Brain and Psychological factors in CPPS

The brain itself may be involved in causing CP/CPPS. Studies suggest that stress accompanied by depression and catastrophizing are potent factors in the development, prolongation, and perpetuation of CP/CPPS symptoms.

catasA resting state fMRI study of men with CP/CPPS found that the areas of brain activation during pelvic symptoms in men with CP/CPPS are different from other pain conditions. So a distinct set of neurological changes may accompany (or predispose to) CP/CPPS.

These psychosocial factors, such as catastrophizing and depression, have a significant effect on quality of life in men with CP/CPPS, but they can be treated using cognitive therapy.


Catastrophizing is a term used by cognitive therapists to describe the anxious person’s tendency to anticipate extreme outcomes or to view unfortunate events as “catastrophic” and beyond their ability to cope. An example would be the traveler who thinks “If I miss my connecting flight, I don’t know what I’ll do!”

Catastrophizing in CP/CPPS found it to be associated with greater disability, depression, urinary symptoms, and pain. Catastrophizing with an element of helplessness is a very robust pain predictor and is linked to longer pain durations.


A depressed mood state increases a patient’s level of catastrophizing, impairs their emotion-regulation neurocircuitry, and amplifies their cortical responses to a noxious stimulus.


HPA axis

Depression and catastrophizing can also influence HPA axis responses. Studies have shown that HPA dysregulation may lead to abnormalities of inflammatory responses, resulting in chronic inflammatory and pain conditions such as interstitial cystitis or CP/CPPS. Men with CP/CPPS have a greater slope of the awakening cortisol response than do age-matched healthy controls, which suggests a dysfunctional HPA axis. Stress could also have an influence here. Several studies have shown an association between increased cortisol levels after awakening and psychological variables in chronically stressed individuals owing to work overload.

Further reading
Pain, Catastrophizing, and Depression in Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome
Development of an evidence-based cognitive behavioral treatment program for men with chronic prostatitis/chronic pelvic pain syndrome.