title: Therapeutic intervention for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review and meta-analysis.
abstract: BACKGROUND
  Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been treated with several different interventions with limited success. This meta-analysis aims to review all trials reporting on therapeutic intervention for CP/CPPS using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI).
  
  
  METHODS
  We searched Medline, PubMed, the Cochrane Pain, Palliative & Supportive Care Trials, the Cochrane Register of Controlled Trials, CINAHL, ClinicalTrials.gov, and the NIDDK website between 1947 and December 31, 2011 without language or study type restrictions. All RCTs for CP/CPPS lasting at least 6 weeks, with a minimum of 10 participants per arm, and using the NIH-CPSI score, the criterion standard for CP/CPPS, as an outcome measure were included. Data was extracted from each study by two independent reviewers. Gillbraith and I-squared plots were used for heterogeneity testing and Eggers and Peters methods for publication bias. Quality was assessed using a component approach and meta-regression was used to analyze sources of heterogeneity.
  
  
  RESULTS
  Mepartricin, percutaneous tibial nerve stimulation (PTNS), and triple therapy comprised of doxazosin + ibuprofen + thiocolchicoside (DIT) resulted in clinically and statistically significant reduction in NIH-CPSI total score. The same agents and aerobic exercise resulted in clinically and statistically significant NIH-CPSI pain domain score reduction. Acupuncture, DIT, and PTNS were found to produce statistically and clinically significant reductions in the NIH-CPSI voiding domain. A statistically significant placebo effect was found for all outcomes and time analysis showed that efficacy of all treatments increased over time. Alpha-blockers, antibiotics, and combinations of the two failed to show statistically or clinically significant NIH-CPSI reductions.
  
  
  CONCLUSIONS
  Results from this meta-analysis reflect our current inability to effectively manage CP/CPPS. Clinicians and researchers must consider placebo effect and treatment efficacy over time and design studies creatively so we can more fully elucidate the etiology and role of therapeutic intervention in CP/CPPS.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Cohen
authors.forename: Adam P
authors.initials: AP
authors.lastname: Fagin
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hariton
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Niska
authors.forename: Michael W
authors.initials: MW
authors.lastname: Pierce
authors.forename: Akira
authors.initials: A
authors.lastname: Kuriyama
authors.forename: Julia S
authors.initials: JS
authors.lastname: Whelan
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jackson
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Dimitrakoff
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002908:Chronic Disease; D059350:Chronic Pain / Q000628:therapy*; D003078:Colchicine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D016239:MEDLINE; D008297:Male; D008613:Mepartricin / Q000627:therapeutic use; D017699:Pelvic Pain / Q000628:therapy*; D011472:Prostatitis / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D008613:Mepartricin; D003078:Colchicine; C004280:thiocolchicoside