Efficacy of Capacitive and Resistive Electric Transfer (CRET) in the management of primary chronic pelvic pain syndrome in women: a randomized placebo-controlled clinical trial.

BACKGROUND

Chronic primary pelvic pain syndrome (CPPPS) in women is common and often highly disabling. It is associated with ongoing pelvic pain and a marked impact on physical, psychological, sexual, and social wellbeing. In many women, pelvic floor muscle (PFM) overactivity goes unrecognized and may contribute to symptom persistence. Capacitive and Resistive Electric Transfer (CRet) diathermy is used in musculoskeletal care, but its usefulness in CPPPS is still unclear.

OBJECTIVE

To compare CRet diathermy with placebo in women with CPPPS and pelvic floor hypertonia, focusing on pain, quality of life, and resting pelvic floor electromyographic (EMG) activity.

METHODS

We conducted a multicentre, randomized, placebo-controlled trial in women aged 18 years or older with CPPPS, diagnosed according to European Association of Urology criteria and with resting surface EMG >5 μV. Participants were randomly assigned to active CRet or sham treatment, both added to usual care. A standardized intravaginal protocol was delivered over several weeks. Pain was assessed with a 100‑mm visual analogue scale and the McGill Pain Questionnaire. Quality of life was measured with WHOQOL-BREF, and resting PFM activity with surface EMG. Assessments were performed at baseline, immediately after treatment, and at 6‑week follow‑up. Data were analysed using parametric or non‑parametric tests as appropriate, and effect sizes were calculated.

RESULTS

Forty-four women completed the study. Groups were similar at baseline. The CRet group showed a larger reduction in pain than the placebo group after treatment (median visual analogue scale reduction around 40-50 mm, p < 0.001), and this improvement was maintained at follow‑up. McGill scores also fell clearly in the active group and stayed low over time. WHOQOL-BREF scores improved in all domains, with the greatest changes in physical and psychological health. Resting PFM EMG activity decreased more in the CRet group at both post-treatment and follow‑up. No adverse events were reported.

CONCLUSIONS

CRet diathermy appears to be a safe and useful adjunct in women with CPPPS and pelvic floor hypertonia, improving pain, quality of life, and pelvic floor muscle activity when added to usual care.