Study Gauges Best Treatments for Chronic Pelvic Pain in Men
TUESDAY Jan. 4, 2011 -- Three treatments for chronic pelvic pain syndrome in men -- antibiotics, anti-inflammatories, and alpha-blockers or nerve inhibitors -- were found to be effective in curing or reducing symptoms of the often puzzling condition, according to a recent analysis of published research.
The review, published in the Jan. 5 issue of the Journal of the American Medical Association, noted that about 9 percent of men in the United States suffer from different types of inflammation of the prostate gland, accounting for about 2 million medical visits annually. Symptoms include pain in the pelvis, urethra or penis, back pain, trouble urinating and frequent urination.
Up to 95 percent of these cases are caused by chronic pelvic pain syndrome triggered by chronic prostatitis, an inflammation of the prostate gland that surrounds the male urethra. The condition -- usually caused by a chronic bacterial infection -- is most likely to affect men between the ages of 35 and 45, according to government statistics.
Not enough research has been done on effective treatments for this condition, one expert said, noting that only 23 studies met the researchers' criteria for inclusion.
"This is a very ambitious study, and it appears to shed some light on a very challenging condition," said Dr. Paul C. Cook, a urologist at the Hermann Memorial Medical Center in Houston, who was not connected to the study. "The fact that they distilled it down to only 23 studies in all the literature that met their criteria exemplifies that there [are so few] really good controlled studies out there."
The most effective treatment for chronic pelvic pain syndrome was the combination of antibiotics and alpha-blockers, particularly when the main symptom was pain while urinating, but "anti-inflammatory medications remain an option for patients" who seek help for pain, according to the authors of the report.
The researchers noted that the role of antibiotics was unclear, since infection has to be ruled out before a man is diagnosed with chronic pelvic pain syndrome. They speculated that the antibiotics might work against unrecognized germs and noted that antibiotics such as quinolones also have anti-inflammatory properties.
Chronic pelvic pain, or pain lasting three of the previous six months, can be a very debilitating condition, said Cook. Symptoms of chronic pelvic pain syndrome include pain in the pelvis, urethra or penis, back pain, trouble voiding, sexual difficulties and frequent urination.
Alpha-blockers, used to block the nerves going into the muscles of the prostate, are often prescribed along with antibiotics for the condition. If that doesn't work another antibiotic is tried. But a man with chronic pelvic pain shouldn't just keep switching around "from one antibiotic to another," Cook said.
"If the patient comes back and the treatment isn't working, it's time to rethink the diagnosis," he suggested. "It's time to start thinking outside the box."
Other conditions that can cause chronic pelvic pain include pudendal nerve entrapment (when nerves get trapped in bony canals) and compression of blood vessels in the pelvis, sometimes caused by long distance bicycle riding, Cook noted.
Calling chronic pelvic pain a "poorly understood condition," Cook said patients need to become proactive.
"It's very important that the patient be a partner with their physician," he said. "I always encourage patients to do independent research on their condition." This sometimes results in a patient helping to pinpoint what is wrong, said Cook.
As men get older the prostate grows naturally, but men sometimes develop an enlarged prostate that presses on the urethra, causing pain and interfering with urination. An enlarged prostate can be treated (shrunken) with medication.
In the study, an international team looked at research published between 1949 and 2010 that compared numerous treatments and their impact on pain, voiding, quality of life and total symptom scores. More than 1,500 subjects were included in the analysis.
Other treatments included steroids, phytotherapy (plant-based alternative medicines), finasteride (also used to treat enlarged prostate) and gabapentinoids, which are used to treat nerve pain. The researchers found that phytotherapies and finasteride might benefit some patients, but added that more research was needed.
Another expert said the study was important because chronic pelvic pain syndrome can cause "enormous frustration" and can interfere with sexual function and overall quality of life.
"For the most part they [patients] fare well," said Dr. David Samadi, vice chairman of urology at Mount Sinai Medical Center in New York City. "Everyone's regimen is a little different. But there are patients who go on for years [with symptoms] and end up trying alternative medicines because they become desperate."
And, he added, 20 to 25 percent of patients with chronic pelvic pain fail to find effective treatment.
A very stubborn bacteria may sometimes be the cause, said Samadi, also chief of robotics and minimally invasive surgery at Mount Sinai.
"We have tried injecting antibiotics directly into the prostate" in such cases, said Samadi, "with some success." He cautioned against overusing alpha-blockers because they can cause drowsiness, headaches and low blood pressure.
Factors that predispose men to the pelvic pain syndrome include infection, hormone imbalance, allergic and immune system triggers, and psychological and hereditary traits, according to the researchers. Samadi also noted that men who are not sexually active for a long time may be a bit more prone to the syndrome.
Posted: January 2011