Shock Wave Therapy May Ease CPPS

[webslave]

Shock Wave Therapy May Ease CPPS
Jody A. Charnow September 02, 2008
From the August 2008 Issue of Renal And Urology News

EXTRACORPOREAL SHOCK wave therapy (ESWT) may hold promise as a treatment for chronic pelvic pain syndrome (CPPS), researchers reported in BJU International (2008; online ahead of print).

Reinhold Zimmermann, MD, of the Public Hospital in Kufstein, Austria, and colleagues investigated this approach in two studies involving a total of 34 men with CPPS (prostatitis IIIb) of least three months' duration and no evidence of prostate cancer or bacteria in urinary and seminal culture tests. On an outpatient basis, subjects underwent perineal ESWT directed at the prostate.

The researchers observed significant improvements in pain and quality of life. Treatments were well tolerated and no anesthesia was required, the investigators noted.

“ESWT could be of significant importance in the treatment of CPPS due to its straightforward applicability with practically no side effects,” the authors concluded.

A double-blind, placebo-controlled study to valid the treatment is underway.

From http://www.renalandurologynews.com/Shoc ... le/116118/

[BrettP]

Where can I sign up? :)

[J Dimitrakov]

Shock Wave Therapy May Ease CPPS
Jody A. Charnow September 02, 2008
From the August 2008 Issue of Renal And Urology News

A double-blind, placebo-controlled study to valid the treatment is underway.

From http://www.renalandurologynews.com/Shoc ... le/116118/

Interesting... It would be quite challenging to design a double-blind trial and blind subjects to the intervention. After all, everyone can tell the difference between this type of intervention and no intervention at all (the correct term would be a "sham-controlled" rather than a "placebo-controlled" trial)

Best,
JD

[latte]

Dr. Dimitrakov, how does this compare to the neuromodulation you used in Bulgaria? Hope you are doing well, Latte.

[J Dimitrakov]

Latte,

The general design of the study was similar (intervention vs. sham-control), hence my question.

The specific intervention was quite different and I am skeptical about the efficacy given the energy parameteres used and their effect on neuromodulation, if any

Best regards,
JD

[coppertop]

Is this the same treatment as they would do for a kidney stone?

[webslave]

Similar, yes.

[webslave]

Beyond the Abstract - Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome in Males: A Randomised, Double-Blind, Placebo-Controlled Study

Reinhold Zimmermann, MD
Wednesday, 01 July 2009


BERKELEY, CA (UroToday.com) - At a glance one could assume that this study was solely empirical – on the contrary!

Shock waves (SWs) seem to have a greater therapeutic potential than is assumed and understood today. Finally, the effect of SW cannot be explained by current models of thinking. The recently published SW model by Wess(1) is a very promising and tremendous basic approach: SW could modify brain processes and pain storage patterns – both to be influenced therapeutically. We are going to follow these concepts by specific research investigating processes inside the brain during SW application. Possible reactions in the brain and changes under running Extracorporeal Shock Wave Treatment (ESWT) are presently the most promising approaches to understanding the working mechanisms of SW. We intend to apply SWs not only clinically, but also to enhance our knowledge by basic research about their therapeutic effects. The missing animal model for chronic pelvic pain syndrome (CPPS) does not contribute to simplifying the understanding of pathophysiological processes influenced by ESWT, in particular due to the fact that the knowledge about CPPS pathophysiology itself is very limited.

Alteration in local perfusion is one more explanation for SW effects: We know that perfusion increases immediately after SW application. As a long-term effect, the VEGF expression in treated tissue increases. There are very conclusive investigations on ischemic heart tissue in which processes of neovascularisation have been induced by ESWT and consecutive VEGF increase. Whether there is a link from increased perfusion to pain relief is, however, still unclear.

Based on most recent in vitro research we could imagine also extending this treatment to chronic bacterial prostatitis. The rationale could be several investigations proving the bactericide effects of SW. The in vitro findings could be linked with clinical effects and results in this group of patients who are still a therapeutic (and personal!) challenge to us urologists.

Finally, ESWT is a typical outpatient therapy that can be offered very easily in private offices. Unfortunately, there is no reimbursement by public health services either in Germany or in Austria at the moment. Therefore, the incentive for urologists to apply ESWT for CPPS in their private offices is low.

Additionally, many urologists are not aware of the fact that SW does not inevitably mean stone therapy, therefore equating to destruction. In fact, SWs have clearly shown tissue-regenerating effects. These effects are successfully used for the treatment of disorders of local perfusion, wound and fracture healing and even for cellulite. This fact must enter into urologists` awareness and the therapeutic potential of ESWT has to be understood. As a result of these changes, hopefully more urologists will consider this treatment as a viable option and recommend it to their CPPS patients.

Reference:

Wess OJ, A neural model for chronic pain and pain relief by extracorporeal shock wave treatment. Urol Res. 2008 Dec;36(6):327-34.

Written by:
Reinhold Zimmermann, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

[davioj]

FYI. This could be of interest...ESWL is usually used to treat kidney stones. Maybe ESWL of the perineum increases blood supply, relaxes muscle or even disrupts trigger points but I believe this is may develop into an interesting new additional potential treatment option. See below.

Eur Urol. 2009 Sep;56(3):418-24. Epub 2009 Mar 25.

Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study.
Zimmermann R, Cumpanas A, Miclea F, Janetschek G.
Department of Urology, Elisabethinen Hospital, University-affiliated Hospital, Linz, Austria. [email protected]

BACKGROUND: There is no sufficiently validated therapy for chronic pelvic pain syndrome (CPPS).

OBJECTIVE: To investigate the effects of extracorporeal shock wave therapy (ESWT) in 60 patients suffering from CPPS.

DESIGN, SETTING, AND PARTICIPANTS: Sixty patients suffering from CPPS for at least 3 mo were investigated in two groups. Both groups were treated four times (once per week), each by 3000 impulses; group 2 was performed as a sham procedure. The investigation was designed as a placebo-controlled, prospectively randomised, double-blind phase 2 study. Standardised follow-up was performed 1, 4, and 12 wk after ESWT.

INTERVENTIONS: Low-energy-density ESWT was performed using a perineal approach without anaesthesia. In the placebo group, the same setting was used without shock wave energy transmission.

MEASUREMENTS: ESWT effects on pain, quality of life (QoL), erectile function (EF), and micturition were evaluated. The parameters were investigated using validated questionn aires (National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI], International Prostate Symptom Score [IPSS], International Index of Erectile Function [IIEF]) and the Visual Analog Scale (VAS) for pain evaluation.

RESULTS AND LIMITATIONS: All patients completed outpatient treatments and follow-ups without any problems. All 30 patients in the verum group showed statistically (highly) significant improvement of pain, QoL, and voiding conditions following ESWT in comparison to the placebo group, which experienced a continuous deterioration of the same parameters during the follow-up period. Perineal ESWT was easy and safe to perform without anaesthesia or any side-effects.

CONCLUSIONS: This is the first prospectively randomised, double-blind study to reveal perineal ESWT as a therapy option for CPPS with statistically significant effects in comparison to placebo. ESWT may in particular be interesting because of its easy and inexpensive application, the lack of any side-effects, and the potential for repetition of the treatment at any time.

[davioj]

http://www.superpraktijk.nl/img/uploads ... _Study.pdf

[Atari]

Amazingly this treatment is now available from one doctor in Sweden. I have booked myself for a series of treatments. The first time you go, you need to see the doctor for an examination. After the visit you can start the treatment. The number of treatments performed by the nurse is between 4-5 sessions. The nurse I spoke to stated that almost all of the earlier patients have become much better of the treatment. Many patient even came back a second time for a new series of treatments. The cost for one treatment is 50 Euro. Since I don’t belong to the county council where the doctor has his practice. I have to pay full price. I will come back with the result after I have started this treatment. It looks very promising!

[gmccormack]

Atari,

Please keep us informed through the process, it would be a big help.

[Atari]

Here comes a little update on the ESWT treatment and how I am doing. I have now done my third session with ESWT.

The clinic is a private one and in located in a smaller town in Sweden. I have to travel there to have the treatment. They are currently evaluation this method for treating Prostatitis. They are only allowed to use the method against this Prostatitis syndrome, illness or whatever it is called. They are not using the method to treat trigger points, joint pain etc.

The first time I was examined by the urologist at the clinic. There where another urologist present at the examination. Don’t exactly know his role in the treatment. But he is somehow involved/or is checking up on this treatment. He is also one of the few in Sweden that carry on research about Prostatitis. Anyhow, during the examination they located where the pain comes from. I had no pain in the prostate itself, everything looked fine. But I had small pain in Levator ani and in the sinews, muscles and joints surrounding my rectum and the prostate.

I was able to do the treatment with ESWT at the first visit. The method is performed by a physiotherapist. She first examined me, and I showed her the spots where the pain comes from. Then she draws the mouthpiece of the ESWT-machine over these spots. She uses different power on different spots; she can’t go full power over spots with bones beneath and sensitive (the prostate) spots. Some spots hurts a lot, but not more then I can manage the pain. She always keeps checking up on how I was during the treatment. Sometimes she switches mouthpiece from a small one to a bigger one. The treatment is performed for around 45 minutes including checking up on how the last treatment has gone.

And the result? Amazing! After three treatments I’m doing very well, my overall pain has dramatically gone down. The trigger points in musculus gluteus and in the stomach have gone down. But mostly the pain when sitting has almost gone away; I can now sit down the whole day at work. But I am still standing at work; don’t want to irritate the spots down there unnecessarily. I had my first cycle tour for more than 1½ year this weekend. I have been out partying and drinking two weekends in a row. I have more energy and take on old projects in my apartment.

I have already decided to do one more session after the summer. I can’t say how much better I have become. Some days I feel 90% better and some days around 50% better.

I think the doctors are on something here. I have spoken to Hacksquat on the forum. It will be fun to see if he also signs up for the treatment. And what the results will be and what he thinks of it.

Ill keep you posted on how I feel after the two last sessions. But I am little busy catching up lost time :).

[critthinker]

Super helpful, Atari. Please keep us updated!

[billy79]

Interesting..Is it possible to get a bit more info on Who/where this is located in Sweden?
after all its my neighbour country;)