Dry Needling

[smackman]

I have located a PT who specializes in dry needling. Has anyone used this for CPPS and had success?
My main issue remains Penis Tip Pain even though it is much better after changing my diet.

I cannot locate anyone who does internal massaging with a wand for CPPS. I live in zip code 71203 area.

[Caedar]

Have you located external trigger points that refer pain to your penis tip? If so, dry needling may help with TPs resistant to regular release. Does the pain feel like it's inside the urethra or around the head?

[smackman]

Inside the Uretha at the tip and also at the tip. It is better than it was one year ago but I have to keep the tip covered to keep my underwear from aggravating the situation.
I can numb the tip and the inside with a topical 4% Lidiocaine solution. I also will use a 5% Lidocainne cream to numb the tip. It always feels worse as the day progresses. I sleep with minimal issues.

[Caedar]

I see that you have a diagnosis of IC. It's likely that the urethral pain (as the lining of the urethra is similar to the lining of the bladder) is still connected to that, and the pain at the tip not at the urethra is from peripheral sensitization associated with the IC-related urethral pain. Considering it takes months to see any results from Elmiron, it might just be a waiting game for those symptoms to abate. Neuropathic pain tends to get worse through the day, so your experience matches that pattern.

Have you tried external PT at all? I'd look into that more thoroughly before starting to think about dry needling.

[smackman]

I was diagnosed with IC using the Potassium Chloride Test On April 16 2013. I had been in pain for months; This was my 5th urologist. I changed to the IC diet, been taking Elmiron since April 16 also along with A low dose of Elavil at night.

I have never been scoped; I do not want to be scoped but sometimes I wish one of the 5 urologists would have done this procedure so I would definitely know if it was a bladder issue causing referred pain.

I have never tried regular PT. Why would you suggest this first instead of Dry Needling? I am just trying to learn and get well. I have had this penis tip pain since Oct. 2012. I just woke up with it one day.

Lidocaine helps big time; I have trouble understanding why when it is referred pain from the bladder. My whole penis used to burn but that sensation is basically gone. The IC diet I feel helped me also.

Thanks for the replies and help.

[webslave]

That opioid patch you are using is a mixed blessing. Opioids goose mast cells, and that can make conditions like CPPS/IC worse.

[Caedar]

I was diagnosed with IC using the Potassium Chloride Test On April 16 2013. I had been in pain for months; This was my 5th urologist. I changed to the IC diet, been taking Elmiron since April 16 also along with A low dose of Elavil at night.

I have never been scoped; I do not want to be scoped but sometimes I wish one of the 5 urologists would have done this procedure so I would definitely know if it was a bladder issue causing referred pain.

Scoping can be helpful, but only about 10% of IC patients have Hunner's ulcers (part of what some urologists call a "classical IC phenotype"), which would be the main finding of the scoping. With the minor pain you're in now compared to earlier, it might not be worth pursuing at this point.

I have never tried regular PT. Why would you suggest this first instead of Dry Needling? I am just trying to learn and get well. I have had this penis tip pain since Oct. 2012. I just woke up with it one day.

Definitely seek external PT before dry needling, as they serve essentially the same purpose (release of trigger points). You will be able to do PT at home, while dry needling must be done by a trained therapist to be safe.

Lidocaine helps big time; I have trouble understanding why when it is referred pain from the bladder. My whole penis used to burn but that sensation is basically gone. The IC diet I feel helped me also.

It might not be referred pain. Urethral pain is a typical symptom of IC, as the urethra is linked to the bladder and the lining of at least part of the urethra is composed of the same epithelial cells as the bladder. Beyond that explanation, bodily structures have the ability to cause inflammation in other areas linked by the nervous system ("neurogenic inflammation"). Also, inflammatory factors (histamines, etc.) in your urine from your bladder might also be irritating your urethra. Finally, sustained pain can sensitize the peripheral and even central nervous system, meaning that even if the area in pain isn't receiving any normally painful input, you can still be in pain; this phenomenon is why I said that the pain you're feeling at the tip might be left over from the pain throughout your whole penis.

[smackman]

My best pain relief seems to be Ativan. I can take 1 mg of Ativan and my pain subsides. I realize Ativan is a benzo and addictive which is not good but I have to have relief. I take up to 3 mg of Ativan over a 24 hour period.

I have read Webslave comments about my 26 mcg/hr Fentanyl Patch. All I can say is I have been using this patch since 2006. My problems with IC/CPPS started in Oct. 2012 after a night of unprotected anal sex. NO infection was ever found and I had many test ran. I actually stopped Lortab 10/500(4X a day) several months ago after 7 years of dependency, It did not help my IC in the least bit.

I ask my Pain Management Doctor about Opiates causing IC pain. He had never heard of this but I realize he is not a IC/CPPS specialist.

Today, my entire penis is mildly burning; Have no answer to why because I remain on a strict diet the IC diet. It is a 2 on a pain scale of 0-10 and is now subsiding since I took 1mg of Ativan 30 min ago.

This chronic issue is/has taking a toll on my life.

[Caedar]

I have read Webslave comments about my 26 mcg/hr Fentanyl Patch. All I can say is I have been using this patch since 2006. My problems with IC/CPPS started in Oct. 2012 ... I ask my Pain Management Doctor about Opiates causing IC pain. He had never heard of this but I realize he is not a IC/CPPS specialist.

The reason opiates can cause IC/CPPS pain is because these disorders likely are connected with mast cell degranulation, which releases inflammatory factors (including histamines, in the bladder). Opiates can cause mast cells to degranulate more readily; considering that opiates were in your system for many years before you developed IC/CPPS, they may have helped cause the IC/CPPS. Are you comfortable talking about why you currently use the Fentanyl patch? If you have other methods of pain relief, getting off opioids may help reduce your IC pain even further.

Today, My entire penis is mildly burning; Have no answer to why

As for why your entire penis might be burning right now, I point back to the sensitization idea that I described in my earlier post. As the body experiences chronic pain, it becomes sensitized. The body can also develop pain triggers (such as thinking about how your entire penis used to burn) that can cause pain to reoccur without painful input. Also, thinking about the pain could have caused you to tense certain pelvic floor muscles without realizing it. It's entirely possible that you aren't having inflammatory IC pain; this could just be a little blip of sensitization and muscle tension.

[smackman]

I wear the Fentanyl Patch due to a major back injury in Sept 2003. I had surgery in Jan. 2006 on my back called a T11,T12 Anterior Corpectomy. The surgery was delayed so long because Workers Compensation Doctors kept denying my surgery which caused me major pain issues. T12 was compressed 80% and split. T11 was compressed 60%. Anyway, the surgery was successful in that the bad vertebrae were removed and replaced with a titanium cage, a titanium plate, bolts and screws. Part of a rib was removed to graft into the titanium cage. My facet nerves are damaged and I have chronic pain; Hence the Opiate.

I was declared totally disabled in 2006 at age 48.

I do not know what I could replace the Fentanyl Patch with. I am "dependent" of it or addicted for a better word after 7 years of use. I tried Radio Frequency Ablation of the Facet Nerves but getting to the nerves in the thoracic area is dangerous so I had little luck there.

I would love to get off this Fentanyl Patch. I kicked the Lortab with the help of Neurontin but I tried to kick the Fentanyl patch by slowly reducing the size of the patch using Mylan Patches; these patches can be cut. The pain in my back was horrendous and I just could not do it. Plus the withdrawals were really bad even on a slow taper. At this point in my life, It would be difficult to stop the opiate. My anxiety level is high due to this IC/CPPS issue. I also have had AFIB issues with my heart but that is under control the last 3 months.

Your explanations seem spot on; I just feel my progress has stopped in the last 6 months.

[Caedar]

I do not know what I could replace the Fentanyl Patch with. I am "dependent" of it or addicted for a better word after 7 years of use.

I too am not sure what you could replace the Fentanyl patch with. I believe high-concentration capsaicin patches have been shown to be effective with low back pain; perhaps combining this with a higher dose of gabapentin or other adjunct? In any case, it's something you should consider talking to your doctor about.

Although you are already on a number of medication, one other medication to consider to counter the mast cell degranulation of the Fentanyl would be Atarax (hydroxyzine), which is a commonly prescribed anti-histamine for IC. At the low doses prescribed for IC (usually ~10 mg), the side effects are often not bad. You should certainly pursue external PT, though, regardless of any medication decisions or exploration. There are ways that you can work with your IC/CPPS at this point; don't give up hope! :)

[smackman]

I start external Physical Therapy next Monday on my lower back /pelvic region to see if I can get some relief.

He will not dry needle unless he sees a need in it. This therapist is considered "the best" in my part of the world when dealing with the pelvic region. My 1st visit will be a e-valve then my therapy will start.

Hoping and believing for the best outcome. No one in my area does internal PT for the pelvic area. Maybe one day someone will..

[smackman]

Started sessions with PT; I have been Dry needle in 2 sessions. I will tell more as I continue my therapy but it seems to be helping. When he Dry Needles certain trigger points, I can feel the sensation in my groin area.

[Caedar]

Which trigger points seem to be helping?

[smackman]

It is hard for me to say which specific trigger points are helping. He tells me but I cannot recall the names.

I have had 3 sessions; The last was around the sacral area and buttocks. I feel really bad the next 24 hours like something is being released when these trigger points are dry needled. I just feel "run down" tired. Maybe it is the stress of all of this.

I just want to be relieved of this penis tip pain; It is so annoying. Whether I have IC or CPPS or both IT SUCKS!