Case studyAcupuncture and Traditional Chinese Medicine for the management of a 35-year-old man with chronic prostatitis with chronic pelvic pain syndrome
Introduction
Studies report that up to 10% to 15% of the male population has chronic prostatitis with chronic pelvic pain syndrome (CP/CPPS) at any one time,1 and it accounts for 2 million outpatient visits per year. The etiology of CP/CPPS is unknown, and yet it is the most common clinical entity of the National Institutes of Health’s (NIH) prostatitis categories (Table 1). It is characterized by pelvic pain for more than 3 of the previous 6 months, urinary symptoms, and ejaculatory pain in the absence of uropathogens. The impact on quality of life associated with CP/CPPS is comparable to that of angina, Crohn disease, or a previous myocardial infarction.1, 2 There is no known cure for this condition.
The use of acupuncture for CP/CPPS is not widely accepted, although some recent studies show that acupuncture therapy may be beneficial because of the anti-inflammatory and neuromodulatory mechanisms of pain relief.3, 4, 5
The NIH-funded Chronic Prostatitis Collaborative Research Network developed a questionnaire to evaluate intensity, frequency, and location of pain; voiding symptoms both irritative and obstructive; and impact on quality of life. This self-administered questionnaire, called the Chronic Prostatitis Symptom Index (CPSI), considered “psychometrically robust,” evaluates valid clinical outcome measures and is useful in both clinical and research settings.1, 6, 7 This questionnaire is considered the international standard for prostatitis symptom evaluation (Fig 1).1
Gram-negative bacteria, specifically Escherichia coli, are the most common causative uropathogens in Categories I and II, acute and chronic bacterial prostatitis.1
Higher levels of oxidative stress have been found to be present in prostate tissue not only when pathogenic bacteria are identified but also in inflammatory and noninflammatory prostatitis (Categories III A and III B), that is, independent of leukocyte and bacteria counts.8, 9, 10 Although this does not shed light on the unknown etiology of Category III A and III B prostatitis, studies are now confirming a correlation between measurements of lowered markers of oxidative stress and successful outcomes of treatment in all categories.9, 10, 11
These findings are important because they broaden the possible treatment options and also because chronic inflammation is considered a risk factor for benign prostatic hypertrophy12 and a higher percentage of men diagnosed with benign prostatic hypertrophy are also diagnosed with prostatitis.8, 13 It is suggested that chronic inflammation can promote prostate growth13 or prostate growth may predispose a patient to bladder and prostate infections by causing incomplete bladder voiding.8 Although a link has not been made between acute or chronic prostatitis and prostate cancer in humans, oxidative stress has been shown to lower levels of tumor suppressor gene Nkx3.1 in mice.13
At present, there are very few case studies that specifically describe treating CP/CPPS with acupuncture14 and no known case reports that describe the combination of acupuncture with Chinese herbal medicine. Therefore, the purpose of this case report is to describe the care of a patient with CP/CPPS using a treatment regimen of acupuncture and Chinese herbal medicine.
Section snippets
Case report
A 35-year-old man presented with pain and discomfort in the perineum that were worse with standing, and lower back pain and pain that radiated down both inner thighs. His vitals included the following: weight, 165 lb; height, 5’8”; waist circumference, 31 in; body mass index, 25.1 kg/m2; blood pressure, 114/71 mm Hg; and oral temperature, 97.6°F. He experienced pain with urination and ejaculation, urgency to urinate, and incomplete voiding. On a scale of 1 to 10, 10 being the worst, he rated
Discussion
There is an increased interest in the use of alternative therapies in the management of CP/CPPS.18
It is the author’s hope that this case report adds new information to the literature and helps describe conservative treatments to address this common condition. The following discussion provides additional information about CP and CPPS including biomedical and acupuncture/TCM approaches.
Acupuncture is considered safe and effective for managing many painful conditions. Promising studies showing the
Conclusion
For this case, the combination of acupuncture to relieve pain and Chinese herbs to resolve dampness and clear heat in this patient seemed to be particularly effective. They were discontinued once an objective change in pulse palpation and tongue appearance, indicating decreased heat signs, was noted. A supportive regimen of anti-inflammatory supplements was started once the 90% to 95% improvement in symptom relief was obtained. This case report describes a patient who responded positively to
Funding sources and potential conflicts of interest
No funding sources or conflicts of interest were reported for this study.
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