Position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) on the Treatment of Musculoskeletal Phenotype in Chronic Pelvic Pain Syndrome

Inés Ramírez-García | Roberto Martínez-García | Carlos Errando-Smet | Bárbara Padilla-Fernández | Salvador Arlandis Guzmán | David Manuel Castro-Díaz | Francisco Cruz | Montserrat Espuña-Pons | Carmen González-Enguita | Luis López-Fando | Alicia Martín-Martínez | Esther Martínez-Cuenca | Carlos Müller Arteaga | Ana Belén Muñoz-Menéndez | Cristina Ros-Cerro | Pedro Blasco-Hernández | Isabel Montes Posada

1. 1. 1.  Introduction
         1.1 Definition
         1.2 Phenotyping
         1.3 Impact on quality of life
         1.4 Objective of the document
      2. Consensus development methodology
         2.1 Expert panel composition
         2.2 Consensus development process
         2.3 Consensus definition
      3. Urogynecological pain, increased muscle tone and muscular pain
         3.1 Diferential diagnosis
         3.2 Terminology for the assessment of pelvic floor muscles in patients with cpps
         3.3 Rehabilitation and physiotherapy techniques. Scientific evidence
         3.3.1 Cognitive and Behavioural Strategies for Pain
         3.3.2 Manual Therapy
         3.3.3 Therapeutic Exercise
         3.3.4 Complementary Therapies
         3.3.4.1 Biofeedback
         3.3.4.2 Transcutaneous Electrical Nerve Stimulation (TENS)
         3.3.4.3 Neuromodulation by Percutaneous or Transcutaneous Tibial Nerve Stimulation (PTNS / TTNS)
         3.3.4.4 Capacitive Resistive Monopolar Radiofrequency (CRMRF)
         3.3.4.5 Graded motor imagery
         3.3.4.6 Transcranial Direct Current Stimulation (tDCS)
         3.3.4.7 Extracorporeal Shock Wave Therapy (ESWT)
         3.3.4.8 Minimally Invasive Treatment
         3.3.4.8.1 Dry Needling
         3.3.4.8.2 Local Anaesthetic Block
         3.3.4.8.3 Botulinum Toxin
         3.3.4.8.4 Platelet-Rich Plasma (PRP)
         3.3.4.9 Acupuncture and Electroacupuncture
         3.4 Diferences among guidelines by specialty and country
         3.4.1 European Association of Urology Chronic Pelvic Pain Guideline (EAU, 2024)
         3.4.2 Society of Obstetricians and Gynaecologists of Canada (SOGC, 2024)
         3.4.3 American College of Obstetricians and Gynecologists (ACOG, 2020)
         3.4.4 American Urological Association (AUA, 2025) – Male Guideline
         3.5 Synthesis of international guidelines and consensus statements (2024-2025)
      4. Position of the SINUG on the management of the musculoskeletal phrnotype in CPPS with rehabilitation and physiotherapy
      5. Bibliography