Burning Penis Pain: a type of allodynia?

[EnVisage]

Hello all.

There have been several posts on the topic of penis pain. The troubling sensation may be experienced during sexual activity or may be caused by nothing more than friction of the skin against underwear. It is described as "burning" or "like glass" or "like sandpaper"....all very good comparisons. (I've had this pain in varying degrees of intensity throughout my four-year-plus battle with CPPS). Many posters have mentioned a change in the color of the overlying skin. Others have been still more specific, stating that the glans of the penis appears to have more visible blood vessels and capillaries than it did before the chronic prostatitis / chronic pelvic pain syndrome began.
(See thread in the Forum (General Discussion): 'Burning Pain at Tip of Penis')

All of this strengthens my already-strong belief that many (perhaps most) cases of chronic prostatitis / chronic pelvic pain syndrome are a form of neuropathic pain / neurogenic inflammation similar to that experienced by persons with RSD (reflex sympathetic dystrophy). The latter condition is also called complex regional pain syndrome (CRPS), a more modern term. The theory of chronic prostatitis / chronic pelvic pain syndrome as a form of CRPS is discussed on this site (see sidebar: Causes>>Neurogenic Pain). The notion gains credibility when one observes that many chronic prostatitis / chronic pelvic pain syndrome sufferers experience pain relief upon taking medications typically employed against neuropathic pain....Elavil, etc.

Persons with CRPS experience chronic or escalating pain (usually in a limb) following injury to the nerves in that region. Characteristic signs of CRPS include:
- changes in color of overlying skin. Typically, the region takes on a dark red or purplish hue, owing to vascular changes (blood vessels & capillaries either constricting or dilating).
- allodynia. This is a term applied to a peculiar type of pain in which discomfort arises from stimuli that do not normally cause pain sensations. For example, the light touch of a garment causes pain that is typically described by the patient as "burning".
http://www.uspharmacist.com/ce/neuropathic/default.htm
It all sounds a lot like the penis pain and discoloration described by many chronic prostatitis / chronic pelvic pain syndrome sufferers. If chronic prostatitis / chronic pelvic pain syndrome is indeed neuropathic in nature, then perhaps the penis pain is a kind of allodynia (?)

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and acetaminophen (paracetamol) have typically proved ineffective against neuropathic pain. COX-2 inhibitors (cyclooxegenase inhibitors) are likewise unable to exert a measurable influence on deep-seated nerve pain. However, the cycloogenase inhibitors may slightly "suppress tactile allodynia" (see http://www.uspharmacist.com/ce/neuropathic/default.htm, reference #11). In most countries, pharmaceutical COX-2 inhibitors (such as Celebrex) can only be obtained with a doctor's prescription. It's worth noting, though, that several natural substances exert a measure of cyclooxgenase inhibition. These include:
- the omega-3 fatty acids in salmon oil
- curcumin in turmeric (a common kitchen spice)
- ginger root extract.
- Herbs that have COX-2 inhibition activity include Devil's Claw and White Willow Bark.
http://www.iasp-pain.org/TC98SeptOct.html
http://store.yahoo.com/iherb/cox2tame.html

The two types of oral medication that have proved most successful in the treatment of neuropathic pain are gabapentin (trade name Neurontin), thought to act by blocking the NMDA receptor, and low-dose TCAs such as amitriptyline (e.g. Elavil), which increase activity of norepinephrine at the alpha-2 adrenergic receptor. As I've mentioned in other posts, the herb kava is thought to be a mild NMDA-blocker, while St John's wort (hypericum) seems to raise levels of serotonin and norepinephrine in a fashion similar to TCAs. Both herbs are used by "alternative practitioners" in the management of chronic pain. Kava is also purported to relieve painful muscle spasm.
http://www.vitastand.com/information/stjohnswort.htm
http://www.i-nutraceutical.com/herbal.html
http://www.healthwwweb.com/herbmed/piper.html
Also a book reference: The Healing Power of Vitamins, Minerals and Herbs (published by Reader's Digest).

(I've tried both St John's wort and kava and have indeed experienced a reduction in both the aching pain and the more superficial penis pain. Placebo effect? I don't think so. The placebo effect (in the context of analgesia) is thought to be mediated by endorphins, to which nerve pains are largely resistant).

I have also found it useful to avoid food substances that can be classed as "excitotoxins", most notably MSG (monosodium glutamate) and the controversial artificial sweetener aspartame.
http://molecular.biosciences.wsu.edu/Fa ... _fibro.htm
http://www.nexusmagazine.com/Aspartame.html

[Ken]

These drugs seemd to help me, but unfortunatly I am very prone to side effects. The Neurotin made my right upper arm and shoulder numb like pins and needles along with involuntary muscle twitching.

The Elavil just caused the involuntary muscle twitching.

These symptoms dissapeared several days after not taking these drugs.

[MS]

The Neurotin made my right upper arm and shoulder numb like pins and needles along with involuntary muscle twitching.

Have you tried Gabatril (tiagabine) or Trileptal (oxcarbazepine) as a substitute for Neurontin?

[Ken]

No, I am gave up on all the drugs except Ultram. I have been doing Stim therapy every day now. I have been feeling a hell of allot better the last few days. I hope it is because of the Stim and not just some kind of flare
down. However this is the best I've felt since I came down with chronic prostatitis / chronic pelvic pain syndrome IIIa