Differential diagnosis of neuropathy

[Hepcat]

New to the group, so please forgive any lapse of posting etiquette

I'm curious as to how one can distinguish between neurogenic pain and pain secondary to inflammation/soft tissue damage.

Allow me to present my question more clearly by way of my history.

I was "diagnosed" with prostatitis about 5 months ago. My presenting with acute onset, then lingering bilateral orchalgia, a short history and a DRE is apparently all it takes to make this firm diagnosis of prostatitis.

I took Cipro for approx. 2 months, with waxing and waning of symptoms throughout. at the end of the course, I had about 2 weeks where the pain was mostly gone. Then, wham, I acquired a lovely addition to my symptoms: constant abdominal pain. Specifically, pain throughout my rectus abdominus and a sensation of indigestion.

The pain is localized exclusively to the rectus, and produces actual tenderness on palpation. As well, a small "trigger point" just lateral and superior to my navel radiates intense pain when the abdomen is flexed.

I should mention also, I have noticed some increasing thoraco-lumbar burning sensations, however, these seem to have subsided somewhat with the wellbutrin my doc prescribed in a feeble attempt to calm me.

Finally, all my symptoms decline overnight. I wake up feeling not too badly, but throughout the day they worsen to the point of a pain scale rating of 6-7 by bed. I have never been woken during the night with pain, thankfully.

I'm curious how typical these symptoms are to Prostatitis. I wonder if my GI flora has been screwed up by the Cipro, there is some funny pelvic pain referral to my abdomen or whether I acquired thoraco-lumbar radicular pain concurrently with my pelvic related symptoms.

What's a typical differential cascade for disentagling these symptoms? It's my understanding that neurogenic pain should be addressed quickly before it becomes hardwired into the nervous pathways. I'm going to ask my doc to place me on neurontin and see if that helps. I'm assuming thats the next logical step.

It would be nice to see urologists, neurologists, and chronic pain specialists collaborate more on this.

Thanks in advance for your thoughts, and apologies for the long post.

[webslave]

It's common to hear reports of abdominal pain like this, and IBS is almost a part of the syndrome. You may want to try an opioid like Ultram to break a pain cycle (I found it useful - YMMV). Interesting point: latest research shows that an opioid, like morphine, given weekly, can control severe intractable OCD (obsessive compulsive disorder), they think by regulating the limbic system in the brain, which is unruly and overactive in OCD. OCD is one of the true "burnt neural pathway" diseases. (Small footnote: severe OCD is in my family - a sibling - and I have noticed OCD reported quite a lot on the prostatitis newsgroup. Howard Stern, one of the high-profile OCD sufferers, has CP/CPPS.).

Another note: I learned yesterday that John Kennedy probably had CP/CPPS.

[J Dimitrakov]

It's common to hear reports of abdominal pain like this, and IBS is almost a part of the syndrome.

Yes, an interesting point, although it might be argued that abdominal pain and testicular pain can fulfil two of the diagnostic criteria for polyarteritis nodosa (a kind of vasculitis). Sadly, no one has proscpectively looked at a large group of patients with such symptoms

You may want to try an opioid like Ultram to break a pain cycle (I found it useful - YMMV).

The only problem is that most opioids cause constipation so if you are already constipated opiods might make it worse.

Interesting point: latest research shows that an opioid, like morphine, given weekly, can control severe intractable OCD (obsessive compulsive disorder), they think by regulating the limbic system in the brain, which is unruly and overactive in OCD. OCD is one of the true "burnt neural pathway" diseases. (Small footnote: severe OCD is in my family - a sibling - and I have noticed OCD reported quite a lot on the prostatitis newsgroup. Howard Stern, one of the high-profile OCD sufferers, has CP/CPPS.).

Yeah, maybe chronic prostatitis / chronic pelvic pain syndrome will turn out to be a disease resulting from neuro-immuno-humoral dysregulation.

Another note: I learned yesterday that John Kennedy probably had CP/CPPS.

I heard the interview with the doctor who wrote it. He actually reported recurrent urinary tract infections which is probably the public way of saying CP/CPPS at this time.

[Hepcat]

Thanks for your advice :)

However, thankfully outside of some mild dyspepsia, I haven't experienced any significant GI problems. In fact, my discomfort is largely present only the areas described.

I have had a thorough workup for systemic disease and am being constantly monitored for any of those types of changes. Outside of some initial trace hematuria and slightly elevated serum creatinine during the first month, I couldn't be healthier apparently.

And, yes, I've had my kidneys checked ad nauseum. 5 years nuclear medicine and another 5 in research cardiovascular physiology has given me a good dose of residents disease =P

Hence, I'm concluding that some rhabdomyolotic-type process might have been at work (as a result of the initial insult to my bladder/prostate?) which may have resulted in the suggested inflammatory/neurogenic response proposed by some investigators.

It may also be that some other condition is at work here. It seemed odd that only the rectus was affected and that a trigger point had developed. The literature suggests abdominal trigger points can blamed for all kinds of mischief, including pelvic pain. But since my knowledge of rehab medicine is pretty limited (and doctors appear to view these types of things as on par with chiropractic) I've had difficulty validating this.

Again, I could see a cross-specialty approach being invaluable. But professional territoriality is always been a hndering factor in research and clinical practice. At least, in my experience.

[webslave]

In may case chronic prostatitis / chronic pelvic pain syndrome came along with what seems to be CFS, or fibromyalgia. I had more strange pains and trigger points than you could poke a stick at. In my case painful muscle insertions predominated. Much better now. I remember being convinced I had (1) gallstones (pain in the classic areas for gallstones) (2) a hernia (3) appendicitis (had it removed - no help) (4) stomach problems (two gastroscopies found diffuse inflammation .. this is still a problem) -- and more.

As the years rolled by I learned not to panic when I developed strong symptoms suggestive of classic diseases. I became tired of negative test results and wasted money. The downside is that if I DO ever develop a nasty cancer one day, I won't see a doctor until it's much too late.

[Hepcat]

Wow.

That IS scary.

That you (we) would have symptoms so far removed from the actual "source" of the problem would seem to suggest a much broader condition is at work here.

Have you found most of the distal pain is present as myalgia? Any strange stuff I get is always in the muscles, but the sensation is very flu-like, clearly different from any other kind of pain I've experienced.

I almost feel guilty my symptoms are relatively mild compared to your's (and many others). Some days I'm ready to toss in the towel after just 5 months. How someone can last 25+ years is beyond me.

Incidentally, are you aware of any stats on how many people experience a so called "burn-out" (remission) of the condition and how long, on average, this takes to occur?

[dshoskes]

Another note: I learned yesterday that John Kennedy probably had CP/CPPS.

I heard the interview with the doctor who wrote it. He actually reported recurrent urinary tract infections which is probably the public way of saying CP/CPPS at this time.

Or (ahem) recurrent urethritis

[webslave]

That you (we) would have symptoms so far removed from the actual "source" of the problem would seem to suggest a much broader condition is at work here.

That's the general thinking nowadays.

Have you found most of the distal pain is present as myalgia?

No. Distal pain for me has been nerve related. Myalgia at insertions of large muscles.

Some days I'm ready to toss in the towel after just 5 months. How someone can last 25+ years is beyond me.

I had it badly for a few years, but it gradually remitted. Today I am mostly quite well, but do react to trigger foods specifically. I treat infrequent flares with Ultram, antihistamine, ALgonot or Quercetin, Vit C an the rest of my "protocol" (see main site).

Incidentally, are you aware of any stats on how many people experience a so called "burn-out" (remission) of the condition and how long, on average, this takes to occur?

No, there are no such stats, but I can tell you that the natural history of this condition is very variable.[/quote]

[Hepcat]

Thanks for sharing your personal experiences with me Mark.

It's helped a lot knowing the condition can be grievous but eventually manageable.

I would like to give your protocol a try. However, living in Canada, obtaining Algonot or any accredited quercetin product would be prohibitively expensive (ie. it's not available here, and our dollar REALLY stinks).

Not sure if your comfortable recommending other reliable brands of quercetin (given your sponsorship), but any herbals (Swiss, GNC, ect) you know of who offer consistantly high quality product?

I'd rather not drink broccoli juice for life

(You might like to move this question to another section, since I suppose it's lost it's relevence here)

[webslave]

Quercetin will give you a month's supply free. Contact them. Failing P-Q and Algonot, try Rooibos tea and a reputable vanilla brand of quercetin, like Twinlabs.

[jp]

The variable symptoms tend to turn a sufferer into a hypochondriac; pain moves around, side-to-side, suprapubic, navel, down legs, etc. My original bout lasted 2/12 yrs., followed by a 2 yr. remission; I'm currently experiencing a second go-round, which has lasted 2 yrs. It's often very difficult to cope w/this disease -- having resouces like this site, w/doctors participating, really helps. I have tried to "manage" the symptoms (pain meds), and take promising and/or rational supplements. JP