Studies probe pain, pathogen origins, interactions

May 15, 2008

In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), two pivotal clinical trials "are going to have an immediate impact on the way you practice," said Anthony J. Schæffer, MD, professor and chairman of the department of urology at the Northwestern University Feinberg School of Medicine, Chicago.

Key Points

The most common and vexing problems in urology will become easier to treat, thanks to the research presented at this year's AUA annual meeting in Orlando, FL. In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), two pivotal clinical trials "are going to have an immediate impact on the way you practice," said Anthony J. Schaeffer, MD, professor and chairman of the department of urology at the Northwestern University Feinberg School of Medicine, Chicago.

Pain management

One study addresses questions that are hot issues in the field: Where is the pain? Is the prostate really the source of the problem? Bucking the trend to look away from any end-organ disease to central nervous system sensitization as a source of pain and pain hypersensitivity is this study of an autoimmune mouse model of CP/CPPS. Disease is induced in the prostate, but the animals clearly show measurable, increased suprapubic pain and hypersensitivity to touch peripherally.

"What's also interesting about this," Dr. Schaeffer said, "is that the mouse model is chronic and is associated with neuropathic changes and chemokines that have been identified in men with prostatitic pain syndromes."

Anesthetic treatment of the prostate eased pain, but the same was not true for pain in the bladder or colon.

"This suggests that pelvic pain syndrome in some men may indeed be associated with prostate disease," Dr. Schaeffer said.

Similar to interstitial cystitis/painful bladder syndrome (IC/PBS) patients, CP/CPPS patients have symptoms sensitive to foods and beverages. Thus, although pelvic pain syndromes may be caused by specific organs, there is still "cross talk" between the bowel and bladder. Consequently, multimodal therapies may be effective, and preventive approaches, such as modifying diet, have a scientific basis, said Dr. Schaeffer.

Pharmacologic approaches

After the meeting, urologists should watch for the results of another important clinical trial in CP/CPPS, this one pitting pregabalin (Lyrica) against placebo. The study will be finished in the coming months.

Farther in the future, the innovative, cross-disciplinary research sponsored through the National Institute of Diabetes and Digestive and Kidney Diseases' new Multidisciplinary Approach to the Study of Chronic Pelvic Pain program that will begin soon should bring an infusion of new ideas and help reveal what the connections might be between CP/CPPS, IC/PBS, and other conditions, such as irritable bowel syndrome and fibromyalgia, that occur with greater frequency in these patients than in the general population. That might bring research closer to finding the etiology of these syndromes and developing therapies effective for pelvic pain and other conditions.

Although urologists have many effective treatments for UTIs, a new diagnostic tool should enable them select the best treatments faster. An electrochemical biosensory array with DNA probes for common pathogens will be presented at the AUA meeting. This tool has the potential to identify pathogens in less than an hour, a tremendous advantage over the typical 48-hour wait for routine cultures.