Chronic pelvic pain is not a topic men often speak about openly. But it is a significant issue affecting up to 6.3% of the population in the United States and 14% of the population worldwide (1). In the past, chronic pelvic pain was associated with the inflammation or infection in the prostate. However, the vast majority of individuals with CP symptoms - over 90 per cent - experience symptoms without an infection or prostatic issue.
This has lead to the creation of Chronic Pelvic Pain Syndrome (CPPS), also called Chronic Prostatitis Category III, Chronic Prostatitis without an inflection (previously referred to as prostadynia).
Men with CPPS suffer from pelvic pain, painful, frequent, urgent, or difficult urination, as well as sexual dysfunction. Pain is not only located in the pelvis or pelvic floor but also in the genitals, lower back, or the lower abdomen (2). These symptoms can be severe and affect all aspects of your life leading to challenges at work and educational opportunities, and trouble in relationships.
Traditional Chinese Medicine Physicians have been using acupuncture to treat these symptoms for over 2000 years. Even though as many as 35% of men over the age of 50 suffer from chronic prostatitis, few know they can use acupuncture for treatment.
Most Americans tend to think of acupuncture for back and knee pain. In China, people seek acupuncture for a wide range of diseases, including chronic prostatitis/ chronic pelvic pain syndrome, and benign prostatic hypertrophy (BHP). In the acupuncture and Traditional Chinese Medicine (TCM) departments of the Hunan University of TCM, I saw first hand many men finding relief from the symptoms of those conditions.
How does acupuncture help treat Chronic Pelvic Pain Syndrome?
Acupuncture and Chinese medicine provide a holistic approach to healing and are effective treatments to relieve the pain, improve sexual function, and decrease urinary problems associated with Chronic Pelvic Pain Syndrome. Acupuncture is a natural treatment with very few side effects.
In fact, Chinese medicine’s 2000 years of history could possibly make it the most used treatment for Chronic Pelvic Pain Syndrome of all time. In one of Chinese medicine’s earliest text called Elementary Questions, TCM has described the diagnosis and treatment many syndromes characterized by painful, frequent, and urgent urination with pain and distention of the lower abdomen and pelvis (3). Of course, this syndrome was not called Chronic Pelvic Pain Syndrome or Chronic Prostatitis at the time. But the practice of Chinese medicine has shown that those same principles of diagnosis and treatment are effective when applied to the symptoms caused by Chronic Pelvic Pain Syndrome.
Acupuncture works to reduce pain and inflammation through regulating neural pain pathways, stimulating the release of natural pain relievers in the body, such as opioids, as well as regulating pain relieving opioid receptors. Many studies have also shown acupuncture to have a anti-inflammatory effect, reducing the circulating inflammatory hormones in the blood (4).
Acupuncture Treatment for Chronic Pelvic Pain
Traditional Chinese Medicine has a holistic approach to diagnosis and treatment, identifying specific imbalances in the body and using acupuncture, Chinese herbs, and acupressure to correct them. The symptoms of pain, urinary changes, sexual dysfunction, as well as digestion, energy, sleep are all factored into identifying the cause of the issues. Examining the muscles within the lower back, pelvis, and legs often reveals trigger points which refer pain to the pelvic floor. The gluteus maximus and medius, adductor magnus, and illopsoas are among the most common problematic muscles. In addition, sacro-iliac joint should be examined for dysfunction. Correcting the imbalance does not just treat the symptoms or mask the condition, but rather corrects the root of the problem by encouraging self-healing of the body.
Chinese medicine works best as a combination therapy that includes acupuncture, tui na (acupressure), and other therapies such as gua sha and cupping. Chinese herbs are also effective and may be required for certain people. Acupuncture diagnosis and treatment focuses on identifying the specific root imbalance causing the condition and tailoring the treatment for you.
During the first visit, your practitioner will complete a medical history and an in depth physical examination, which focuses on an examination of acupuncture points and trigger points of the lower back, abdomen, hips, and pelvis. This information creates the picture of the specific imbalance causing the problem.
Often, men will have significant reduction in pain within a few weeks of treatment. The full treatment course normally lasts a number of months. It is like peeling off the layers of an onion until you correct the root cause of the problem.
Research on Acupuncture for CP/CPPS
A number of research studies have shown positive results for acupuncture's effect on prostatitis. One small placebo controlled study included 12 bi-weekly sessions of electro-acupuncture (EA) vs. advice and exercise with sham electro-acupuncture (SEA), and advice and exercise (AE) alone (5). Acupuncture points used included bilateral stimulation of Ciliao BL-32, Zhongliao BL-33 and Huantiao GB-30. All twelve participants in the EA group had at least a six-point reduction in total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores compared to only two of the 12 in the SEA group. The reduction in the EA group was significant compared to both the SEA and AE groups in terms of both NIH-CPSI total score and pain levels.
Another small study included ten men with category III CP/CPPS were given a standardised acupuncture treatment twice weekly for six weeks (6). Deqi was obtained at acupuncture points including Waiguan SJ-5, Zulinqi GB-41, Taichong LIV-3, Hegu L.I.-4, Diji SP-8 and Sanyinjiao SP-6, and the auricular points Shenmen, Kidney, Liver, Lung and Spleen were needled unilaterally, alternating ears between visits. The needles were retained for 20 to 25 minutes and re-stimulated utilising the scraping and even needle techniques. The decrease in NIH-CPSI scores after three and six weeks following treatment were significant (P<.006), as were decreases in total symptoms and improvement in quality of life (P<.0002). Improvement in the quality of life survey also showed significant improvement in quality of life in categories such as physical function, role limitations, emotional heat, vitality, social functioning, and bodily pain. There were no adverse effects. These studies support the use of acupuncture a safe and effective treatment of Chronic prostatitis/Chronic Pelvic Pain Syndrome.
References:
1. Daniels NA, Link CL, Barry MJ, & McKinlay JB. (2007) Association between past urinary tract infections and current symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome. J Natl Med Assoc. May (5), 509-16.
2. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (Current Clinical Urology). Daniel A. Shoskes (ed.) Humama, Totowa, NJ. 2008.
3. Wiseman N, Feng Y. A Practical Dictionary of Chinese Medicine. Brookline, MA: Paradigm; 1998:583.
4. Napadow V, Ahn A, Longhurst J, et.al. The Status and Future of Acupuncture Mechanism Research. J Altern Complement Med. 2008 September; 14(7): 861–869.
5. Lee SH & Lee BC (2009). Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology. May, 73(5), 1036-41.
6. Capodice JL, Jin Z, Bemis DL, et. al. (2007) A pilot study on acupuncture for lower urinary tract symptoms related to chronic prostatitis/chronic pelvic pain. Chin Med, Feb 6(2),1.
About Joseph Alban MS, L.Ac
Joseph Alban is a New York State licensed acupuncturist and diplomate in Oriental Medicine. He graduated from Touro’s Graduate Program in Oriental Medicine and continued his Postgraduate Studies in Hunan China. His New York City acupuncture practice focuses on treating chronic pelvic pain in men and women.
For more information, please call 212.319.5757, e-mail [email protected], or go to www.AlbanAcupuncture.com.