Despite some allegations to the contrary (e.g. ‘man flu’), it is generally accepted that men tend to suffer in silence, being reluctant to discuss health problems with friends, family or the medical profession. It is not surprising therefore that the facts about chronic pelvic pain syndrome (CPPS) in men are not better known. It is thought that up to 10% of men aged between 20 and 74 years have characteristic symptoms which can vary in frequency and intensity from intermittent and mild to severe and permanent. The key symptom is pain although there can be a constellation of other symptoms. The most common site of the pain is in the perineum, then deep in the anus, then in the lower back, although it can also present in the tip of the penis (unrelated to urination), in the urethra, pubic or bladder area or testicles. There may be pain during or after ejaculation. Among other accompanying symptoms there might be painful or burning urination, obstructed urination, lowered libido, fatigue (even extreme), yellowish seminal fluid, impaired memory and difficult concentration, and painful lymph nodes. Many theories have been proposed to explain this disorder, including chronic infection or inflammation of the prostate (which is why it is also known as chronic prostatitis), however it remains a little understood condition with generally poor results achieved with most conventional approaches to treatment. It should also not be underestimated how severe this condition can be, with Keith B. Armitage MD, for example, saying that “Some patients experience so much pain that the condition is handled much like a chronic pain syndrome that occurs secondary to cancer. Therapy may begin with judicious use of narcotics until the patient experience some relief”.
The good news for sufferers of CPPS, however, is that one treatment seems to offer the prospect of significant relief, and that is acupuncture. One of the most recent studies, published in the journal Pain Medicine1 involved 97 patients suffering from CPPS. They received six, weekly treatments at a single acupuncture point (Zhongliao BL-33), a treatment approach that may suit a clinical study of this kind but which does not match real life practice where multiple points and individually tailored treatment would be given. Nevertheless, in the context of this often intractable disorder, the results were astounding, with 92% of patients showing more than 50% decrease in overall symptoms (pain, urinary function, quality of life scores etc.). This level of response had already been demonstrated in a number of earlier studies. In a 2009 paper published in Urology2, Korean researchers randomised 39 CPPS sufferers to receive either a. advice and exercise plus 12 sessions of electroacupuncture at Ciliao BL-32, Zhongliao BL-33 and Huantiao GB-30, b. advice and exercise plus twelve sessions of sham acupuncture, or c. advice and exercise alone. Every participant in the a. group experienced at least a six-point decrease in prostatitis symptom scores, compared with 16.7% in the b. group and 25% in the c. group. In 2008, a Malaysian study published in the American Journal of Medicine3 found that acupuncture was more than twice as likely as sham acupuncture to show long-term benefit among 89 CPPS patients randomised to receive either one or the other. Treatment was given over ten weeks and – significantly for CPPS which often shows periods of remission – at 24 weeks after the end of the treatment, 32% of the true acupuncture group showed long-term benefit compared to 13% of the sham acupuncture group. Other, earlier, studies4,5,6 showed similar levels of improvement. The immense discomfort and physical and mental suffering that CPPS can cause in men, and their often fruitless search for effective treatment, means that the facts about CPPS and acupuncture should be spread as widely as possible.
- Effectiveness of Acupuncture in Patients with Category IIIB Chronic Pelvic Pain Syndrome: A Report of 97 Patients. Pain Med. 2010 Jan 22.
- Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology. 2009 May;73(5):1036-41
- Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Am J Med. 2008 Jan;121(1):79.e1-7
- Acupuncture for chronic prostatitis/chronic pelvic pain syndrome. Chen RC, Nickel JC. Current Urology Reports 5 (4): 305-8, Aug 2004
- Effects of acupuncture for chronic pelvic pain syndrome with intrapelvic venous congestion: preliminary results. Honjo H, Kamoi K, Naya Y, Ukimura O, Kojima M, Kitakoji H, Miki T. Int J Urol. 2004 Aug;11(8):607-12
- A pilot study on acupuncture for lower urinary tract symptoms related to chronic prostatitis/chronic pelvic pain. Capodice J L et al. Chinese Medicine 2007, 2:1