Effectiveness of acupuncture for Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)

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The prostate is a small gland in men located at between the penis and bladder. The prostate can be inflamed called prostatitis which can be very painful and distressing. Prostatitis can develop in men of all ages. However, it commonly affects men aged between 30 and 50. It can be acute or chronic and it also can be caused by infection and non-infection. Chronic nonbacterial prostatitis is most common. About 90% men with chronic prostatitis have chronic prostatitis/chronic pelvic pain syndrome(CPPS). Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects approximately 90% to 95% of men worldwide. The most prominent symptom is chronic pain in the region of the pelvis. Pain can be in the perineum, testicles, tip of penis, pubic or bladder area and may spread out to the back and rectum; and it is often associated to accompanied with bladder pain, urination pain, frequent urination and urgency, ejaculatory pain, erectile dysfunction, and psychosocial symptoms, lasting for at least 3 to 6 months. Post ejaculatory pain may be present. The cause of CP/CPPs is not clear, but it may be related to hormonal changes, autonomic nervous system imbalance , abnormal local or systemic inflammation, altered immune function and genetic factors. Stress could be a contributing factor for CP/CPPS. The treatments can be challenging with limited success.

The idea of acupuncture treatment for CP/CPPS has been accepted in Western countries. Capodice JL et al in USA investigated the effect of acupuncture on CP/CPPS. There were 10 men aged between 18-65 participated the study. They have been diagnosed with chronic prostatitis for greater 6 months, had at least 1 conventional therapy antibiotics, anti-inflammatory agents, 5-α reductase inhibitors or α-1 blockers), scoring >4 on the pain subset of the NIH-CPSI which was used to assess the severity of the CP/CPPS. After 3 weeks, 6 weeks of acupuncture treatment and 6 weeks of followup the NIH-CPSI scores were significantly decreased. Pain and urinary symptoms and quality of life were also significantly improved. No side effects were reported. They suggested that acupuncture cold be the effective treatment option for patients with CP/CPPS.

The benefits of acupuncture on CP/CPPS have been well established according to clinical trials. It is listed in the guidelines of European Association Urology. How many treatments needed are uncertain. In published research paper 6-24 sessions are normally used. A study using meta-regression approach explored the dose-response association between acupuncture sessions and acupuncture effects on chronic prostatitis/chronic pelvic pain syndrome. The result involving 329 participants has shown that overall, more acupuncture sessions received for CP/CPPS patients is associated with increased symptom relieving. After 6 acupuncture sessions, the NIH-CPSI decreased from 26.1 to 18.5 and 18 acupuncture sessions could reach a clinically meaningful improvement regarding NIH-CPSI score. Prolonged acupuncture sessions were associated with less NIH-CPSI score. They concluded that there is dose-response relationship between acupuncture sessions and CP/CPPS outcome. Six acupuncture sessions might be the minimal required 'dose' to reach its clinical effects.

A study summarised research paper up to February 2019 about acupuncture on CP/CPPS with total 11 studies involved in 748 patients with CP/CPPS. The result has shown that acupuncture significantly reduced the pain score for CP/CPPS ad improved patient’s quality of life with little side effects.

Why can acupuncture be used to treat chronic prostatitis/CPPS? Acupuncture has been proved in effectively treating chronic prostatitis/CPPS. The mechanisms are also studied in current research to provide scientific evidence for the treatment and it is suggested that acupuncture reduces local inflammation and improves local microcirculation. Acupuncture was seen to increase immunoglobulin A in the prostatic fluids and improve local immune function of the prostate. It was also seen that interleukin-2 and testosterone, tumor necrosis factor-α (TNF-α) and the expression of intercellular adhesion molecule 1 (ICAM-1) were altered which were involved in inflammatory reaction. For example a recent study participated by 47 patients with CP/CPPS. After received acupuncture treatments pain or discomfort score decreased remarkably as compared with that before treatment. The levels of IL-8, IL-10 and TNF-alpha which were inflammatory markers were lower than those before treatment. The positive correlation was obtained between IL-10 level and pain score. They suggested that acupuncture has significant efficacy on CP/CPPS through reducing IL-10 level to ease pain, and reducing the levels of IL-8 and TNF-alpha to relieve inflammatory reaction. Recently, a small sample clinic trial was conducted to investigate the mechanism of acupuncture underlying the treatment of chronic prostatitis/CPPS. 12 patients participated the study. Immune function tests were performed before and after 10 weeks acupuncture treatment. At the end of study 67% responded the treatments. The acupuncture group averaged a 5% increase in natural killer cell levels compared to control group. Similarly, patients randomized to acupuncture reported a reduction in other white blood cell parameters examined. This study supported the possibility that immunity might be important in the pathophysiology of CP/CPPS and suggested potential mechanism of acupuncture treatment. References

Qin Z et al Ann Transl Med 2019 Mar;7(6):116. doi: 10.21037/atm.2018.11.45.

Engeler D, Baranowski AP, Borovicka J, et al. EAU Guidelines on Chronic Pelvic Pain. 2017. Available online:

Capodice JL et al Chin Med (2007) 2:1

Li J et al Pain Res Manag. 2020 Mar 9;2020:5921038. doi: 10.1155/2020/5921038. eCollection 2020. Yang ZX et al Zhong Xi Yi Jie He Xue Bao (2012) 10:293-7 Yuan SY et al Zhongguo Zhen Jiu (2011) 31:11-4 Ohlsen BA J Chiropr Med (2013) 12:182-90 Lee SW et al Complement Ther Med (2014) 22:965-9

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