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Sandler MD. et al., 2023: Biopsychosocial approach to male chronic pelvic pain syndrome: recent treatments and trials.

Sandler MD, Ledesma B, Thomas J, Ben-Ezra L, Lokeshwar SD, Paz LA, White J, Ramasamy R, Masterson TA.
Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, United States.
Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
Department of Urology, School of Medicine, Yale University, New Haven, CT 06520, United States.

Abstract

Introduction: Chronic pelvic pain syndrome (CPPS) is a common urologic condition that can cause significant disability in affected individuals. Physiologic explanations of chronic pain are often incomplete; appropriate management of CPPS includes recognition of biological, psychological, and social elements, known as the biopsychosocial model.

Objective: The aim of this narrative review is to investigate treatments for men with CPPS, with a special focus on those utilizing the biopsychosocial model of care.

Methods: A comprehensive literature search was conducted on the electronic databases PubMed, Embase, and Cochrane Library, using relevant Medical Subject Heading terms and keywords related to CPPS treatments. The search was limited to studies published in English from inception to January 2023. Additionally, reference lists of selected studies were manually reviewed to find studies not identified by the initial search. Studies were included if they investigated pharmacologic or nonpharmacologic treatments for men with CPPS.

Results: A total of 30 studies met the inclusion criteria. Antibiotics, α-blockers, nonsteroidal anti-inflammatory drugs, gabapentinoids, antidepressants, and phosphodiesterase type 5 inhibitors were among the pharmacologic agents included in trials attempting to reduce symptoms of male CPPS. Studies that focused on treating CPPS without medication included interventions such as shockwave therapy, acupuncture, physical therapy, botulinum toxin, cryotherapy, electrotherapy, exercise, and cognitive behavioral therapy.

Conclusion: α-Blockers and nonsteroidal anti-inflammatory drugs have shown promising results in treating CPPS in men, while the effectiveness of antibiotics remains controversial. Antidepressants and phosphodiesterase type 5 inhibitors may also be useful in decreasing symptoms in patients with CPPS. Treatments such as pelvic floor muscle therapy, acupuncture, shockwave therapy, and cognitive behavioral therapy must be considered effective complements to medical management in men with CPPS. While these interventions demonstrate benefits as monotherapies, the individualization and combination of treatment modalities are likely to result in reduced pain and improved quality of life.

Sex Med Rev. 2023 Dec 23;12(1):59-66. doi: 10.1093/sxmrev/qead038. PMID: 37717957

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Comments 2

Jens Rassweiler on Monday, 10 June 2024 11:00

his article discusses the biopsychosocial approach to treating male chronic pelvic pain syndrome (CPPS), along with recent treatments and trials associated with this condition. CPPS, also known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is a complex condition characterized by persistent pain in the pelvic region, often with no clear underlying cause. The following issues are reviewed and summarized:
Definition and Prevalence: CPPS in men is characterized by pelvic pain lasting at least 3 months with a noninfectious etiology. It affects daily activities and sexual function, leading to a reduction in quality of life. Global prevalence is estimated to be between 8% to 25%.
Diagnostic Workup: The diagnostic workup includes biothesiometry to evaluate genital sensitivity to vibration and identify potential contributing factors like nerve damage, bladder dysfunction, stress, anxiety, and depression. However, in many cases, the exact cause remains unknown.
Biopsychosocial Model: The biopsychosocial approach on which the article focuses acknowledges the multifaceted nature of CPPS, incorporating biological, psychological, and social elements into its management.
Treatment Modalities include
- Pharmacologic Interventions: Antibiotics, α-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, antidepressants, and phosphodiesterase type 5 inhibitors (PDE5is) have been explored. However, the effectiveness of antibiotics remains unclear, while α-blockers and NSAIDs show some promise.
- Physical Interventions: Acupuncture, shockwave therapy (SWT), botulinum toxin injections, cryotherapy, myofascial release, and electrotherapy have been investigated. Acupuncture and SWT have shown promising results in reducing symptoms.
- Psychosocial Interventions: Cognitive-behavioral therapy (CBT), distraction techniques, exercise, and dietary modifications play crucial roles in managing CPPS. CBT targets catastrophizing, while distraction techniques and exercise help improve symptoms and quality of life.
Social support, socioeconomic status, and lifestyle factors like diet and sexual habits interact with biological and psychological factors, influencing the chronic pain experience..
Extracorporeal shockwave therapy (ESWT) has emerged as a promising noninvasive treatment modality for chronic pelvic pain syndrome (CPPS) in men. ESWT utilizes high-energy acoustic waves to promote tissue regeneration and has been shown to reduce passive muscle tone, inflammation, and nociceptor hyperstimulation while inducing angiogenesis, neuroregeneration, and nitric oxide synthesis.
Studies investigating the efficacy of ESWT in CPPS have reported positive outcomes, including improvements in pain scores, quality of life, and urinary symptoms. For example, one double-blind placebo-controlled trial found that patients receiving ESWT experienced improved pain, urinary, and quality of life scores compared to placebo, with sustained benefits observed over follow-up periods.
Furthermore, ESWT has been explored as both a standalone treatment and as an adjunct to other therapies such as pharmacotherapy. Combined therapy approaches have shown promising results in reducing symptoms and improving overall outcomes for patients with CPPS.
Overall, while further research is needed to optimize treatment parameters and confirm long-term efficacy, ESWT represents a promising therapeutic option for men with CPPS, offering a noninvasive alternative with the potential to alleviate symptoms and improve quality of life.
The authors concluded, that CPPS management requires individualized approaches based on demographics, pain levels, psychological factors, and patient preferences. While various treatments have shown individual benefits, combining therapies may lead to reduced symptoms and improved quality of life. Further studies, particularly in psychosocial interventions, are needed to enhance treatment selection
Overall, this review underscores the complexity of CPPS management and emphasizes the importance of a multidisciplinary approach integrating pharmacologic, physical, and psychosocial interventions.

Jens Rassweiler

his article discusses the biopsychosocial approach to treating male chronic pelvic pain syndrome (CPPS), along with recent treatments and trials associated with this condition. CPPS, also known as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is a complex condition characterized by persistent pain in the pelvic region, often with no clear underlying cause. The following issues are reviewed and summarized: Definition and Prevalence: CPPS in men is characterized by pelvic pain lasting at least 3 months with a noninfectious etiology. It affects daily activities and sexual function, leading to a reduction in quality of life. Global prevalence is estimated to be between 8% to 25%. Diagnostic Workup: The diagnostic workup includes biothesiometry to evaluate genital sensitivity to vibration and identify potential contributing factors like nerve damage, bladder dysfunction, stress, anxiety, and depression. However, in many cases, the exact cause remains unknown. Biopsychosocial Model: The biopsychosocial approach on which the article focuses acknowledges the multifaceted nature of CPPS, incorporating biological, psychological, and social elements into its management. Treatment Modalities include - Pharmacologic Interventions: Antibiotics, α-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, antidepressants, and phosphodiesterase type 5 inhibitors (PDE5is) have been explored. However, the effectiveness of antibiotics remains unclear, while α-blockers and NSAIDs show some promise. - Physical Interventions: Acupuncture, shockwave therapy (SWT), botulinum toxin injections, cryotherapy, myofascial release, and electrotherapy have been investigated. Acupuncture and SWT have shown promising results in reducing symptoms. - Psychosocial Interventions: Cognitive-behavioral therapy (CBT), distraction techniques, exercise, and dietary modifications play crucial roles in managing CPPS. CBT targets catastrophizing, while distraction techniques and exercise help improve symptoms and quality of life. Social support, socioeconomic status, and lifestyle factors like diet and sexual habits interact with biological and psychological factors, influencing the chronic pain experience.. Extracorporeal shockwave therapy (ESWT) has emerged as a promising noninvasive treatment modality for chronic pelvic pain syndrome (CPPS) in men. ESWT utilizes high-energy acoustic waves to promote tissue regeneration and has been shown to reduce passive muscle tone, inflammation, and nociceptor hyperstimulation while inducing angiogenesis, neuroregeneration, and nitric oxide synthesis. Studies investigating the efficacy of ESWT in CPPS have reported positive outcomes, including improvements in pain scores, quality of life, and urinary symptoms. For example, one double-blind placebo-controlled trial found that patients receiving ESWT experienced improved pain, urinary, and quality of life scores compared to placebo, with sustained benefits observed over follow-up periods. Furthermore, ESWT has been explored as both a standalone treatment and as an adjunct to other therapies such as pharmacotherapy. Combined therapy approaches have shown promising results in reducing symptoms and improving overall outcomes for patients with CPPS. Overall, while further research is needed to optimize treatment parameters and confirm long-term efficacy, ESWT represents a promising therapeutic option for men with CPPS, offering a noninvasive alternative with the potential to alleviate symptoms and improve quality of life. The authors concluded, that CPPS management requires individualized approaches based on demographics, pain levels, psychological factors, and patient preferences. While various treatments have shown individual benefits, combining therapies may lead to reduced symptoms and improved quality of life. Further studies, particularly in psychosocial interventions, are needed to enhance treatment selection Overall, this review underscores the complexity of CPPS management and emphasizes the importance of a multidisciplinary approach integrating pharmacologic, physical, and psychosocial interventions. Jens Rassweiler
Guest - MR Datesh Daneshwar(FRCS Urol) on Tuesday, 11 June 2024 04:30

Thank you Prof for the review and affirmation that Prostate physical therapy needs more airtime and discussion. As discussed with you in Paris I primarily use ESWT as stand alone therapy with veery promising results which seem to sustain over the long term.

Thank you Prof for the review and affirmation that Prostate physical therapy needs more airtime and discussion. As discussed with you in Paris I primarily use ESWT as stand alone therapy with veery promising results which seem to sustain over the long term.
Saturday, 13 July 2024