Urologic pain syndromes are multifactorial and diverse. Physiotherapy has an important role in its management and there is evidence for its efficacy from randomised controlled clinical trials. Physiotherapy treatments are as diverse as the presentations of these syndromes. They include an array of treatments ranging from those that target the tissues to psychological informed treatments to address maladaptive pain cognitions. Physiotherapists must tailor interventions to the individual presentation, but guidance is needed to match the appropriate modalities to pain presentation, and to identify when physiotherapy is not indicated. The International Association for the Study of Pain (IASP) defines three major pain descriptors that can help guide the selection of treatments—these are nociceptive, neuropathic and nociplastic pain. Each assumes a different underlying mechanism that will require different treatments. There is considerable confusion regarding application of this classification to urologic pain syndromes. This workshop will discuss the role of physiotherapy in the management of urologic pain syndromes and the patients for whom it is indicated, how identification of pain descriptors could guide matching of treatments to patients and the interplay between the roles of the physiotherapist and those of the urologist/urogynaecologist.
Schedule
| Topic |
Speaker |
| Introduction |
Linda McLean, PhD University of Ottawa |
| Pain mechanisms in chronic pelvic pain |
Paul Hodges, PhD, University of Brisbane, Physiotherapist and Neuroscientist |
| Physiotherapy management of urological pain syndromes – what and for which patients? |
Melanie Morin, PhD, Université de Sherbrooke, Canada |
| How urologists and urogynaecologists can interface with physiotherapy to optimize care for those with urological pain syndromes. |
Arun Sahai, MD, PhD, Consultant Urological Surgeon & Reader in Urology, University College Hospital, London, UK |
| Panel discussion |
All |
Learning objectives
- Understand how pain descriptors apply to urological pain syndromes
- Understand how identification of the predominant pain descriptor can guide the allocation of the right treatment to the right patient
- Understand the role of physiotherapy in the management of urological pain syndromes
- Understand the interplay between physiotherapy and urology/urogynaecology for optimal management of urological pain syndromes
Suggested reading
- Shraim MA, Sluka KA, Sterling M, Arendt-Nielsen L, Argoff C, Bagraith KS, Baron R, Brisby H, Carr DB, Chimenti RL, Courtney CA, Curatolo M, Darnall BD, Ford JJ, Graven-Nielsen T, Kolski MC, Kosek E, Liebano RE, Merkle SL, Parker R, Reis FJJ, Smart K, Smeets RJEM, Svensson P, Thompson BL, Treede R-D, Ushida T, Williamson OD, Hodges PW. Features and methods to discriminate between mechanism-based categories of pain experienced in the musculoskeletal system: a Delphi expert consensus study. PAIN 2022;163(9):1812-1828.
- Małgorzata Starzec-Proserpio, Helena Frawley, Kari Bø, Mélanie Morin,
Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis, American Journal of Obstetrics and Gynecology, 232 (1), 2025,42-71, https://doi.org/10.1016/j.ajog.2024.08.006.
- Colemeadow J, Sahai A, Malde S. Clinical Management of Bladder Pain Syndrome/Interstitial Cystitis: A Review on Current Recommendations and Emerging Treatment Options. Res Rep Urol. 2020 Aug 18;12:331-343. doi: 10.2147/RRU.S238746. PMID: 32904438; PMCID: PMC7455607.