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作者：Jill Stein  
出處：WebMD醫學新聞

　　June 1, 2010 (加州舊金山) — 研究者在美國泌尿科協會2010年科學會議中報告指出，包括物理治療和認知行為治療的6天專注式計劃，對嚴重難治型「慢性攝護腺炎/慢性骨盆疼痛症狀(chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS))」治療有效。
　　
　　加州Palo Alto史丹佛大學醫學院的研究顯示，對傳統治療無效、持續疼痛的男性，可以從包括聚焦在肌筋膜痛連鎖反應點治療(myofascial trigger-point therapy)和認知行為與放鬆訓練的密集式計畫中獲得幫助。
　　
　　第一作者、泌尿科教授Rodney Anderson醫師在訪談中向Medscape Urology表示，一旦你讓病患好轉，要瞭解他們的生理變化，學習如何在心智上和身體方式上控制它，這個處方效果和任何有效的口服藥物效果一樣。
　　
　　他指出，此計劃傾向用於有骨盆肌群壓痛表現的病患。
　　
　　這些男性病患進行體檢、回答疼痛症狀問卷，之後連續6天每天花幾小時接受肌筋膜痛連鎖反應點釋放，與矛盾放鬆(paradoxical relaxation)訓練，許多病患接受指導如何進行他們自己的操作。每天舉行認知行為治療課程，以幫助病患處置焦慮和與症狀有關的悲觀思考。
　　
　　整體而言，125名男性參加追蹤評估，在訓練/治療計畫後3-42個月時進行，研究對象的平均年紀是48歲，症狀期間中位數為4.8年。
　　
　　有92%男性的疼痛部位是陰莖，會陰有78%、直腸有71%。
　　
　　【多元治療可以有明顯改善】
　　結果顯示，「國家健康研究中心(NIH)-慢性攝護腺炎症狀指數(CPSI)」分數有顯著改善 (P< .001)，在6個月中位數之後，整體分數平均減少約30%。NIH-CPSI是CP/CPPS男性症狀評估一種廣被認可的工具。
　　
　　整體而言，116名病患中有70人(60%) 的NIH-CPSI整體分數減少6分以上。
　　
　　專注式計劃之後，症狀有所改善且在長期追蹤時仍持續。
　　
　　106名病患中，63人(59%)自我報告指出，在整體反應評估上，症狀有中度或顯著改善；14人(11%)指出症狀沒有改變。
　　
　　整體而言，78%的病患指出，他們持續使用放鬆影片—且有許多人每週使用不只一次。
　　
　　Anderson醫師表示，這個結果對我們有實際鼓舞，因為對這個狀況而言，實在沒有常規的治療，所有的口服藥物都可以用來嘗試治療該狀況，但是沒有實際表達其生物生理學，因為沒有人真正知道它是什麼。
　　
　　密蘇里州堪薩斯市大學醫學中心泌尿科副主席、副教授、AUA發言人Tomas L. Griebling醫師在Medscape Urology的訪問中表示，我認為這篇研究提出一個重要的臨床問題，我們發現許多CP/CPPS病患對使用於此病的一般藥物沒有反應。
　　
　　本篇研究的結果不錯，支持使用多元治療，這是我們以前未曾進行科學檢視的一個治療方式。
　　
　　Griebling醫師表示，以前，開業醫師考量這些治療方式時有些猶豫，因為我們沒有好的科學資料支持它們，而這篇研究看來設計良好且有不錯的結果。
　　
　　美國泌尿科協會(AUA)2010年科學會議：摘要?794。發表於2010年5月31日。  


Intensive Therapy Regimen Helps Men With Chronic Pelvic Pain Syndrome

By Jill Stein
Medscape Medical News

June 1, 2010 (San Francisco, California) — A 6-day immersion program involving physiotherapy and cognitive behavioral therapy is showing promise in the treatment of severely refractory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), researchers reported here at the American Urological Association (AUA) 2010 Annual Scientific Meeting.

The study, by a group from Stanford University School of Medicine in Palo Alto, California, showed that men with longstanding pain refractory to traditional treatment benefited from an intensive program involving focused myofascial trigger-point therapy and cognitive behavior and relaxation training.

"Once you get patients to turn the corner, understand what's going on in their body, and learn how to control it mentally and with physical manipulations, this regimen works as well as any oral drug has ever worked," lead author and professor of urology Rodney Anderson, MD, told Medscape Urology in an interview.

The program is intended for patients exhibiting the phenotype of pelvic musculature tenderness, he pointed out.

Men referred for treatment underwent physical examination, answered pain-symptom questionnaires, and then spent several hours per day for 6 consecutive days undergoing myofascial trigger-point release and training in paradoxical relaxation. Many patients were taught how to perform their own manipulations. Cognitive behavioral therapy sessions were held daily to help patients manage the anxiety and catastrophic thinking associated with their symptoms.

In all, 125 men participated in follow-up assessments, which were performed from 3 to 42 months after the training/treatment program. The average age of the study population was 48 years, and the median duration of symptoms was 4.8 years.

The penis was the site of pain in 92% of men, the perineum in 78%, and the rectum in 71%.

Sustained Improvements Seen With Multimodal Therapy

Results showed that scores on the National Institutes of Health (NIH)-Chronic Prostatitis Symptom Index (CPSI) improved significantly (P?< .001), with an average decrease of about 30% in total score after a median of 6 months. The NIH-CPSI is a widely validated tool for the symptomatic evaluation of men with CP/CPPS.

Overall, 70 of 116 patients (60%) had a decrease of 6?points or more in NIH-CPSI total score.

Symptomatic improvements after the immersion protocol were sustained even in patients who had longer-term follow-up.

Of 106 patients, 63 (59%) self-reported moderate or marked improvements in symptoms on the global response assessment; 14 (11%) patients indicated no change in their symptoms.

In all, 78% of patients indicated that they continue to use relaxation audiotapes — in many cases more than once weekly.

"We are really encouraged by the results, as there has really been no conventional treatment for the condition," Dr. Anderson said. "There is a whole gamut of oral agents that can be given to try to treat the condition but nothing really addresses the biophysiology of it because no one really knows what it is."

"I think this study addresses an important clinical problem. We see a lot of patients who have CP/CPPS who may not respond to the treatments usually used in this population," Tomas L. Griebling, MD, MPH, an AUA spokesperson and associate professor and vice-chair of the Department of Urology at the University of Kansas City Medical Center in Kansas City, Missouri, said in an interview with Medscape Urology.

"The results in this study were good and support the use of multimodal therapy and a type of therapy we might not have looked at in such a scientific way previously."

In the past, there has been some hesitation among practitioners to consider these types of therapies because we haven't had good scientific data to support them, and this study appears to be very well designed and has good outcomes," Dr. Griebling said.

American Urological Association (AUA) 2010 Annual Scientific Meeting: Abstract?794. Presented May?31, 2010.