Position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) on the treatment of musculoskeletal phenotype in chronic pelvic pain syndrome

Abstract

Background and objective Given the high prevalence of the musculoskeletal component in chronic pelvic pain syndrome (CPPS), and the need for improved understanding of its management among healthcare providers, we aimed to review the available evidence addressing musculoskeletal management in primary CPPS. Methods The SINUG (Iberoamerican Society of Neurourology and Urogynecology) has designated a multidisciplinary panel including urologists, gynecologists, physiatrists/rehabilitation specialists, and physiotherapists, all with recognized clinical and academic expertise in the field. The development process followed a structured, multi-step methodology inspired by modified Delphi procedures and current guideline-development standards. Key findings The musculoskeletal phenotype of CPPS requires multimodal interventions including behavioural, physical, and psychological aspects, combined with multidisciplinary oral or invasive treatments. Isolated interventions tend to have limited effectiveness, and the active participation of the patient is required. Thus, treatment should be delivered by specialized physiotherapists trained not only in the musculoskeletal component, but also in the psychological mechanisms underlying this pain process. They must also be prepared to incorporate future therapies that demonstrate scientific efficacy in the management of CPPS. Direct communication between physiotherapists and urologists, gynaecologists, colorectal surgeons, and rehabilitation specialists is essential to coordinate and implement all interventions in this multidisciplinary therapeutic plan. As in all chronic pain processes, referrals of CPPS patients to physiotherapy should occur without delay. Conclusions SINUG considers physiotherapy an indispensable therapeutic option within the multidisciplinary treatment of CPPS, not only when a musculoskeletal phenotype is identified, but also when the patient develops a secondary, self-perpetuating painful contracture of the pelvic floor in other phenotypes.