Yang Claire C, Lee Jay C, Kromm Brenda G, Ciol Marcia A, Berger Richard E
Department of Urology, Box 356510, University of Washington, 1959 N.E. Pacific Street, Seattle, WA 98195-6510, USA.
J Urol. 2003 Sep;170(3):823-6; discussion 826-7. doi: 10.1097/01.ju.0000082710.47402.03.
Male chronic pelvic pain syndrome (CPPS) is a chronic and debilitating symptom complex, and inconsistent outcomes of antibiotic and anti-inflammatory treatments have created an interest in investigating the neurological mechanisms of CPPS pain. Because chronic pelvic pain likely results in hyperexcitability of dorsal horn neurons, ie central sensitization, thermal algometry may be useful in the assessment of CPPS. We evaluated men with and without CPPS to determine if there were differences between the 2 groups in their responses to noxious heat stimuli.
We recruited 66 healthy men without CPPS and 36 men with a history of CPPS for the study. Mean age of CPPS subjects was 43.1 years (range 18 to 62) and mean age of controls was 35.1 (range 21 to 61). All subjects with pain completed a National Institutes of Health-Chronic Prostatitis Symptom Index. We conducted thermal sensory tests with a small thermode programmed to deliver 2 series of 4 rapid bursts of noxious heat stimuli to the perineum and the anterior thigh. The subjects reported sensation on a computerized visual analog scale (COVAS) with a manual sliding lever. The average peak COVAS values and time to peak values from thigh and perineum of each series of thermal bursts were compared between CPPS and controls.
The mean pain score on questionnaires was 9.7 (4 or greater indicating significant pain), mean urinary score was 4.7 (range 0 to 10) and mean quality of life impact score was 7.3 (range 3 to 13). Compared to controls men with CPPS reported higher mean peak COVAS values in the perineum. There was no difference between groups in the peak COVAS value on the thigh.
Men with CPPS have altered heat sensation/pain sensitization in the perineum compared to controls. This finding is another that supports the resemblance of CPPS to other chronic pain syndromes and may help explain why CPPS is often refractory to treatment. Further investigations into male CPPS should focus on the mechanisms inducing and maintaining pain in an effort to treat this condition effectively.
男性慢性盆腔疼痛综合征（CPPS）是一种慢性且使人衰弱的症状复合体，抗生素和抗炎治疗效果不一，这引发了对研究CPPS疼痛神经机制的兴趣。由于慢性盆腔疼痛可能导致背角神经元兴奋性过高，即中枢敏化，热痛觉测定法可能有助于评估CPPS。我们评估了患有和未患有CPPS的男性，以确定两组对有害热刺激的反应是否存在差异。
我们招募了66名无CPPS的健康男性和36名有CPPS病史的男性进行研究。CPPS受试者的平均年龄为43.1岁（范围18至62岁），对照组的平均年龄为35.1岁（范围21至61岁）。所有有疼痛症状的受试者都完成了美国国立卫生研究院慢性前列腺炎症状指数调查。我们使用一个小型热刺激器进行热感觉测试，该热刺激器被编程为向会阴和大腿前部发送2组每组4次快速的有害热刺激脉冲。受试者通过手动滑动杆在计算机化视觉模拟量表（COVAS）上报告感觉。比较了CPPS组和对照组在每组热刺激脉冲时大腿和会阴的平均峰值COVAS值以及达到峰值的时间。
问卷上的平均疼痛评分为9.7（4分及以上表明存在明显疼痛），平均排尿评分为4.7（范围0至10），平均生活质量影响评分为7.3（范围3至13）。与对照组相比，患有CPPS的男性报告会阴部位的平均峰值COVAS值更高。两组在大腿部位的峰值COVAS值没有差异。
与对照组相比，患有CPPS的男性会阴部的热感觉/疼痛敏化发生了改变。这一发现进一步支持了CPPS与其他慢性疼痛综合征的相似性，并且可能有助于解释为什么CPPS通常对治疗具有难治性。对男性CPPS的进一步研究应聚焦于诱导和维持疼痛的机制，以便有效地治疗这种疾病。
