Psychometric Profiles and Hypothalamic-Pituitary-Adrenal Axis Function in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome.
Anderson RU, Orenberg EK, Chan CA, Morey A, Flores V.
Department of Urology, Stanford University School of Medicine, Stanford, California.
PURPOSE: Abnormal regulation of the hypothalamic-pituitary-adrenal axis and diurnal cortisol rhythms are associated with several pain and chronic inflammatory conditions. Chronic stress may have a role in the disorder of chronic prostatitis/chronic pelvic pain syndrome related to initiation or exacerbation of the syndrome. We tested the hypothesis that men with chronic pelvic pain syndrome have associated disturbances in psychosocial profiles and hypothalamic-pituitary-adrenal axis function.
MATERIALS AND METHODS: A total of 45 men with chronic pelvic pain syndrome and 20 age matched, asymptomatic controls completed psychometric self-report questionnaires including the Type A personality test, Perceived Stress Scale, Beck Anxiety Inventory and Brief Symptom Inventory for distress from physical symptoms. Saliva samples were collected on 2 consecutive days at 9 specific times with strict reference to time of morning awakening for evaluation of free cortisol, reflecting secretory activity of the hypothalamic-pituitary-adrenal axis. We quantified cortisol variations as the 2-day average slope of the awakening cortisol response and the subsequent diurnal levels.
RESULTS: Men with chronic pelvic pain syndrome had more perceived stress and anxiety than controls (p <0.001). Brief Symptom Index scores were significantly increased in all scales (somatization, obsessive/compulsive behavior, depression, anxiety, hostility, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychoticism) for chronic pelvic pain syndrome, and Global Severity Index rank for chronic pelvic pain syndrome was 93rd vs 48th percentile for controls (p <0.0001). Men with chronic pelvic pain syndrome had significantly increased awakening cortisol responses, mean slope of 0.85 vs 0.59 for controls (p <0.05).
CONCLUSIONS: Men with chronic pelvic pain syndrome scored exceedingly high on all psychosocial variables and showed evidence of dysfunctional hypothalamic-pituitary-adrenal axis function reflected in augmented awakening cortisol responses. Observations suggest variables in biopsychosocial interaction that suggest opportunities for neurophysiological study of relationships of stress and chronic pelvic pain syndrome.
PMID: 18207189 [PubMed - as supplied by publisher]
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Age:37 | Onset Age: 35 | Symptoms: pain in testicles that comes and goes that also switches sides-trying to find a pattern as to "why" this happens/Rectal Burn at the 6 O'clock position at my anus which tends to flare around the periphery of my anus typically after defication but no perineum pain-no "golf ball" pain. Pain in testicles worsens as I sit but not always...Pain is not always present but depresses me. Pain used to be at a very high level but has subsided in time to a low level but has not gone away. Pain used to flare after sex but not as much as before although it still like playing russian roulette./
/Lack of SleepHelped By: I haven't found anything that has helped to my knowledge. Tried many many sessions of PT, accupuncture and chiropractic care but still have not found steady relief that takes me back to a pre CPPS state.
Well, I have been cogitating on this subject for months, and writing about it for weeks here in the forum, and then Boom!, he goes and publishes this. It is a case of synchronicity if ever there was one.
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The question remains: If this condition is a result of HPA axis dysfunction how would the SP be of any use?
HPA axis dysfunction connotes a neurological imbalance. I would not be jumping for joy over this revelation as I think it would be highly speculative that PT for trigger points could be of any use for something so complex as the HPA...
Age:37 | Onset Age: 35 | Symptoms: pain in testicles that comes and goes that also switches sides-trying to find a pattern as to "why" this happens/Rectal Burn at the 6 O'clock position at my anus which tends to flare around the periphery of my anus typically after defication but no perineum pain-no "golf ball" pain. Pain in testicles worsens as I sit but not always...Pain is not always present but depresses me. Pain used to be at a very high level but has subsided in time to a low level but has not gone away. Pain used to flare after sex but not as much as before although it still like playing russian roulette./
/Lack of SleepHelped By: I haven't found anything that has helped to my knowledge. Tried many many sessions of PT, accupuncture and chiropractic care but still have not found steady relief that takes me back to a pre CPPS state.
Well, ask yourself: how does the HPA axis get its knickers in a knot? The answer leads you to part of the Stanford/Wise-Anderson Protocol called paradoxical relaxation.
Is the pain cycle self-reinforcing? Yes it is (wind-up, allodynia), so treating trigger points is extremely helpful.
You do not seem to understand the concept fully.
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Dr. Anderson is slow on the draw...
HPA Dysfunction has been a theory of CPPS for a while.
I was hoping there was no link but if there is indeed I really don't see how the SP is applicable other than learning to relax as I am very much abreast on the SP after reading AHIP and having tons of PT...
Age:37 | Onset Age: 35 | Symptoms: pain in testicles that comes and goes that also switches sides-trying to find a pattern as to "why" this happens/Rectal Burn at the 6 O'clock position at my anus which tends to flare around the periphery of my anus typically after defication but no perineum pain-no "golf ball" pain. Pain in testicles worsens as I sit but not always...Pain is not always present but depresses me. Pain used to be at a very high level but has subsided in time to a low level but has not gone away. Pain used to flare after sex but not as much as before although it still like playing russian roulette./
/Lack of SleepHelped By: I haven't found anything that has helped to my knowledge. Tried many many sessions of PT, accupuncture and chiropractic care but still have not found steady relief that takes me back to a pre CPPS state.
Actually, if I am not mistaken, this the first published paper specifically linking CPPS and the HPA axis.
Other than that, the only connections of CPPS to HPA were in Dr Theoharides's papers, where he gives one or two passing references to "chronic prostatitis" as one of a list of other possible maladies linked to HPA axis dysfunction.
Do you have other information?
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Age:37 | Onset Age: 35 | Symptoms: pain in testicles that comes and goes that also switches sides-trying to find a pattern as to "why" this happens/Rectal Burn at the 6 O'clock position at my anus which tends to flare around the periphery of my anus typically after defication but no perineum pain-no "golf ball" pain. Pain in testicles worsens as I sit but not always...Pain is not always present but depresses me. Pain used to be at a very high level but has subsided in time to a low level but has not gone away. Pain used to flare after sex but not as much as before although it still like playing russian roulette./
/Lack of SleepHelped By: I haven't found anything that has helped to my knowledge. Tried many many sessions of PT, accupuncture and chiropractic care but still have not found steady relief that takes me back to a pre CPPS state.
I look at this information as good news because I have always believed my symptoms are a result from many years of anxiety built up over time. Why I have anxiety could be from HPA axis function. So all the cognitive work I do to control my anxiety via neurofeedback, therapy, relaxation and Elavil play a strong roll in my recovery.
So I think SP is a way to treat the symptoms and promote healing by addressing the TP's or tight muscles that are a result from the stress. Doesn't matter what type of relaxation paradoxical, autogenic or yoga. As long as your calming the mind. The brain is amazing and you can train it to do what needs to be done for calming. Just my thoughts here....
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I encourage anxiety prone UCPPS people to consider L-Theanine Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
This HPA thingie, someone want to explain it to me in English as to what it means, and if this finding is a good or bad thing?
Age: 33 | Onset Age: 32 Initial Symptoms: Frequent urination Current Symptoms: The odd feeling of frequency but not much else Helped By: Not thinking about it, hot bath, red wine, light exercise, Bowen technique seems to help, getting on with my life Worsened By: catastrophic thinking, worrying things will get worse, feeling depressed, reading websites too often! Work! Sitting in work all day isn't good!! Current Progress : Since 1st Sept 08, no pain!!! :)
Basically...years of stress can alter the normal function of this complex system and can contribute to CP/CPPS. Basically our bodies can release more cortisol then normal which is a stress hormone. Connect the dots from there...http://en.wikipedia.org/wiki/Corticosteroid
How do you fix this That's the million dollar question....Follow our protocol here for starters...
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I encourage anxiety prone UCPPS people to consider L-Theanine Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
Rufus wrote:If you go to google scholar you'll find lots n lots n lots of info related to pelvic pain and the HPA axis.
Rufus, not one of the links you posted goes to a study that links CP/CPPS and HPA axis dysfunction. Thank you for confirming that I am right in saying that this is the FIRST study, a landmark study therefore, linking these two concepts.
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carld wrote:Why I have anxiety could be from HPA axis function.
It's the other way around: the HPA axis is reacting to your stress. Your anxiety is causing the axis to overwork.
Ahhhhh...understood....
I am not a medical doctor. Please fill out your signature (click here) ☼ ☼ My Starter List for new members
I encourage anxiety prone UCPPS people to consider L-Theanine Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
That's the million dollar question....Follow our protocol here for starters... 