Male Pelvic Pain
Top Contributors - Stacy Schiurring, Kim Jackson, Lucinda hampton and Jess Bell
Introduction[edit | edit source]
Definition of pain:
QUOTE BOX: Pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” - Revised IASP Definition of Pain (2020)
Further notes on the new definition of pain:
- Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
- Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
- Through their life experiences, individuals learn the concept of pain.
- A person’s report of an experience as pain should be respected.*
- Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
- Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a non-human animal experiences pain.
Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., ... & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976-1982.
Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., ... & Wang, S. J. (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19-27.
Classification models[edit | edit source]
Traditionally Prostate related
Chronic Prostatitis Related[edit | edit source]
- I-Acute bacterial prostatitis
- II-Chronic Bacterial prostatitis
- III-Chronic Prostatitis/Chronic pelvic pain syndrome (IIIa (inflammatory CPPS), IIIb Non-Inflammatory CPPS
- IV-Non-Asymptomatic Inflammatory prostatitis
- Bacterial Growth seen in Type I, II and Iv)
- No Bacterial Growth not seen in all presentation
UPOINTS (contemporary management system for men with chronic pelvic pain/Chronic Prostattitis)[edit | edit source]
Magistro, G., Wagenlehner, F. M., Grabe, M., Weidner, W., Stief, C. G., & Nickel, J. C. (2016). Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. European urology, 69(2), 286-297.
Bryk, D. J., & Shoskes, D. A. (2021). Using the UPOINT system to manage men with chronic pelvic pain syndrome. Arab Journal of Urology, 19(3), 387-393.
- U for Urinary (Storage/voiding symptoms/post void residual
- P for Psychological (Depression/catastrophizing)
- O for Organ Specific (Prostate tenderness, calcification, lower urinary obstruction)
- I for Infection (UTI/Prostate positive cultures)
- N for Neurologic/Systemic (Pain Beyond pelvis/IBS/Fibromyalgia/Chronic Fatigue syndrome
- Tenderness (Pelvic Floor spasm/Muscle trigger point)
- Sexual Dysfunction (Erectile dysfunction, ejaculatory dysfunction, orgasmic Dysfunction.
Anatomically Driven[edit | edit source]
- Prostate Pain Syndrome
- IBS
- Anal Pain Syndrome
- Neuromuscular Pain (PN/PFM)
- Bladder Pain Syndrome
- Scrotal Pain syndrome
- High % of chronic overlapping conditions & Therapy should extend far beyond the viscera
Clemens, J. Q., Mullins, C., Ackerman, A. L., Bavendam, T., van Bokhoven, A., Ellingson, B. M., ... & Landis, J. R. (2019). Urologic chronic pelvic pain syndrome: insights from the MAPP Research Network. Nature Reviews Urology, 16(3), 187-200.
Biospychosocial Framework[edit | edit source]
Aftab, A., & Nielsen, K. (2021). From Engel to Enactivism: Contextualizing the Biopsychosocial Model. This issue. European Journal of Analytic Philosophy, 17(2), M2.
- Bio- The body (pelvis and beyond)
- Psycho- The brain and nerves
- Social- the world we live in
- IS it Peripheral Mechanisms/Central Mechanisms
- Role of questionnaires
- Diagnosis Patterns
- Bladder Pain Syndrome
- Scrotal Pain syndrome
- Pudendal Neuralgia/Pelvic Floor Dysfunction
- Differential Diagnosis
- Prostate and bladder pain syndrome
- Scrotal Pain syndrome
Assessment[edit | edit source]
Pena, V. N., Engel, N., Gabrielson, A. T., Rabinowitz, M. J., & Herati, A. S. (2021). Diagnostic and management strategies for patients with chronic prostatitis and chronic pelvic pain syndrome. Drugs & aging, 38(10), 845-886.
- Exclude dangerous underlying pathology
- Determine the diagnosis (taxonomic or phenotypic)
- Determine the emotional, cognitive, behavioural, sexual and functional consequences
Assessment History[edit | edit source]
- The Pain
- Where is it?
- What is it like?
- When does it happen?
- What makes it better/worse?
- Do you have any other pain?
- Functional Symptoms
- Bladder
- Bowel
- Sexual
- Neurological
- Medical History
- Previous Investigations
- Previous Treatment
- Medical and Surgical history
- Medications
- Psychological Features
- Anxiety about the pain
- Impact of the pain
Assessment Red Flags[edit | edit source]
- Blood in Urine (Hamaturia)
- Blood in semen (Haematospermia)
- Smoking
- Occupational Petrochemicals
- Pelvic Radiation
- Ketamine abuse
- TB or schistosomal endemic areas
- NEW onset of UI or Faceal Incontinence
Physical Examination[edit | edit source]
- Addominal
- External Genitalia
- Perineum
- Digital Rectal Examination
- Lower Limb Neurological Examination
- Examination Red Flags
- Palpable bladder
- Penile/Tesiticula Mass
- Excusitie tenderness/ Prostate/perineum
- Reduced anal tone
- Lower Limb Neurological Changes
- Lower Limb Oedema
Management[edit | edit source]
Masterson, T. A., Masterson, J. M., Azzinaro, J., Manderson, L., Swain, S., & Ramasamy, R. (2017). Comprehensive pelvic floor physical therapy program for men with idiopathic chronic pelvic pain syndrome: a prospective study. Translational andrology and urology, 6(5), 910.
- A single intervention will rarely work
- Management is usually multidisciplinary
- Management should be individualised, and phenotype focused
- The strategy may include elements of self management
The Multidisciplinary Team[edit | edit source]
- GP
- Urologist/gastroenterologist/ colorectal surgeon
- Pain specialist
- Physiotherapist (pelvic floor down training, stretching, MFR/Education
- Psychologist/Psychiatrist
- Acupuncturist/Alternative medicine
- Dietery advice etc
Resources[edit | edit source]
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