Psychological therapies may benefit CP/CPPS patients

March 1, 2006

Baltimore--Psychological treatment, particularly cognitive behavioral therapy, can help ease chronic pain. That's why these therapies may be able to do the same for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients, argued Judith Turner, PhD, at the NIDDK-sponsored Chronic Pelvic Pain/Chronic Prostatitis Scientific Workshop here.

Physical findings don't seem to explain the differences in levels of pain and degrees of physical and psychosocial dysfunction in chronic pain patients, she pointed out.

"Biological, psychological, and social and environmental factors can all interact to influence a patient's symptoms, behaviors, and response to treatment," said Dr. Turner, a professor in the department of psychiatry and behavioral sciences at the University of Washington, Seattle.

"It's not telling someone to 'think positive,' " Dr. Turner emphasized.

Cognitive behavioral therapy typically includes progressive relaxation, abdominal and diaphragmatic breathing, and setting and working toward behavioral goals. Those goals might gradually and systematically increase activities with which the pain has interfered and include developing a plan to maintain the gains. The therapy also includes ways of coping with pain flare-ups, which are anticipated, so the patient isn't surprised when they happen and thinks treatment has failed.

Demonstrated effectiveness

Meta-analyses of controlled studies of the effects of these types of therapies in chronic pain indicate a statistically significant, but moderate, effect. A 1999 meta-analysis included 25 randomized controlled trials in adults with chronic pain (Pain 1999; 80:1-13). In the studies that compared patients receiving cognitive and other behavioral therapies with waiting list controls, the mean effect size therapy was .36 to .60 for pain, mood, activity level, and social role functioning. In studies that compared those treatments against other active treatments, the mean effect size was smaller for pain-.29- but still statistically significant.

A more recent Cochrane review of behavioral treatment for low back pain analyzed 21 studies and found strong evidence that cognitive behavioral therapy was more effective than waiting list control for short-term pain relief, but long-term differences and effects on back-specific functional status were unknown (Cochrane Database Syst Rev 2005, Art. CD002014.pub2). (Waiting list patients go into active treatment, so long-term comparisons with no therapy are not possible.) The authors reported moderate evidence that progressive relaxation training has a large, positive effect on pain and behavioral outcomes in the short term, and limited evidence of a positive effect on functional status.

No similar studies have been done on the effectiveness of these therapies in CP/CPPS patients, but Dr. Turner and her colleagues have started to characterize the connection between stress and outcome for these patients and their concerns.

In men who have a new diagnosis of prostatitis made at a recent HMO visit, her team found that perceived stress scores averaged over the next 6 months predicted pain intensity and disability at 1 year (Arch Intern Med 2005; 165:1054-9). Furthermore, worries and concerns about symptoms persisted over the next year for many of these men.

At the initial visit, 93% of men were concerned that the prostatitis problem would worsen if left untreated. At 1 year, 71% of the men who had experienced prostatitis symptoms in the past month still had that concern.