Abigail Bayer-Mertens Human, Tayyaba Ahmed DO, Charity Hill MD, Gautam Shrikhande MD FACS, Allyson Shrikhande MD

Pelvic Rehabilitation Medicine, New York, NY

Patients with chronic pelvic pain syndrome (CPPS) often have debilitating symptoms and decreased functionality related to their pelvic organs and pelvic floor musculature.  CPPS is underdiagnosed and treatment options are not well researched.  The objective of this study is to determine the effectiveness of alpha-2 macroglobulin therapy in patients with CPPS.

One promising CPPS treatment is the usage of alpha-2 macroglobulin as a protease inhibitor to mitigate inflammation and pain. Alpha-2 macroglobulin, a regenerative, non-opioid treatment option, is a plasma glycoprotein which occurs naturally in humans.  This retrospective study analyzed the effectiveness of alpha-2 macroglobulin in eleven patients, seven male and four female, with CPPS. Patients were aged 31-59, and additionally had diagnoses ranging from central pain syndrome, interstitial cystitis, and endometriosis. Patients were initially evaluated with a detailed history and physical exam, including internal pelvic floor evaluation. All patients had unsuccessfully attempted other treatments for their pain in the past. Patient’s scores on the Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS) were collected pre-treatment and 12 weeks post-treatment. The FPPS is a scale which measures 8 categories (bladder, bowel, intercourse, walking, sleeping, working, running and lifting) to determine a patient’s functionality in relation to their pelvis. The scale rates each category from 0 to 4, with 0 being normal and 4 being most debilitating. The patient can thus be given a total score from 0 to 32.

Patients all continuously underwent weekly physical therapy. Approximately 90 milliliters of the patient’s blood was drawn and centrifuged with the APIC system to separate its components. The alpha-2 macroglobulin concentrate (8-10 milliliters) was thereby isolated and then injected locally under ultrasound guidance in the region of the iliococcygeus, pubococcygeus, and puborectalis muscles. Pudendal nerve hydrodissection was also performed.

The mean age of the patients was 42.9. Pre-treatment, the mean VAS score was 5.18 (SD 2.48) and post-treatment the mean VAS score was 3.18 (SD 1.54); P<.05,  95% CI 0.16-3.84. Pre-treatment, the mean overall FPPS score was 12.36 (SD 5.80) and post-treatment, the mean overall FPPS score was 5.55 (SD 4.27); P<.05, 95% CI 2.29-11.35. Analysis of the subcategories within the FPPS indicated the improvement was statistically significant in the categories of bowel, intercourse, walking, sleeping, working and lifting. Pre-treatment, the mean FPPS bowel score was 1.36 (SD 0.67) and post-treatment it was 0.45 (SD 0.52); P<.05,  95% CI 0.37-1.45. For intercourse, the mean FPPS score pre-treatment was 2.56 (SD 1.24) and post-treatment it was 1.00 (SD 1.50); P<.05,  95% CI 0.18-2.93. Pre-treatment, the mean FPPS walking score was 1.88 (SD 0.83) and post-treatment it was 0.88 (SD 0.83); P<.05,  95% CI 0.11-1.89.  For sleeping, the mean FPPS score pre-treatment was 1.67 (SD 0.71) and post-treatment it was 0.67 (SD 0.50); P<.05,  95% CI 0.39-1.61.  Pre-treatment, the mean FPPS working score was 2.5 (SD 0.71) and post-treatment it was 1.5 (SD 0.85); P<.05,  95% CI . For lifting, the mean FPPS score pre-treatment was 2.25 (SD 1.16) and post-treatment it was 0.38 (SD 0.74); P<.05,  95% CI 0.83- 2.92.

This study has promising results in regards to the usage of localized alpha-2 macroglobulin as a novel, regenerative, non-opioid treatment option for patients with CPPS. This study also provides the foundation for further research into this topic, which will involve larger sample sizes and longer follow-up.