Stress-induced HPA axis changes in CP/CPPS

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Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/chronic pelvic pain syndrome

Tuesday, 13 October 2009
Department of Urology, Stanford University School of Medicine, Stanford, California.

Chronic pelvic pain in men has a strong relationship with biopsychosocial stress and central nervous system sensitization may incite or perpetuate the pain syndrome. We evaluated patients and asymptomatic controls for psychological factors and neuroendocrine reactivity under provoked acute stress conditions.

Men with pain (60) and asymptomatic controls (30) completed psychological questionnaires including the Perceived Stress, Beck Anxiety, Type A behavior and Brief Symptom Inventory for distress from symptoms. Hypothalamic-pituitary-adrenal axis function was measured during the Trier Social Stress Test with serum adrenocorticotropin hormone and cortisol reactivity at precise times, before and during acute stress, which consisted of a speech and mental arithmetic task in front of an audience. The Positive and Negative Affective Scale measured the state of emotions.

Patients with chronic pelvic pain had significantly more anxiety, perceived stress and a higher profile of global distress in all Brief Symptom Inventory domains (p < 0.001), scoring in the 94th vs the 49th percentile for controls (normal population). Patients showed a significantly blunted plasma adrenocorticotropin hormone response curve with a mean total response approximately 30% less vs controls (p = 0.038) but no differences in any cortisol responses. Patients with pelvic pain had less emotional negativity after the test than controls, suggesting differences in cognitive appraisal.

Men with pelvic pain have significant disturbances in psychological profiles compared to healthy controls and evidence of altered hypothalamic-pituitary adrenal axis function in response to acute stress. These central nervous system observations may be a consequence of neuropsychological adjustments to chronic pain and modulated by personality.

Written by:
Anderson RU, Orenberg EK, Morey A, Chavez N, Chan CA. Are you the author?

Reference:
J Urol. 2009 Sep 15. Epub ahead of print.
doi:10.1016/j.juro.2009.07.042

PubMed Abstract
PMID:19762053

[carld]

This is huge...

We have always associated stress and anxiety with our syndrome. Again the irony we have said about the old school uros saying it's all in our heads is so ironic...They were right after all...

Here is the key factor...what came first the chicken or the egg...Were these controls prior to onset riddled with issues such as anxiety...I'm sure they were...