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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Both acute and chronic bacterial prostatitis are generally caused by gram-negative organisms. However, acute infections are seen in younger men and cause fever, difficulty in voiding, low back and perineal pain, and other systemic symptoms. Chronic infections are more often seen in older men and may or may not be associated with symptoms of prostatitis. Nonbacterial prostatitis is the most common type. Patients have symptoms and signs of prostatitis, but infecting organisms cannot be demonstrated. Studies attempting to identify a causative organism have not been conclusive. Prostatodynia is a complex of symptoms similar to prostatitis that occurs without objective findings that definitely implicate the prostate gland. Bladder disorders such as internal sphincter dyssynergia, tension myalgia of the pelvic floor, or, at times, stress and emotional problems may be associated. Management depends on the precipitating factor.
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PMID:Prostatitis. Sorting out the different causes. 841 32

Depending on the location, bladder, urethral, penile and prostate pain syndromes are distinguished. In addition to the investigation of urine and ejaculate with the aim of detecting an infection, clinical examination, uroflowmetry are employed and, where indicated, imaging techniques to exclude cancer disease. Chronic pelvic pain is a non-cancer-related pain persisting for more than six months. In the absence of an underlying treatable disease, appropriate pain therapy can be initiated with antiphlogistic analgesics, COX 2 inhibitors or opioids. Depending on the clinical presentation, further therapeutic options or such non-drug measures as bladder training, dietetic measures or surgery may be applied in addition.
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PMID:[Pelvic pain--definitions, diagnosis and therapeutic options]. 1535 77

Chronic abacterial prostatitis (or prostatitis Category III according to the National Institutes of Health terminology) is subject to re-evaluation. Organizations such as the International Continence Society, the International Association for the Study of Pain and the European Association of Urology have been involved in a continuous endeavour to design a more accurate taxonomy system. The term prostate pain syndrome (PPS), as a subcategory of chronic pelvic pain syndromes, has recently been suggested as the most relevant. This condition is common, very bothersome and enigmatic. Symptoms are usually prolonged and, generally speaking, treatment results are unsatisfactory. During the last decade, research has focused on the distress caused by the condition, but although our knowledge has certainly increased there have been no real breakthroughs; controversies and many unanswered questions remain. Examples of pertinent issues are as follows: the criteria that need to be fulfilled for a diagnosis; the significance or lack of significance of leucocytes in expressed prostatic secretion; and the association between erectile dysfunction and PPS. The fundamental question remains: is the prostate really involved in the majority of men with PPS? This article focuses on some of the controversies.
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PMID:Controversies in chronic abacterial prostatitis/pelvic pain syndrome. 1843 26

The aim of this prospective observational study was to present relevant data on the efficacy and safety of levofloxacin in the treatment of chronic bacterial prostatitis (NIH-II) in the daily clinical routine of urologists in their practices. In total, 243 patients were treated, including 62 patients with a microbiologically confirmed diagnosis -based on expressed prostatic secretion (EPS). The current evaluation is based on these patients. Their median age was 53 years. The patients were treated with levofloxacin 500 mg / day for 29 days (median) which is in accordance to the -registered recommendation for this indication. Clinical symptoms were assessed using a standardised questionnaire. The clinical symptoms dysuria, painful ejaculation, perineal pain, urinary obstruction, increased urgency, prostate pain during palpation as well as CRP and number of leukocytes showed statistically significant improvements at the end of therapy with levofloxacin as compared to baseline. At the end of treatment 93.5 % (n = 58 / 62, 95 % confidence interval: 84.5 %-97.8 %) of the patients were cured or improved. The patients were able to resume their regular activities after 10 days (median). 93.5 % (n = 58 / 62) of the patients and 95.2 % (n = 59 / 62) of the doctors were satisfied or very satisfied with this treatment. In all 62 patients the diagnosis was microbiologically confirmed based on EPS. In 39 patients (62.9 %) E. coli was identified. At the end of therapy microbiological testing was performed in 62.9 % (n = 39 / 62) of the patients, in 29 cases including EPS. In 37 of these 39 patients (94.9 %) no pathogen was identified. In 2 cases (5.1 %) a pathogen was identified (Proteus mirabilis and Staphylococcus species). In 181 patients without microbiological confirmation -based on EPS comparable clinical results were found. In the total population of 243 patients 5 adverse drug reactions were reported in 3 patients (incidence 1.2 %, n = 3 / 243), The results of this study confirm the efficacy and safety of levofloxacin in the treatment of chronic bacterial prostatitis in daily clinical practice.
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PMID:[Practice management of chronic bacterial prostatitis with levofloxacin]. 2144 24

Chronic pelvic pain syndrome (CPPS) is the most common form of prostatitis, accounting for 90-95% of all diagnoses. It is a complex multi-symptom syndrome with unknown etiology and limited effective treatments. Previous investigations highlight roles for inflammatory mediators in disease progression by correlating levels of cytokines and chemokines with patient reported symptom scores. It is hypothesized that alteration of adaptive immune mechanisms results in autoimmunity and subsequent development of pain. Mouse models of CPPS have been developed to delineate these immune mechanisms driving pain in humans. Using the experimental autoimmune prostatitis (EAP) in C57BL/6 mice model of CPPS we examined the role of CD4+T-cell subsets in the development and maintenance of prostate pain, by tactile allodynia behavioral testing and flow cytometry. In tandem with increased CD4+IL17A+ T-cells upon EAP induction, prophylactic treatment with an anti-IL17 antibody one-day prior to EAP induction prevented the onset of pelvic pain. Therapeutic blockade of IL17 did not reverse pain symptoms indicating that IL17 is essential for development but not maintenance of chronic pain in EAP. Furthermore we identified a cytokine, IL7, to be associated with increased symptom severity in CPPS patients and is increased in patient prostatic secretions and the prostates of EAP mice. IL7 is fundamental to development of IL17 producing cells and plays a role in maturation of auto-reactive T-cells, it is also associated with autoimmune disorders including multiple sclerosis and type-1 diabetes. More recently a growing body of research has pointed to IL17's role in development of neuropathic and chronic pain. This report presents novel data on the role of CD4+IL17+ T-cells in development and maintenance of pain in EAP and CPPS.
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PMID:IL17 Mediates Pelvic Pain in Experimental Autoimmune Prostatitis (EAP). 2759 12

Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months' duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.
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PMID:Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection. 2609 97