Effects of functional versus conventional Physiotherapy-Based pain management on symptoms, psychological outcomes, and quality of life in women with Bladder Pain Syndrome: A Randomized Controlled Trial.

Abstract

Bladder Pain Syndrome (BPS) is a chronic pelvic pain condition characterized by urinary symptoms, psychological distress, and reduced quality of life (QoL). Given its biopsychosocial nature, physiotherapy approaches targeting peripheral and central pain mechanisms may provide broader benefits than symptom-focused interventions. Objective: To investigate the effects of functional and conventional physiotherapy on symptom severity, pain-related and psychological outcomes, and QoL in women with BPS. Twenty-eight women with BPS were randomly allocated to a functional program consisting of pain science education, cognition-targeted exercises, and relaxation exercises (n = 13) or a conventional program including transcutaneous electrical nerve stimulation (TENS) and pelvic floor stretching exercises (n = 15). Both interventions were delivered twice weekly for six weeks. Primary outcomes were symptom severity and pain intensity. Secondary outcomes included urinary symptoms, pain cognitions, pain-related disability, psychological symptoms, and QoL. Both groups improved in symptom severity and pain intensity, with no significant between-group differences for primary outcomes (all p > .05). In the functional group, symptom severity (Mean difference (MD) = 5.92, 95% CI: 2.61-9.24; p = .002; d = 1.08) and pain intensity (MD = 2.17, 95% CI: 0.77-3.56; p = .005; d = 0.94) decreased significantly. Significant improvements were observed in pain-related disability (p = .001; d = 1.18), pain catastrophizing (p = .004; d = 0.98), and pain self-efficacy (p = .003; d = 1.03). The conventional group showed improvements in pain-related disability (p = .049; d = 0.56) and energy/fatigue (p = .006; d = 0.84). A significant group × time interaction favored the functional group for social functioning (p = .027). Both approaches reduced symptom severity and pain intensity, while the functional program yielded broader improvements across pain-related, psychological and QoL domains. These findings support multidimensional, biopsychosocial rehabilitation in BPS management and warrant multicenter trials. This trial was registered at ClinicalTrials.gov (NCT05155384).