Trigger Point Injections helps 50% of CPPS patients

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Trigger Point Injections helps 50% of CPPS patients

Post by webslave »

Transl Androl Urol. 2017 Jun; 6(3): 534–537.

Utility of trigger point injection as an adjunct to physical therapy in men with chronic prostatitis/chronic pelvic pain syndrome
Nicholas N. Tadros, Anup B. Shah, and Daniel A. Shoskes

Background
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is often associated with pelvic floor muscle spasm. While pelvic floor physical therapy (PFPT) is effective, some men are unable to resolve their symptoms and have residual trigger points (TPs). TP injection has been used for treatment in several neuromuscular pain syndromes. The objective of this study was to examine the efficacy and side effects of TP injection in men with CP/CPPS and pelvic floor spasm refractory to PT.

Methods
Using an IRB approved Men’s Health Registry we reviewed the records of all men with a diagnosis of CP/CPPS who received at least 1 TP injection. Patients were phenotyped with UPOINT (all had the “T” domain for tenderness of muscle) and symptoms measured with the NIH Chronic Prostatitis Symptom Index (CPSI). Response was measured by a 5-point Global Response Assessment (GRA) and change in CPSI (paired t-test). For pelvic TPs, a pudendal block was done in lithotomy position and then each TP was identified transrectally by palpation. A nerve block needle was passed through the perineum into the TP confirmed by palpation. Between 0.5–1 cc was injected into each TP of a local anesthetic mixture (30:70 of 2% lidocaine and 0.25% bupivacaine). For anterior TPs, an ultrasound guided ilioinguinal block was done first and then each TP injected by direct palpation through the abdominal skin. Men were offered up to three sets of injections separated by 6 weeks each.

Results
We identified 37 patients who had a total of 68 procedures. Three men had no follow-up after their first injection and were included for side effects but not included for outcome. The indication was failure to progress on PT in 33, recurrent symptoms in 1 and refusal to do PT in 3. Mean age was 43.7 years (range 21–70 years) and median UPOINT domains was 3 (range 1–5). Initial CPSI was pain 13.7±3.4, urinary 5.3±2.2, quality of life 9.8±2.1 and total 28.8±6.0. 16 men had 1 injection, 11 had 2 and 10 had 3. All had pelvic TPs injected and 9 also had anterior TPs. By GRA, 12 had significant improvement (35.3%), 10 had some improvement (29.4%), 11 had no change (32.3%) and 1 was worse (2.9%). Mean CPSI dropped from 28.8±6.0 to 21.8±7.2 (P<0.0001). 18 men had a drop of 6 or more points in CPSI (53%). Of note, none of 3 men who were noncompliant with PT had benefit. 3 men had temporary numbness in the lateral thigh after the injection (4.4%) and 1 had difficulty weight bearing on 1 leg for about 30 minutes.

Conclusions
TP injection in CP/CPPS patients as an adjunct to PT is well tolerated and leads to symptom improvement in about half. Durability and long term results are yet to be determined.
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johnnyblotter
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Re: Trigger Point Injections helps 50% of CPPS patients

Post by johnnyblotter »

Interesting. I'm considering going in for an appointment to see Dr. Alyson Shrikandhe in NYC. They recommend a series of 6 ultrasound guided TP injections that contain traumeel and lidocaine. Has anyone tried similar trigger point injections with any success? This study would seem to indicate that it could be worth trying.

I'm not sure if I can post the link but this is how they describe the injections: https://www.pelvicrehabilitation.com/tr ... njections/

As usual there are almost no testimonials from males and they told me over the phone it would cost 6k for the series of 6 injections, which is pretty ridiculous...but as I've continued to struggle over the months and years using every other technique, I'm considering going in for a consultation.
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Age: 41| Onset Age: 30 | Symptoms: rectal discomfort | Helped By:yoga ball | Worsened By: spicy food/poor diet| Other comments:i seem to have recurring episodes of this yearly
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Re: Trigger Point Injections helps 50% of CPPS patients

Post by webslave »

Let us know what happens if you do go. I had not heard of "Traumeel" before. Here is what it is:
Traumeel is a fixed combination of diluted plant and mineral extracts. It has been available over the counter in Germany for over 60 years and in Austria for over 40 years, and is currently available in approximately 50 countries, including the USA. The combination is currently used to treat acute musculoskeletal injuries, such as sprains and traumatic injuries, and as supportive therapy in pain and inflammation of the musculoskeletal system. It can be used in the form of tablets, drops, injection solution, ointment, and gel. The ingredients of Traumeel have been used for many years for therapeutic purposes, such as for pain (Atropa belladonna), inflammation (Echinacea), bruising (Arnica montana), wound healing (Matricaria recutita, Calendula officinalis), bleeding (Achillea millefolium), edema (Mercurius solubilis), and infections (Hepar sulfuris). Based on such observations, Traumeel was developed by the German physician, Dr Hans-Heinrich Reckeweg in the 1930s; he combined botanical and mineral substances to produce this natural medicine to treat musculoskeletal injuries and inflammation.
More : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085232/
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