Neuropathic Pain in Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

ABSTRACT

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been a frustrating condition that is characterized by pain in areas including the perineum, rectum, prostate, penis, testicles, and abdomen. Unfortunately, effective treatment for the chronic pelvic pain remains uncertain and most urologists still believe we have little to offer these patients once traditional therapy including antibiotics has failed. Proposed mechanisms in development of pain in CP/CPPS is that biological insult in the context of alterations in psychoimmunoneurendocrine factors produces the chronic pain experience. There is increasing evidence that the chronic pain is associated with long-lasting changes both to the structure and function of the nervous system. Nerve injury, such as in neuropathic pain, peripheral sensitization, and central sensitization might play an important role in CP/CPPS and therefore be a therapeutic target. Newer medications, such as the anticonvulsant gabapentin and pregabalin, are becoming increasingly used for neuropathic pain in CP/CPPS. Now, urologists should understand the neuropathic pain in CP/CPPS and become on some level a pain doctor.