UCPPS - Prostatitis, Interstitial Cystitis Forum

Is the pain of chronic prostatitis / chronic pelvic pain syndrome considered neuropathic, or is it just muscular?

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.

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.

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.

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.

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.

Both would be my guess too, Jay.

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.

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) 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.

Hi graeme,

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 ...

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