Discovering the true nature of chronic pelvic pain: Are we asking the right questions?

Chronic pelvic pain is a debilitating complex condition affecting men and women, but the knowledge gaps are salient. The condition impacts somatic, sexual, and mental health, as well as social, family, and work life. The complexity of the condition demands for a giant step away from traditional dualistic clinical approach. This commentary underpins the need to interweave multidisciplinary research within a biopsychosocial framework, as well as enhanced inclusion of the user perspective.

The role of gut microbiota involved in prostate microenvironment and symptoms improvement in chronic prostatitis/chronic pelvic pain syndrome patients treated with low-intensity extracorporeal shock wave.

BACKGROUND: Low-intensity extracorporeal shockwave therapy (Li-ESWT) is emerging as a promising and safe treatment for Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In this study, we aimed to investigate the role of the gut microbiota involved in the prostate microenvironment and symptom improvement during the Li-ESWT for CP/CPPS patients. METHODS: CP/CPPS patients not taking antibiotics or other treatments were included. NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5) were used to evaluate the effectiveness of Li-ESWT at the end of treatment. Visual analogue scale/score was used to evaluate the pain during procedure. Stool and semen samples were collected before and after Li-ESWT. Shotgun metagenomics analyzed gut microbiota, while ELISA and other diagnostic kits detected biochemical changes in seminal plasma. RESULT: Of the 60 enrolled patients, 52 completed treatment. Li-ESWT response rate was 78.8% (41/52) at end of treatment. Among responders, the subitems of the NIH-CPSI; IPSS; and IIEF-5 scores improved significantly, and the seminal plasma analysis showed decreased TNF-a and MDA levels and increased SOD and Zn2+ levels posttreatment. Gut microbiome analysis indicated that posttreatment, both α and ß diversity increased, and the abundance of certain specific species significantly increased. Fifty-eight pathways significantly enriched posttreatment, notably in branched-chain amino acid synthesis and butyrate synthesis. The abundance of several specific species was found to be significantly higher in non-responders than responders. Among responders, at the species level, some bacteria associated with NIH-CPSI and its subscales, IPSS, IIEF-5, and prostate microenvironment markers (TNF-a, MDA, Zn2+, and SOD) were identified. CONCLUSIONS: Our study demonstrates for the first time that Li-ESWT improves the prostate microenvironment and gut microbiota in CP/CPPS patients. Treatment nonresponse may be associated with a high abundance of specific pathogens before treatment. The gut microbiota could have a significant impact on Li-ESWT response and the prostate microenvironment.

A Pain Desensitization Algorithm for Phenotyping and Treating Chronic Pelvic Pain.

Background: Chronic pelvic pain remains challenging for physicians to manage due to central and peripheral sensitization and multiple pain generators including the bladder, pelvic floor, and pudendal nerve. Pain management providers have used nerve blocks for years for diagnosis and treatment. We developed a desensitization algorithm that provides a stepwise approach to improve patients pain scores. Methods: This is a prospective observational cohort study of 182 women aged 15-90 years old with chronic pelvic pain using an algorithm from 2016 to 2018. Treatment started with an Anesthetic Challenge Test of the bladder to guide us through a protocol of intravesical therapy and/or pudendal nerve blocks as a second step. Results: ACT POSITIVE patients, who received intravesical therapy: 84% had a Visual Analog Score pain improvement of at least 50%, 64% improved at least 80% (41% pain-free). Those desiring additional relief that received further Pudendal Blocks: 83% had final improvement of at least 50% (67% pain-free). ACT NEGATIVE patients received Pudendal Blocks with 80% of subjects achieving at least 50% relief, 65% improved at least 80% (35% pain-free). All final groups showed a statistically significance of P < .05% when compared to their initial pain scores. Conclusion: Management of women with chronic pelvic pain would ideally start with treating a specific diagnosis which, in most cases, is difficult to establish since the majority have more than one pain generator. Our algorithm simplified the approach and reduced the severity of pain scores prior to any further necessary surgical interventions.

Management Strategies for Patients with Non-Infectious Cystitis: A Review of the Literature.

PURPOSE OF REVIEW: The management of noninfectious cystitis continues to evolve as new treatments continue to be developed and investigated. This review aims to synthesize the most recent data regarding management strategies for noninfectious cystitis focused on non-ulcerative, ulcerative, eosinophilic, and ketamine-induced cystitis. RECENT FINDINGS: Several novel treatments have shown promise as management options including combination antihistamine therapy, phosphodiesterase 5 inhibitors, alpha lipoic acid supplements, and onabotulinumtoxin A. Recent studies have also found pentosan polysulfate sodium to have adverse ophthalmologic effects. For patients with ulcerative cystitis, recent research has shown that fulguration with or without triamcinolone injections should not be delayed. The treatment of noninfectious cystitis should be patient specific based on factors including etiology and symptom profile. Multimodal regimens are often the most effective. Treatment should be started with conservative options and escalated as necessary to oral treatments, intravesical options, or procedural management.

Influence of App-Based Self-Management on the Quality of Life of Women With Endometriosis.

INTRODUCTION: Endometriosis can significantly impair the quality of life of those affected. Multimodal self-help measures are recommended but are often difficult to access. Smartphone apps have been shown to improve the quality of life for other conditions with chronic pain. The aim of this study was to examine the impact of the Endo-App (Endo Health GmbH, Chemnitz, Germany) on both disease-related quality of life and symptoms of endometriosis affecting it. METHODS: In the present randomized, controlled pilot study, the impact of utilizing the Endo-App on the quality of life among a sample of 122 women affected by endometriosis is assessed. To measure the changes over a 12-week period, the study incorporates the validated Endometriosis Health Profile (EHP-5 and EHP-30) questionnaire from Oxford University, among other assessment tools. RESULTS: The use of the Endo-App leads to significant changes in the following areas after 12 weeks compared to the control group: pain disability, pain self-efficacy, fatigue, depressive symptoms, and Endometriosis Health Profile scores. The EHP-5 score from T0 to T12 is reduced by -16.76 (p-value of the Mann-Whitney U test (pU) = 0.008), and the EHP-30 score by -15.48 (pU = 0.004). The results remain significant in sensitivity analyses. The effect size of Cohen's d was in the medium range. CONCLUSION: In summary, the Endo-App improves both physical and psychological symptoms and the patient's self-efficacy. The Endo-App contributes to improving endometriosis care in Germany and enables women suffering from endometriosis to significantly increase their quality of life.

Clinical, laboratory and ultrasonographic correlates of prostate calcifications in patients with chronic prostatitis/chronic pelvic pain syndrome.

Introduction: The research aim was to determine the role of clinical, laboratory, immunological and sonographic parameters in the development of an assessment tool for the symptomatic manifestations of prostate calcifications in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Material and methods: All men underwent a transabdominal ultrasonographic examination using a grayscale B-mode and color Doppler mapping, the evaluation of the National Institutes of Health-Chronic Prostatitis Symptom Index and the Patient Health Questionnaire-9, spermogram. Vascular endothelial growth factor (VEGF), serotonin and gamma-aminobutyrate (GABA), interleukins 1ß and 10 were determined in blood serum and ejaculate. Results: This study included 102 men aged 18-45 years. Group 1 (n = 34) consisted of patients with CP/CPPS. Group 2 included patients (n = 34) with asymptomatic prostatitis. Group 3 consisted of healthy volunteers (n = 34). More severe symptoms of prostatitis and depression, as well as frequent exacerbations in patients with CP/CPPS, were associated with ultrasound evidence of prostate calcifications, and especially the twinkling artifact (Spearman's r = 0.481; р <0.001; Spearman's r = 0.437; р <0.001, respectively).The presence of prostate calcifications in both CP/CPPS and asymptomatic prostatitis was accompanied by a significantly higher concentration of pro-inflammatory cytokine IL-1ß and a lower concentration of anti-inflammatory cytokine IL-10 in the ejaculate (p < 0.05 in both cases, Kolmogorov-Smirnov test). The clinical manifestations observed in patients with CP/CPPS and asymptomatic prostatitis were not correlated with the leukocyte count in the ejaculate or the levels of VEGF, GABA, and serotonin in both blood and ejaculate. Conclusions: Twinkling artifact potentially could serve as a valuable tool for evaluating the condition of patients with CP/CPPS and prostate calcifications.

Examining the risk factors of chronic pelvic pain and its effect on the quality of life in refugee and non-refugee women.

BACKGROUND: This study aimed to determine the prevalence of chronic pelvic pain(CPP) in refugee and non-refugee women, determine the factors associated with CPP, and evaluate the effect of CPP on life quality. METHODS: This was a cross-sectional study conducted among 283 non-refugee and 278 refugee women in Turkey. A questionnaire including questions assessing chronic pelvic pain and related factors, World Health Organization Quality of Life Scale Short Form(WHOQOL-BREF), Depression Anxiety Stress Scale-21, were administered to the participants. Chi-square test, Mann-Whitney U test and multiple logistic regression analysis were used for statistical analysis. RESULTS: The prevalence of chronic pelvic pain was 41.0% in refugee women and 19.1% in non-refugee women (p< 0.001). The prevalence of CPP was 1.68 times higher in refugee women than in non-refugee women (OR;95%CI:1.68;1.01-2.81). In the multivariate analysis performed in the study group, refugee status, low family income status(OR;95%CI:2.09;1.26-3.46), low back pain(OR;95%CI:2.02;1.21-3.35), dyspareunia (OR; 95%CI:2.96;1.75-4.99), number of three or more miscarriages (OR;95%CI:3.07;1.18-8.01), history of gynaecological surgery (OR;95%CI:2.44;1.33-4.50), diarrhea (OR;95%CI:2.01;1.07-3.76), urinary tract infections(OR; 95%CI:1.66;1.02-2.71) and anxiety(OR; 95%CI:1.17;1.10-1.24) were found to be risk factors for CPP. In the refugee and non-refugee groups, those with CPP had lower scores in all subdomains of the WHOQOL-BREF scale than those without CPP (p < 0.05). CONCLUSIONS: Refugee status independently contributes to the risk of developing CPP. Targeted interventions to address CPP and its associated risk factors are needed, particularly in vulnerable refugee populations, to improve their quality of life.

Meta-analysis of the effectiveness and safety of magnetic stimulation for chronic pelvic pain.

OBJECTIVE: To systematically assess the effectiveness and safety of magnetic stimulation (MS) for treating chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) through a meta-analysis. METHODS: A comprehensive search of databases including PubMed, The Cochrane Library, EMbase, VIP, Web of Science, WanFang, China Biology Medicine disc (CBMdisc), and China National Knowledge Internet (CNKI) databases was conducted to retrieve randomized controlled trials (RCTs) on MS interventions for CPPS from inception to the present. The search employed keywords such as "MS", "CPPS", and "prostatitis". Data analysis was performed using RevMan 5.4 software, focusing on NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), maximal urinary flow rate (Qmax), and international index of erectile function-5 (IIEF-5) score. RESULTS: Eight RCTs involving 636 patients were included. Our meta-analysis revealed that extracorporeal MS significantly reduced NIH-CPSI scores [MD = -6.65; 95% CI (-8.15, -5.15), P < 0.00001] and improved Qmax [MD = 2.98; 95% CI (1.36, 4.59), P = 0.0003] compared to the control group. Although a trend toward improved IIEF-5 scores was observed [MD = 0.81; 95% CI (-0.34, 1.95), P = 0.17], the results were not significant. CONCLUSION: MS is effective in alleviating clinical symptoms and enhancing Qmax in patients with CP/CPPS.

Psychological characteristics and structural brain changes in women with endometriosis and endometriosis-independent chronic pelvic pain.

STUDY QUESTION: Are there neurobiological changes induced by endometriosis? SUMMARY ANSWER: Women with endometriosis demonstrate specific neurobiological changes distinct from those in patients with chronic pelvic pain (CPP) in the absence of endometriosis. WHAT IS KNOWN ALREADY: Endometriosis is a chronic disease affecting women of reproductive age that presents with pain and infertility often accompanied by comorbid mental disorders. Only one study with a number of limitations has investigated changes in gray matter volumes and functional connectivity in a small group of patients with endometriosis. STUDY DESIGN, SIZE, DURATION: This prospective study recruited 53 women undergoing a laparoscopy due to suspicion of symptomatic endometriosis and 25 healthy, pain-free women. Clinical and psychological characteristics, thermal pain perception, and voxel- and surface-based morphology were assessed in all study participants. Thereafter, the patients underwent a laparoscopy, where endometriosis was either histologically confirmed and removed, or ruled out. Correspondingly, patients were assigned into the group with endometriosis (n = 27) or with endometriosis-independent CPP (n = 26) and compared to the pain-free controls. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study groups were generally representative for the population of women with endometriosis. Sociodemographic, medical, clinical, and psychological characteristics were collected using various questionnaires and a structured clinical interview. Thermal pain perception and voxel- and surface-based morphometry were assessed using thermode and MRI, respectively. MAIN RESULTS AND THE ROLE OF CHANCE: Despite comparable pain intensity and burden of mental disorders, both patient groups demonstrated distinct neurobiological patterns. Women with endometriosis exhibited increased gray matter volume (GMV) in the left cerebellum, lingual gyrus and calcarine gyrus, compared to those with endometriosis-independent CPP. Patients with CPP had decreased GMV in the right cerebellum as compared to controls. Dysmenorrhoea severity correlated positively with GMV in the left inferior parietal lobule, whereas depressive symptoms were associated with decreased GMV in the right superior medial gyrus across patient groups. Dyspareunia correlated negatively with cortical thickness in the left inferior temporal gyrus and left middle temporal gyrus. LIMITATIONS, REASONS FOR CAUTION: The study groups differed in a few baseline-characteristics, including educational levels, smoking and BMI. While measuring pain perception thresholds, we did not attempt to mimic CPP by placement of the thermode on the abdominal wall. WIDER IMPLICATIONS OF THE FINDINGS: Changes in gray matter volume associated with endometriosis differ from those observed in women with endometriosis-independent CPP. Our results underline an involvement of the cerebellum in pain perception and the pathogenesis of pain associated with endometriosis. STUDY FUNDING/COMPETING INTEREST(S): This work was funded by the START Program of the Faculty of Medicine, RWTH Aachen, Germany, and supported by the International Research Training Group (IRTG 2150) of the German Research Foundation (DFG)-269953372/GRK2150, Germany. S.T. was supported by postdoctoral fellowship of the Faculty of Medicine, RWTH Aachen, Germany. There are no conflicts of interest. TRIAL REGISTRATION NUMBER: DRKS00021236.

Dorsal root ganglion stimulation for patients with chronic pelvic pain: A retrospective review of patient experiences and long-term outcomes.

Introduction: Chronic pelvic pain (CPP) is a refractory condition that has physical, emotional, and financial impacts on patients. Dorsal root ganglion stimulation (DRGS) is a promising interventional modality for patients with refractory CPP, however studies of long-term outcomes are limited. We aim to present the results from a retrospective review of 31 patients with CPP treated using DRGS. Materials and methods: IRB approval was obtained. A retrospective chart review was conducted, including 31 patients who underwent a DRGS trial between 2017 and 2022 at two academic centers. Pain history, trial/implant lead configuration, complications/revisions, pain scores, functional goals, and medication use were recorded. Results: Thirty-one patients with CPP underwent a 7-10 day DRGS trial between 2017 and 2022. Of the 31 patients, 21 (68%, CI 50-81%) had a successful trial, defined as >50% reported pain relief. Twenty patients underwent DRGS implantation. Average follow-up was 28.2 ± 17.3 months. Nine patients (45%) required revision surgery for lead migration or fracture. Thirteen patients remain implanted with an average reported percent relief of 55 ± 15%. Seven patients were explanted (35%), with an average time to explant of 12.5 ± 3 months. Conclusions: This study presents one of the largest groups of patients with DRGS for the treatment of CPP. The results highlight the variable experiences of patients after DRGS trial/implant. We report on the incidence of lead migration and fracture, sparingly described in the literature. Larger, prospective studies are needed to elucidate which patients with CPP may benefit most from DRGS, and to better understand the incidence and implications of complications.

Symptoms of depression, anxiety and stress in women with chronic pelvic pain attended at a private hospital in São Luís, Maranhão: a cross-sectional study.

The study aimed to evaluate the relation between depression, anxiety stress symptoms, duration and pain intensity in women with chronic pelvic pain (CPP). This study consisted of a sample of women diagnosed with CPP from April 2021 to August 2023, including women aged 18 years or older who agreed in writing to participate in the study with the Free Informed Consent Form, who could understand the study's objectives and participate. Women between 31 and 37 years old, married or in a stable relationship, with a higher education degree predominated. Were observed outside the normal range scale 58.8 percent of depression, 66.7 percent of anxiety and 59.8 percent of stress. The level of alteration most often observed in patients was extremely severe in 24 percent of with depression and 33.3 percent of anxiety, and the level was mild in 19.6 percent of stress symptoms. No statistical association was found between duration of pain and emotional states of anxiety, depression or stress. Regarding pain intensity levels, there was no significant association with the presence or absence of symptoms of depression outside the normal range or its levels. It's was significantly associated with the presence or absence of anxiety symptoms outside the normal range (p = .003) and with their levels (p = .005). Also significantly associated with the presence or absence of stress symptoms outside the normal range (p = .007), as was its levels (p = .023). The symptoms of depression, anxiety and stress occur frequently in women with CPP and that the intensity of pain experienced is significantly associated with the presence of stress and anxiety but not with depression.

Efficacy of acupuncture on drinkers with chronic prostatitis / chronic pelvic pain syndrome: secondary analysis of a randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of acupuncture in drinkers with chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). METHODS: We conducted a secondary analysis of a randomized controlled trial across multiple centers, involving 224 drinkers. Patients received either acupuncture or sham acupuncture treatment. The primary outcome was the proportion of responders, defined as participants who had a reduction of 6 points or more from baseline in the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) total score at weeks 8 and 32. Secondary outcomes measures included the Global Response Assessment (GRA), International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5 (IIEF-5). RESULTS: One hundred and twelve drinkers were included in each group (n = 224 in total). The proportion of responders in terms of NIH-CPSI was 58.9% versus 40.3% in the acupuncture group (AG) and sham acupuncture group (SAG), respectively, with a statistically significant difference of 18.6% (p = 0.002) at week 8. Higher proportions of responders with respect to NIH-CPSI (p < 0.001 at week 32) and GRA (p < 0.001 at week 8 and p = 0.01 at week 32) were observed in the AG compared with the SAG. No between-group differences were found in the changes in IPSS at any assessment time point. Changes in IIEF-5 score were significantly higher in the AG than in the SAG at weeks 20 and 32, while the difference was not statistically significant at week 8. CONCLUSION: Acupuncture appeared to alleviate the symptoms of pain among drinkers with CP/CPPS and improve their quality of life, but had no demonstrable effect on urinary tract symptoms or erectile function among these patients. TRIAL REGISTRATION NUMBER: NCT03213938 (ClinicalTrials.gov).

[Electrophysiological technique for treatment of chronic prostatiti: Curative effect observation].

OBJECTIVE: To observe the clinical effect of electrophysiological technique in treating chronic prostatitis. METHODS: Choose 40 patients of chronic prostatitis/chronic pelvic pain syndrome (chronicprostatis/chronicpelvicpainsyndrome, CP/CPPS) in People's Hospital in Zhijin and People's hospital in Guizhou Province from January 2022 to April 2023, The patients were randomly divided into control group (n=20) and treatment group (n=20). The treatment group received low-frequency neuromuscular electrical stimulation combined with drug therapy, while the control group received drug therapy alone. The improvement of prostatitis symptom score (NIH-CPSI) and International Prostatitis Symptom score (IPSS) before and after treatment was compared and analyzed. RESULTS: A total of 37 patients were followed up (1 patient in the treatment group withdrew due to hypersensitivity to the electrode; 2 patients in the control group were lost to follow-up. )There was no significant difference in baseline data between the two groups (P > 0.05). The NIH-CPSI score and IPSS score before and after treatment were compared between the two groups, and the difference was statistically significant (P< 0.05). The IPSS score of the two groups after treatment was compared, the average reduction of the treatment group was 15.84±0.92 points, and that of the control group was 7.17±0.40 points, and the difference was statistically significant (t=4.792, P< 0.05). The NIH-CPSI score of the two groups after treatment was compared, and the average reduction was 17.47±0.92 points in the treatment group and 10.56±0.49 points in the control group. The difference between the two groups was statistically significant (t=6.654, P< 0.05). CONCLUSION: The effect of electrophysiological combined drug therapy is obviously better than that of simple drug therapy. Electrophysiological therapy for chronic prostatitis has definite clinical effect and is worth promoting and applying.

Effectiveness of nonpharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of nonpharmacological conservative therapies for women with CPP. DATA SOURCES: A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials comparing a nonpharmacological conservative therapy to inert (eg, placebo, usual care) or nonconservative (eg, surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (eg, electrophysical agents, manual stretching). STUDY APPRAISAL AND SYNTHESIS METHODS: All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using postintervention scores for data that included similar interventions and outcomes. Standardized mean differences were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the Physiotherapy Evidence Database scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations criteria. RESULTS: Of 5776 retrieved studies, 38 randomized controlled trials including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or nonconservative treatments in both the short (standardized mean difference -1.69, 95% confidence interval -2.54, -0.85; high certainty) and intermediate-terms (standardized mean difference -1.82, 95% confidence interval -3.13, -0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (standardized mean difference -0.18, 95% confidence interval -0.56, 0.20; moderate certainty) and a slight difference in sexual function (standardized mean difference -0.28, 95% confidence interval -0.52, -0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (standardized mean difference 1.08, 95% confidence interval -1.38, 3.54, nonstatistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence. CONCLUSION: This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with chronic pelvic pain with a high certainty of evidence.

NLRP3-mediated IL-1ß in regulating the imbalance between Th17 and Treg in experimental autoimmune prostatitis.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a urinary disorder that affects youthful to middle-aged men most frequently. It has been revealed that Th17/Treg imbalance is a crucial factor in the pathophysiological mechanisms behind this disease. However, this imbalance's mechanisms are unknown. In the experimental autoimmune prostatitis (EAP) mouse model, the NLRP3 inflammasome was turned on, IL-1ß levels went up. Moreover, there exists a discernible positive association between the upsurge in IL-1ß and the perturbation of Th17/Treg equilibrium. Additionally, we have revealed that IL-1ß plays a vital role in promoting the differentiation of Naïve CD4+ T cells into the Th17 cells and enhances the conversion of Treg cells into Th17 cells. Further studies revealed that IL-1ß promotes STAT3 phosphorylation, which is what causes Treg cells to become Th17 cells. All data strongly suggest that the NLRP3 inflammatory influence Th17 cell development and the conversion of Treg cells into Th17 cells through IL-1ß, disrupting the Th17/Treg balance and exacerbating EAP inflammation. In this article, we provide new theories for the pathogenesis of CP/CPPS and propose new prevention and therapy methods.

Transcatheter Arterial Embolization for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Retrospective Study of 44 Patients.

PURPOSE: To investigate the preliminary treatment outcomes of transcatheter arterial embolization (TAE) for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS: This retrospective study included patients with refractory CP/CPPS who underwent TAE between April 2022 and February 2023. All patients had persistent pelvic pain for at least 3 months, a total score of at least 15 on the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and lacked evidence of infection. All procedures were performed by injecting imipenem/cilastatin sodium (IPM/CS) from bilateral prostatic arteries ± internal pudendal arteries. NIH-CPSI, pain numeric rating scale (NRS), and complications were evaluated at 1, 3, and 6 months after the initial TAE and at the final follow-up. RESULTS: Out of 48 patients, 44 were included in this study, with four excluded because of loss of follow-up. No severe procedure-related complications were observed. Pretreatment and post-treatment evaluations at 1, 3, and 6 months after the initial TAE and at the final follow-up (mean 16.6 months) revealed a decrease in the mean NIH-CPSI scores from 27 ± 6 to 21 ± 8, 20 ± 9, 17 ± 9, and 18 ± 9, respectively (all P < 0.001). Pain NRS scores were also decreased from 7.0 ± 1.6 to 4.8 ± 2.5, 4.1 ± 2.6, 3.7 ± 2.4, and 3.4 ± 2.3, respectively (all P < 0.001). The proportions of clinical success, defined as a reduction of at least 6 points from baseline in the NIH-CPSI, at 6 months after TAE and at the final follow-up were 70 and 64%, respectively. CONCLUSIONS: This study provides evidence of the feasibility of TAE using IPM/CS for CP/CPPS, suggesting both symptomatic improvement and safety.

[Changes in seminal plasma composition and corresponding sperm quality in patients with chronic prostatitis / chronic pelvic pain syndrome: Progress in studies].

Prostatitis is one of the three most common prostate diseases in men, the other two being prostatic hyperplasia and prostate cancer, and about 50% of men worldwide have been attacked by prostatitis during their lives. The incidence of infertility is significantly higher in patients with chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) than in those without it, which is mainly attributed to the changed semen composition of the CP/CPPS patients. Using the key words chronic prostatitis, chronic pelvic pain syndrome, sperm, semen, and seminal plasma, we searched PubMed and Medical Lines online for originals, review articles, clinical trials, case reports and associated citations on humans and animals published up to 2024. We comprehensively reviewed the previous studies and investigations relating chronic prostatitis, seminal plasma change and sperm quality, and discussed the impact of the change of semen composition on sperm quality.

Pain from Internal Organs and Headache: The Challenge of Comorbidity.

Headache and visceral pain are common clinical painful conditions, which often co-exist in the same patients. Numbers relative to their co-occurrence suggest possible common pathophysiological mechanisms. The aim of the present narrative review is to describe the most frequent headache and visceral pain associations and to discuss the possible underlying mechanisms of the associations and their diagnostic and therapeutic implications based on the most recent evidence from the international literature. The conditions addressed are as follows: visceral pain from the cardiovascular, gastrointestinal, and urogenital areas and primary headache conditions such as migraine and tension-type headache. The most frequent comorbidities involve the following: cardiac ischemic pain and migraine (possible shared mechanism of endothelial dysfunction, oxidative stress, and genetic and hormonal factors), functional gastrointestinal disorders, particularly IBS and both migraine and tension-type headache, primary or secondary dysmenorrhea and migraine, and painful bladder syndrome and headache (possible shared mechanisms of peripheral and central sensitization processes). The data also show that the various visceral pain-headache associations are characterized by more than a simple sum of symptoms from each condition but often involve complex interactions with the frequent enhancement of symptoms from both, which is crucial for diagnostic and treatment purposes.

Investigating the overlapping presentation of irritable bowel syndrome and vulvodynia: a scoping review of the evidence and mechanisms.

INTRODUCTION: Vulvodynia is a complex and multifactorial medical condition characterized by pain in the vulvar area without any identifiable cause. Vulvodynia is underdiagnosed, leading to increased risk of sexual dysfunction and reduced quality of life. Irritable bowel syndrome (IBS) is a gastrointestinal disorder predominantly affecting women. Vulvodynia and IBS frequently co-occur in women, with a 2- to 4-fold increased likelihood of IBS diagnosis in those with vulvodynia. These conditions may share underlying causes, highlighting the need for research to better understand their shared pathophysiology and develop effective therapeutics. OBJECTIVE: The aim of this scoping review was to assess the evidence of simultaneous presentation of IBS and vulvodynia. METHODS: A comprehensive search was conducted in 6 databases between inception of database and August 2023: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, and Cochrane Library. Studies included primary research about IBS and vulvodynia in terms of presentation overlap, diagnosis, or treatment. Data were extracted from eligible studies, summarized, and collated. RESULTS: Of the 306 unique articles identified, 33 were included in the final analysis: 20 cross-sectional studies, 4 case-control studies, 2 case reports, 4 cohort studies, 2 quasi-experimental studies, and 1 randomized trial. Common themes included a high prevalence of overlapping vulvodynia and IBS with a significant diagnostic delay in vulvodynia, mast cell involvement and visceral hypersensitization as common pathophysiology, and the need for a multimodal treatment. CONCLUSION: Our review adds to the evidence that there is an association between vulvodynia and IBS. Despite this, research on the underlying molecular mechanisms of this association is scarce, and diagnostic delays persist for vulvodynia. Increasing awareness of the overlap of these conditions will improve screening for vulvodynia in the patient population with IBS, thereby improving the diagnostic delay, and understanding the pathophysiology will enable treatment strategies that address both conditions.

Pain Severity and Depressive Symptoms in Endometriosis Patients: Mediation of Negative Body Awareness and Interoceptive Self-Regulation.

Endometriosis-related pain may be associated with depressive symptoms. Although a growing body of evidence supports this association, the underlying mechanisms are still largely unclear. Impaired perceptions of bodily external and internal stimuli may be involved in this process. This study aims to assess the mediating role of 2 facets of interoception-the awareness of negative body signals and interoceptive self-regulation-in the association between pain severity and depressive symptoms among women with endometriosis. A total of 301 patients who reported a diagnosis of endometriosis were recruited from an endometriosis and chronic pelvic pain outpatient university clinic and through patient associations and completed self-reported instruments. A parallel mediation analysis was conducted. Almost half of women (48.2%) reported depressive symptoms above the self-rating scale cutoff values. Pain severity significantly predicted depressive symptoms (ß = .39, 95% bootstrap confidence interval [CI] [.719, 1.333]). Negative body awareness (ß = .121, 95% bootstrap CI [.174, .468]) and interoceptive self-regulation (ß = .05, 95% bootstrap CI [.035, .252]) partially mediated this relationship. Our findings indicated that pain may interfere with the perception of the body as a source of calmness and safety, limiting the individual's ability to effectively regulate emotions. Future research should further explore these mechanisms and evaluate the efficacy of interventions focusing on interoceptive sensibility to enhance the psychological well-being of endometriosis patients. PERSPECTIVE: This article investigates for the first time the potential role of 2 facets of interoceptive sensibility in the relationship between pain severity and depressive symptoms in women with endometriosis. These findings may contribute to advancing knowledge about the mechanisms involved in the complex pain-depression cycle.