituto Osteopatia Milano, Research Department, Viale Sarca 336 F, 20126, Milan, Italy. 2Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy. 3Department of Health Science, University of Milan, Milan, Italy. 4Clinical-based Human Research Department, C.O.ME. Collaboration, Pescara, Italy. 5Italian Pelvic Floor Center, Bergamo, Italy. 6SOMA Istituto Osteopatia Milano, Research Department, Viale Sarca 336 F, 20126, Milan, Italy. 7Manima Not-for-Profit Healthcare and Assistance, Milan, Italy.
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.