[Long-term effects of osteopathic treatment of chronic prostatitis with chronic pelvic pain syndrome: a 5-year follow-up of a randomized controlled trial and considerations on the pathophysiological context].

BACKGROUND: The etiology of chronic prostatitis chronic pelvic pain syndrome (CP/CPPS) is still unclear. As no pathological findings exist the diagnosis of CP/CPPS is essentially a diagnosis by exclusion and functional disorders, so-called somatoform disorders play a more important role. Osteopathy treats functional disorders of the musculoskeletal system including all associated internal organs but little attention has so far been paid to this treatment method. Therefore, the 5-year follow-up period was intended to show that this is a sustainable form of therapy using exclusively manual and gentle techniques and simple treatment procedures resulting in manageable costs.
MATERIALS AND METHODS: The aim of this study was to investigate whether sustainability of osteopathic treatment could be demonstrated even after 5 years. This was a randomized controlled study initially involving 5 treatment sessions, a follow-up without treatment after 6 weeks and further follow-up after 1.5 and 5 years. Of the 20 patients 19 in the test group participated in the 5-year follow-up. The control group were not asked because it would have been unacceptable to expect the patients to refrain from having treatment for as long as 5 years. The men were aged between 29 and 70 years. The patients were asked to complete the international prostate symptom score (IPSS), the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) and the quality of life (QOL) questionnaires once again and in particular to state whether they had received osteopathic treatment specifically for the prostate problem and how often they had been treated.
RESULTS: The follow-up assessment of the symptoms of chronic prostatitis (NIH-CPSI) showed that they had further improved after 1.5 years (intragroup difference -1.8 points, 95 % confidence interval CI=-3.8 to 0.3) and also after 5 years (intragroup difference -1.3 points 95 % CI=-3.4 to 0.8). The urinary tract symptoms (IPSS) showed a statistically significant improvement (intergroup difference 8.9 points, 95 % CI=4.7-13.1, p<0.0005). At the second follow-up after 1.5 years there was a further improvement (intragroup difference -2.2 points, 95% CI=-3.9 to -0.4, p=0.02) which was found to remain constant after 5 years (intragroup difference 0.2 points). The quality of life (QOL) with respect to the symptoms showed a statistically significant improvement in comparing both groups during the study phase (intergroup difference χ 2: p<0.005). At follow-up after 5 years out of 19 patients 15 answered the question"how would you feel if the symptoms currently present would not change in the future?" with excellent or satisfactory and 11 patients would not have wanted further osteopathic treatment. Of the patients 8 reported that since the second follow-up (within 3.5 years) they had received osteopathic treatment one to eight times; however, this was partially more prophylactic than due to pain.
CONCLUSIONS: Due to the sustainability of osteopathic treatment and the low amount of time involved, osteopathy should be taken seriously as a treatment for patients with CP/CPPS. Furthermore, due to the osteopathic treatment the patients learnt to alleviate or even eliminate their own symptoms in treating themselves. In order to help many other affected persons out of their dilemma it would be desirable if more urologists and internists would become acquainted with osteopathy in order to be able to offer this to patients at an early stage. Further studies with larger numbers of patients should be carried out to confirm these results.

RCT Entities:   Population Interventions Outcomes