Egan K J, Krieger J N
Department of Anesthesiology, University of Washington Medical Center, Seattle 98195.
Clin J Pain. 1994 Sep;10(3):218-26. doi: 10.1097/00002508-199409000-00008.
Men with chronic prostatitis are frequently seen in urological practice and are difficult to treat with standard antimicrobial medications. This pilot study was designed to take a different perspective in assessing chronic prostatitis patients with pain by evaluating them using a standard chronic pain clinic psychological approach.
Twenty men, 27% of the referred group of patients with chronic prostatitis and pain, completed the MMPI and a structured psychological interview. Their findings were compared to age- and education-matched men seeking treatment for chronic low back pain.
Data were collected at the Pain Clinic within the Department of Anesthesiology at the University of Washington Medical Center.
Patients were 20 men referred from a urology-based Prostatitis Clinic and 20 men referred to the Pain Clinic for chronic low back pain.
The two groups differed in the impact of their pain problem on their lives. Prostatitis patients were employed but reported that their symptoms greatly interfered with their sexual/romantic relationships. Back pain patients reported that their pain interfered primarily with work; most of these patients had long-term marital relationships, whereas few prostatitis patients did. Half of the prostatitis patients met criteria for major depression, but back pain patients were more somatically focused, depressed, and anxious. The constellation of relationship problems, disruptions in sexual functioning, levels of depression, along with failure of multiple previous medical treatments in men with chronic prostatitis indicates that continued antimicrobial therapy is unlikely to provide the "cure" these patients seek. Psychological evaluation, couples' counseling, individual counseling, and medications for depression all may play a role in a comprehensive approach to these patients. These results must be considered as preliminary and as representative of a possibly skewed sample of prostatitis patients since only those men who accepted the referral to a pain clinic psychologist for an evaluation were assessed. Clearly, they are likely to be among the patients who are most psychologically and sexually impaired by the chronic prostatitis and associated pain. A further study with less self-selection is indicated.
慢性前列腺炎男性患者在泌尿外科临床中较为常见，且采用标准抗菌药物治疗效果不佳。本初步研究旨在从不同角度，运用标准慢性疼痛门诊的心理学方法对伴有疼痛的慢性前列腺炎患者进行评估。
20名男性（占慢性前列腺炎伴疼痛转诊患者组的27%）完成了明尼苏达多相人格调查表（MMPI）及结构化心理访谈。将他们的结果与年龄和教育程度匹配的慢性下腰痛患者进行比较。
数据在华盛顿大学医学中心麻醉科的疼痛门诊收集。
20名男性患者来自泌尿外科的前列腺炎门诊，另有20名因慢性下腰痛转诊至疼痛门诊的男性患者。
两组患者疼痛问题对生活的影响存在差异。前列腺炎患者有工作，但报告其症状严重干扰了他们的性/浪漫关系。下腰痛患者报告其疼痛主要影响工作；这些患者大多有长期婚姻关系，而前列腺炎患者中很少有。一半的前列腺炎患者符合重度抑郁症标准，但下腰痛患者更关注躯体症状、抑郁和焦虑。慢性前列腺炎男性患者存在一系列关系问题、性功能障碍、抑郁水平，以及之前多次医学治疗均无效，这表明持续的抗菌治疗不太可能提供这些患者所寻求的“治愈”效果。心理评估、夫妻咨询、个体咨询以及抗抑郁药物在对这些患者的综合治疗中都可能发挥作用。这些结果必须被视为初步的，且仅代表可能存在偏差的前列腺炎患者样本，因为只有那些接受转诊至疼痛门诊心理医生进行评估的男性患者被纳入评估。显然，他们很可能是受慢性前列腺炎及相关疼痛影响最严重的心理和性功能受损患者。有必要进行一项自我选择较少的进一步研究。
