LAUSR

Dear Dr. Dmochowski, I have had the opportunity to review Neuromuscular treatment approach for women with chronic pelvic pain syndrome improving pelvic pain and functionality, Neurourology and Urodynamics. 2022;41:220–228. With approximately 15%–20% of women (and nearly 10% of men) suffering from chronic pelvic pain in the absence of a single highly effective therapy, this topic is important and relevant. I am, however, concerned that the absence of the appropriate denominator in this manuscript will mislead the reader (especially those busy clinicians that do not get past the abstract). The authors provide a retrospective analysis of patients 186 women treated at a private group practice, Pelvic Rehabilitation Medicine, over a 23‐month period who have failed to respond to manual physical therapy. The authors appear to have reported only on those patients who completed therapy (which involved more physical therapy and various injection therapies) and completed the 3‐month questionnaires. The results cannot be interpreted without knowing the denominator, the total number of patients treated during this 23‐month period. It is unrealistic to believe that 100% of patients who began this treatment plan completed the protocol (Woodburn et al. noted a 20% compliance with PT for CPP). The denominator must be reported, and an intent to treat analysis should be strongly considered. Without such disclosure and analysis, the reported drop in pain equated to approximately 32% at 3 months. This is a drop that would be anticipated for placebo intervention. Of final note, although the authors report no conflict of interest, all authors either own or are employed by the same cash‐pay clinic, Pelvic Rehabilitation Medicine https://www.pelvicrehabilitation.com/team/. That cash pay clinic https://www.pelvicrehabilitation.com/ insurance-coverage/performs this protocol https://www. pelvicrehabilitation.com/services/ultrasound-guidedtrigger-point-injections/, as part of its for‐profit cash‐pay business model. Although this may not be the typical industry conflict of interest, it certainly creates bias that the reader should be allowed to consider.