[Acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial].

OBJECTIVE: To observe the short-term efficacy, long-term efficacy and safety of acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: Forty-two patients with CP/CPPS were randomly divided into an acupuncture group (21 cases, 1 case dropped off) and a sham acupuncture group (21 cases). The patients in the acupuncture group were treated with acupuncture at bilateral Zhongliao (BL 33), Huiyang (BL 35), Shenshu (BL 23) and Sanyinjiao (SP 6); the needling depth of Zhongliao (BL 33) and Huiyang (BL 35) was 60 to 80 mm, while Shenshu (BL 23) and Sanyinjiao (SP 6) was directly punctured of 30 mm. The patients in the sham acupuncture group were treated with acupuncture at non-acupoints, including points 2 cm next to Shenshu (BL 23), Zhongliao (BL 33) and Huiyang (BL 35), and the midpoint of the connecting line between the spleen meridian and the kidney meridian. All the non-acupoints were treated with directly puncture of 2 to 3 mm. The needles were left for 30 min in both groups, once every other day in the first four weeks, three times a week, and twice a week in the next four weeks, totally 20 treatments. Before treatment, after treatment and in follow-up of 24 weeks after treatment completion, the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) score and urinary flow rate were observed in both groups; the clinical efficacy and safety were evaluated. RESULTS: Compared with those before treatment, the pain and discomfort scores, urination symptoms scores, quality of life scores and total scores of NIH-CPSI in both groups were reduced after treatment in the two groups (P<0.01), while each item score and total score of NIH-CPSI in the acupuncture group were reduced in follow-up (P<0.01, P<0.05). After treatment and in follow-up, each item score and total score of NIH-CPSI in the acupuncture group were lower than those in the sham acupuncture group (P<0.05, P<0.01). After treatment, the maximum and average urinary flow rates in the acupuncture group were higher than those before treatment (P<0.05), and the average urinary flow rate in the acupuncture group was higher than that in the sham acupuncture group (P<0.05). The total effective rate was 75.0% (15/20) in the acupuncture group, which was higher than 42.9% (9/21) in the sham acupuncture group (P<0.05). No significant adverse reactions were observed in the two groups, and there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). CONCLUSION: Acupuncture could effectively alleviate the clinical symptoms, improve quality of life, and has a sustained, safe and reliable therapeutic effect in patients with CP/CPPS.

Long-term low-dose morphine for patients with moderate cancer pain is predominant factor effecting clinically meaningful pain reduction.

PURPOSE: Patients with cancer often experience pain that affects their daily activities and quality of life. The analgesic ladder recommended by the World Health Organization has proved insufficient for many, and its scientific basis has been questioned. This retrospective study investigated factors related to adherence to long-term opioid therapy for patients with moderate cancer pain, including an evaluation of low-dose morphine relative to tramadol. METHODS: Clinical data were collected of patients with moderate cancer pain (n = 353) who received either low-dose morphine or tramadol and were followed for ≥ 27 weeks. Factors related to regime adherence were investigated, including the analgesia type, cancer therapy (antitumor therapy or palliative care), pain type (nociceptive, neuropathic, or mixed), and living distance to the hospital. Factors related to clinically meaningful pain reduction (≥ 30% reduction in pain from baseline) were also investigated. RESULTS: Patients taking tramadol, receiving antitumor therapy, experiencing neuropathic pain, and living far from the hospital were more likely to change analgesic strategy compared with, respectively, patients receiving low-dose morphine, palliative care, experiencing nociceptive pain, and living nearby. Factors that increased the likelihood of adherence to the analgesic regime were also associated with the likelihood of clinically meaningful pain reduction. Among adverse effects, a significantly higher percentage of patients experienced constipation in the tramadol group compared with those given morphine. CONCLUSIONS: Among patients with moderate cancer pain, long-term low-dose morphine was safe and more effective than tramadol for clinically meaningful pain reduction, and patients were less likely to change the analgesic strategy.