CPPS pain - neuropathic or nociceptive?
CPPS pain - neuropathic or nociceptive?
Is the pain of chronic prostatitis / chronic pelvic pain syndrome considered neuropathic, or is it just muscular?
Age:33 | Onset Age: 21 | Symptoms: Penile/rectal/testicular pain, urgency/frequency, constipation | Helped By: Relaxation, PT, eating healthy, just started some acupuncture-seems to be helping | Worsened By: stress/anxiety, poor diet
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Re: CPPS pain - neuropathic or nociceptive?
Nociceptive pain and neuropathic pain are the two main kinds of pain.
Neuropathic pain is by definition pain initiated or caused by a primary lesion or dysfunction in the nervous system (incl. brain and spinal cord). The other type of pain, nociceptive pain, is caused by stimulation of a nociceptor, due to a chemical, thermal, or mechanical event that has the potential to damage body tissue. So damage to the nervous system itself, due to disease or trauma, may cause neuropathic (or neurogenic) pain. Neuropathic pain may refer to peripheral neuropathic pain, which is caused by damage to nerves, or to central pain, which is caused by damage to the brain, brainstem, or spinal cord.
Myofascial pain is considered to be a form of deep nociceptive pain.
Nobody knows enough about chronic prostatitis / chronic pelvic pain syndrome yet to say that it is one form of pain or the other, or a mixture of both, and whether this is the primary cause or something downstream of another problem, eg. hormonal or genetic, etc.
Neuropathic pain is by definition pain initiated or caused by a primary lesion or dysfunction in the nervous system (incl. brain and spinal cord). The other type of pain, nociceptive pain, is caused by stimulation of a nociceptor, due to a chemical, thermal, or mechanical event that has the potential to damage body tissue. So damage to the nervous system itself, due to disease or trauma, may cause neuropathic (or neurogenic) pain. Neuropathic pain may refer to peripheral neuropathic pain, which is caused by damage to nerves, or to central pain, which is caused by damage to the brain, brainstem, or spinal cord.
Myofascial pain is considered to be a form of deep nociceptive pain.
According to wikipedia, neuropathic pain or "neuropathy" often results in numbness, abnormal sensations called dysesthesias and allodynias that occur either spontaneously or in reaction to external stimuli, and a characteristic form of pain, called neuropathic pain or neuralgia, that is qualitatively different from the ordinary nociceptive pain one might experience from stubbing a toe. Neuropathic pain may have continuous and/or episodic (paroxysmal) components. The latter are likened to an electric shock. Common qualities of the pain include burning or coldness, "pins and needles" sensations, numbness and itching. "Ordinary" (nociceptive) pain results from exclusive stimulation of pain fibers, while neuropathic pain often results from the firing of both pain and non-pain (touch, warm, cool) sensory nerve fibers serving the same area. The result is signals that the spinal cord and brain do not normally receive.Deep somatic pain originates from ligaments, tendons, bones, blood vessels, fasciae, and muscles. It is detected with somatic nociceptors. The scarcity of pain receptors in these areas produces a dull, aching, poorly-localized pain of longer duration than cutaneous pain; examples include sprains, broken bones, and myofascial pain.
Nobody knows enough about chronic prostatitis / chronic pelvic pain syndrome yet to say that it is one form of pain or the other, or a mixture of both, and whether this is the primary cause or something downstream of another problem, eg. hormonal or genetic, etc.
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Re: CPPS pain - neuropathic or nociceptive?
Interesting question and reply!
I would think some mixture of the two types, no? Obviously, quite a few people have muscular symptoms I guess would be deemed nociceptive, and said muscles are the popular target of treatment here - combined with relaxation. Many guys (myself included) have symptoms that seem more on the neuropathic side, however. For example, burning pain, shooting ("nerve-like") pains, or some measure of allodynia. Both have been relieved in many cases with trigger point release, so I'd think there is some interplay between the two types of pain.
Or, maybe I'm dumb.
I would think some mixture of the two types, no? Obviously, quite a few people have muscular symptoms I guess would be deemed nociceptive, and said muscles are the popular target of treatment here - combined with relaxation. Many guys (myself included) have symptoms that seem more on the neuropathic side, however. For example, burning pain, shooting ("nerve-like") pains, or some measure of allodynia. Both have been relieved in many cases with trigger point release, so I'd think there is some interplay between the two types of pain.
Or, maybe I'm dumb.
I am not a physician. This is not medical advice. Consult your doctor!
Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
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Re: CPPS pain - neuropathic or nociceptive?
Both would be my guess too, Jay. 
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Re: CPPS pain - neuropathic or nociceptive?
Conventional painkillers work poorly for neuropathic pain and I guess this shows in my case, the constant ache and tenderness numbs and that I am glad of or was (have not needed now for 6 weeks) 
But these painkillers can't touch stinging, burning, shooting pain I get at the start of a flare which could be neuropathic. Both are involved I'm sure.
But these painkillers can't touch stinging, burning, shooting pain I get at the start of a flare which could be neuropathic. Both are involved I'm sure. Age:33 | Onset Age:19 | Symptoms:burning urethra, deep sore stinging around the perineum, dribbling | Helped By:when flare starts deep relaxing over a toilet to let out dribbling urine, hot bath, rubbing a heat cream on the perineum, Tens with a pad on the perineum, running, medication (solpadol) for pain. Current treatment: PT. | Worsened By:sitting, stressing over it, ejaculation, sometimes alcohol but I risk it. Been feeling a lot better last 6 months about 85% with a few flares lasting about 5 days. No longer having PT. Stretching every other night and I believe time is also a big factor for me
Re: CPPS pain - neuropathic or nociceptive?
Hi graeme,graeme wrote:Conventional painkillers work poorly for neuropathic pain and I guess this shows in my case, the constant ache and tenderness numbs and that I am glad of or was (have not needed now for 6 weeks)
Did I read that you had tried Tramadol, or am I thinking of someone else? I happened to read a study yesterday that said Tramadol (aka Ultram) had proven useful in addressing neuropathic pain. It seems to be a very unusual drug as painkillers go ...
I am not a physician. This is not medical advice. Consult your doctor!
Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
Age: 26 Onset Age: 17 Symptoms: Shooting, nerve-like pains throughout the penis, which abruptly hit and leave. Testicular pain, perineum pain, burning/irritative urination, extended pain after ejaculation. Occasionally, some allodynia or ache in the coccyx/sacrum/thigh/buttocks/legs. Diagnosis: Pelvic floor dysfunction, degenerated lumbar disk, and mildly herniated lumbar disk. Helped By: Physical therapy, pain management doctor, hot baths, therapy pool, stretching regimen, breathing exercises, relaxation, distraction. Worsened By: Arousal/ejaculation (worst), constipation, panicking/obsessing, other triggers depend upon current symptoms. Tests/Prior Treatments: Too many antibiotics to count, multiple urine tests (all normal), testicular ultrasound (normal), bladder and renal ultrasound (normal), lumbar and pelvic MRI with and w/o contrast (revealed disk problems), Elavil 25mg (caused retention), Flomax 0.4mg.
Re: CPPS pain - neuropathic or nociceptive?
Hi jay !
I have tried Tramadol but find solpadol much more effective ,the 60mg of codeine works better for me than a dose of 100mg of tramadol
I have tried Tramadol but find solpadol much more effective ,the 60mg of codeine works better for me than a dose of 100mg of tramadol
Age:33 | Onset Age:19 | Symptoms:burning urethra, deep sore stinging around the perineum, dribbling | Helped By:when flare starts deep relaxing over a toilet to let out dribbling urine, hot bath, rubbing a heat cream on the perineum, Tens with a pad on the perineum, running, medication (solpadol) for pain. Current treatment: PT. | Worsened By:sitting, stressing over it, ejaculation, sometimes alcohol but I risk it. Been feeling a lot better last 6 months about 85% with a few flares lasting about 5 days. No longer having PT. Stretching every other night and I believe time is also a big factor for me