Review article on CPPS by Nickel and Berger

[kevin]

Here is a link to what I consider a very good review article by J. Curtis Nickel and Richard Berger (also Andrew Baranowski, Michel Pontari, Dean Tripp) entitled "Management of Men Diagnosed With Chronic Prostatitis/Chronic Pelvic Pain Syndrome Who Have Failed Traditional Management". It was published in Volume 9, No. 2 - Spring 2007 of Reviews in Urology. Discussion of physical therapy/psychological treatment is toward the end.

Main Points

• In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), pain is perceived in the pelvis and, in the absence of classical pathology, is called pelvic pain syndrome.
• If nonpainful stimuli are more intense but not painful, the process is called hypersensitivity. If nonpainful stimuli become painful, it is called allodynia.
• Referred pain occurs when pain is felt in a part of the body other than where it originates.
• Pain is a sensation that requires perception and thus is associated with interpretation and a range of responses, both physical and psychological.
• Tricyclic antidepressant medications have been shown to be effective in treating neuropathic pain.
• The anticonvulsants gabapentin and pregabalin have the potential to alleviate the neuropathic pain associated with CP/CPPS.
• CP/CPPS has many similarities to interstitial cystitis/painful bladder syndrome/bladder pain syndrome, including the presence of pelvic pain and, often, voiding symptoms.
• Incision of the bladder neck has been reported to be effective in men with prostatitis and evidence of bladder neck dyssynergy on videourodynamic studies.
• Neuromodulation may play a role in treating CP/CPPS.
• Recognition of the role of myofascial abnormalities of the pelvis in CP/CPPS has led to several reports of symptom relief by physiotherapy.
• Cognitive-behavioral interventions are successful in other chronic pain states, and an NIH-sponsored pilot program is evaluating their use in CP/CPPS management.

[kevin]

By the way, I think this article serves as a good introduction to theories about CPPS. This is the kind of thing you could show your urologist if he's receptive.