What you call something dictates the treatment you will get.

[gonslo]

Treatment for chronic prostatitis / chronic pelvic pain syndrome is available in the Uk if you get the right diagnosis. Originally diagnosed with prostatitis I was sent down the anti biotic route with no success. Painkillers did not work either. After seeing three different specialists from different medical disciplines and four MRI scans I was told they could find nothing wrong with me. After extensive research, including this site, I insisted on a referral to pain management. There I was diagnosed with piriformis syndrome and am currently awaiting anaesthetic injections into the piriformis on both sides. This is the successful type of treatment described by Doggweiler in her paper "Urologic Myofascial Pain". If this does not work my consultant will consider the use of Botox. Are your members aware of the current study being done by Washington University, Seattle? This is due to report in August. They are testing the effect of Botox injected into one of the perineal muscles. Preliminary results were successful.

[Howden]

I went down the same route and eventually was offered Botox to the piriformus. I decided to postpone the treatment untill I could get some feedback from Seattle. There have been discussions about Botox injections on this site, some favourable, some less so. Early reports from the Seattle study were promising.

[gonslo]

Have you seen the paper by Zermann, Ishigooka, Schubert and Schmidt -Botulinum Toxin A as a treatment for prostatic pain? Once again this study posted favourable results. It was done in 2000. I have also uncovered papers relating to its use for piriformis syndrome(successful), in the treatment of acute constipation due to a non relaxing puborectalis muscle and in pudendal nerve entrapment.
I also have friends who have dystonia. They suffer involuntary muscle spasms which cause great pain. They go for three monthly injections of Botox.
Best regards

[MB]

I tried Botox but it didn't help me at all. It was injected in the adductor, levator, obturator, and coccygeus.

[alprost]

There I was diagnosed with piriformis syndrome and am currently awaiting anaesthetic injections into the piriformis on both sides. .

Exactly how did they diagnose you with piriformis syndrome? The only way to get an accurate diagnosis of chronic prostatitis / chronic pelvic pain syndrome due to myofascial pain is to be thoroughly examined, both internally and externally, for trigger points by someone who is trained and experienced. If you had this done, then great.

If not, and you don't get significantly better following treatment, do not give up on pursuing treatment for trigger points.

Have you read AHIP?

[gonslo]

Yes I was thoroughly examined by a pain consultant whose speciality is pelvic pain in women. She noted hypertonicity of the pelvic floor muscles by doing a DRE.
Yes I have read AHIP. The treatment described is based on Travell and Simons work. Similar though more "medicalised" treatment is described by Doggweiler and Weiss and is available in pain clinics if you know where to look. I was lucky enough to see the right consultant. This type of treatment has been used for women for a number of years.
What we are now seeing is the influence of pain specialists coming to the fore in the treatment of these conditions. The ideas of Dr Baranowski, who was a contributor to the Oct 2005 symposium in Baltimore are significant in this respect. His comments in Urology Times, which I found on your site, are very apt. i.e.. the "itis" in prostatitis may be a barrier to effective treatment. Or words to that effect.
He is establishing a multi disciplinary diagnostic and treatment team in London. The aim is to identify end organ disease and treat it. What is left will likely be a variety of pain syndromes which are currently under diagnosed. Once identified these to can be treated or managed.
I have already experienced the multi disciplinary approach in pain management as I also suffer from temporo mandibular jaw dysfunction I am aware of David Wise's comments on the similarity of this to pelvic pain in terms of aetiology. I am also aware that it is a co morbid condition along with pelvic pain.
The Baranowski initiative is significant for the UK as it is difficult to access treatment along the lines of the Stanford/Wise-Anderson Protocol.
Look out for the June edition of the British Journal of Urology. Baranowski has an article in it on this issue.
Regards,
gonslo

[alprost]

She noted hypertonicity of the pelvic floor muscles by doing a DRE.

That's my point! - noting hypertonicity is NOT a systematic evaluation of myofascial trigger points in specific locations in the pelvic floor known to refer the symptom complex typical of CPPS. These are completely different constructs which may or may not be related. Re-read the section of AHIP which deals with how elevated pelvic floor EMG signals tell us nothing about whether the pelvic floor muscles contain trigger points - I also know this through personal experience. You need to ask some questions of your pain specialist here.....

It's great that the approach is changing from Uro's to pain clinics, but I see a great danger here in that inexperienced clinicians (no matter what their title or status) assume a knowledge of chronic prostatitis / chronic pelvic pain syndrome in males they simply do not have, and replace one range of ineffective treatment options with another.

Again, the bottom line is that, in order to recover from chronic prostatitis / chronic pelvic pain syndrome you need to follow a systematic process of:
1 - Identifying and eliminating the cause of the excess muscle tension - i.e. if you habitually tense your pelvic floor, you need to address the habit; if you have an infection (<5%), treat it, if you have biomechanical/ ergonomic issues, these need to be corrected.
2 - Identifying and treating myofascial trigger points at specific locations. It is a mistake to judge an approach on how 'medicalised' it is. The bottom line is that the treatment must identify and eliminate trigger points. For external trigger points this can be done by manual methods or injections. For most internal ones, only manual methods can be used. In both cases, the trigger points first need to be identified.
3 - Facilitating you recovery by incorporating behaviours which promote the self-healing mechanism of you body - relaxation/meditation; nutrition; stress management; appropriate exercise; adequate sleep etc..

Number 2 is the most difficult part here in the UK.

[GP2]

Alprost,

How long did you go for PT for? It was Bill Talor right? Do you continue to treat yourself?

[LightningTree]

My brother and I learned about the Stanford/Wise-Anderson Protocol approach through a pain clinic he attended. I agree that they can be a good direction to go if you are looking for help.

[alprost]

Alprost,

How long did you go for PT for? It was Bill Talor right? Do you continue to treat yourself?

Sorry for the delay in getting back to you. I recently answered this question for another poster. Check out my post on this thread:

viewtopic.php?t=3810