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Open Access 01-12-2020 | Contraception | Research article

The risk factors related to the severity of pain in patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Authors: Jing Chen, Haomin Zhang, Di Niu, Hu Li, Kun Wei, Li Zhang, Shuiping Yin, Longfei Liu, Xiansheng Zhang, Meng Zhang, Chaozhao Liang

Published in: BMC Urology | Issue 1/2020

Abstract

Background

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a disease with diverse clinical manifestations, such as pelvic pain or perineal pain. Although recent studies found several risk factors related to the pain severity of CP/CPPS patients, results were inconsistent. Here, we aimed to identify novel risk factors that are closely related to the severity of pain in patients with CP/CPPS.

Methods

We retrospectively collected the clinical records from patients with CP/CPPS from March 2019 to October 2019. The questionnaire was used to obtain related parameters, such as demographics, lifestyle, medical history, etc. To identify potential risk factors related to pain severity, we used the methods of univariate and multivariate logistic regression analyses. Further, to confirm the relationship between these confirmed risk factors and CP/CPPS, we randomly divided CP/CPPS patients into the training and the validation cohorts with a ratio of 7:3. According to the co-efficient result of each risk factor calculated by multivariate logistic regression analysis, a predicting model of pain severity was established. The receiver operating characteristic curve (ROC), discrimination plot, calibration plot, and decision curve analyses (DCA) were used to evaluate the clinical usage of the current model in both the training and validation cohorts.

Results

A total of 272 eligible patients were enrolled. The univariate and multivariate logistic regression analysis found that age [odds ratio (OR): 2.828, 95% confidence intervals (CI): 1.239–6.648, P = 0.004], holding back urine (OR: 2.413, 95% CI: 1.213–4.915, P = 0.005), anxiety or irritability (OR: 3.511, 95% CI: 2.034–6.186, P < 0.001), contraception (OR: 2.136, 95% CI:1.161–3.014, P = 0.029), and smoking status (OR: 1.453, 95% CI: 1.313–5.127, P = 0.013) were the risk factors of pain severity. We then established a nomogram model, to test whether these factors could be used to predict the pain severity of CP/CPPS patients in turn. Finally, ROC, DCA, and calibration analyses proved the significance and stability of this nomogram, further confirmed that these factors were closely related to the pain severity of CP/CPPS patients.

Conclusions

We identify age, holding back urine, anxiety or irritability, contraception, and smoking are risk factors closely related to the pain severity in patients with CP/CPPS. Our results provide novel inspirations for clinicians to design the personalized treatment plan for individual CP/CPPS patient who has suffered different encounters.

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Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998;159(4):1224–8.PubMedCrossRef

Schwartz ES, Xie A, La JH, Gebhart GF. Nociceptive and inflammatory mediator upregulation in a mouse model of chronic prostatitis. Pain. 2015;156(8):1537–44. https://doi.org/10.1097/j.pain.0000000000000201.PubMedPubMedCentralCrossRef

Rees J, Abrahams M, Doble A, Cooper A, Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015;116(4):509–25. https://doi.org/10.1111/bju.13101.PubMedPubMedCentralCrossRef

Liang CZ, Li HJ, Wang ZP, et al. The prevalence of prostatitis-like symptoms in China. J Urol. 2009;182(2):558–63. https://doi.org/10.1016/j.juro.2009.04.011.PubMedCrossRef

Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282(3):236–7. https://doi.org/10.1001/jama.282.3.236.PubMedCrossRef

Murphy SF, Schaeffer AJ, Thumbikat P. Immune mediators of chronic pelvic pain syndrome. Nat Rev Urol. 2014;11(5):259–69. https://doi.org/10.1038/nrurol.2014.63.PubMedPubMedCentralCrossRef

Magistro G, Wagenlehner FME, Grabe M, Weidner W, Stief CG, Nickel JC. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2016;69(2):286–97. https://doi.org/10.1016/j.eururo.2015.08.061.PubMedCrossRef

Magri V, Wagenlehner FM, Marras E, et al. Influence of infection on the distribution patterns of NIH-Chronic Prostatitis Symptom Index scores in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Exp Ther Med. 2013;6(2):503–8. https://doi.org/10.3892/etm.2013.1174.PubMedPubMedCentralCrossRef

Tadros NN, Shah AB, Shoskes DA. Utility of trigger point injection as an adjunct to physical therapy in men with chronic prostatitis/chronic pelvic pain syndrome. Transl Androl Urol. 2017;6(3):534–7. https://doi.org/10.21037/tau.2017.05.36.PubMedPubMedCentralCrossRef

10.

Wagenlehner FM, van Till JW, Magri V, et al. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2013;63(5):953–9. https://doi.org/10.1016/j.eururo.2012.10.042.PubMedCrossRef

11.

Chen X, Hu C, Peng Y, et al. Association of diet and lifestyle with chronic prostatitis/chronic pelvic pain syndrome and pain severity: a case–control study. Prostate Cancer Prostatic Dis. 2016;19(1):92–9. https://doi.org/10.1038/pcan.2015.57.PubMedCrossRef

12.

Zhang R, Sutcliffe S, Giovannucci E, et al. Lifestyle and risk of chronic prostatitis/chronic pelvic pain syndrome in a cohort of United States male health professionals. J Urol. 2015;194(5):1295–300. https://doi.org/10.1016/j.juro.2015.05.100.PubMedPubMedCentralCrossRef

13.

Magistro G, Wagenlehner FME, Grabe M, et al. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2016;69(2):286–97. https://doi.org/10.1016/j.eururo.2015.08.061.PubMedCrossRef

14.

Lee SH, Lee BC. Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology. 2009;73(5):1036–41. https://doi.org/10.1016/j.urology.2008.10.047.PubMedCrossRef

15.

Litwin MS, McNaughton-Collins M, Fowler FJ Jr, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999;162(2):369–75. https://doi.org/10.1016/s0022-5347(05)68562-x.PubMedCrossRef

16.

Barry MJ, Simmons LH. Prevention of prostate cancer morbidity and mortality: primary prevention and early detection. Med Clin North Am. 2017;101(4):787–806. https://doi.org/10.1016/j.mcna.2017.03.009.PubMedCrossRef

17.

Manuel RG, Zelber SS, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol. 2017;67(4):829–46. https://doi.org/10.1016/j.jhep.2017.05.016.CrossRef

18.

Anwar T, Cooper CS, Lockwood G, Storm DW, et al. Assessment and validation of a screening questionnaire for the diagnosis of pediatric bladder and bowel dysfunction. J Pediatr Urol. 2019;15(5):528.e1–.e8. https://doi.org/10.1016/j.jpurol.2019.07.016.CrossRef

19.

Dunstan DA, Scott N, Todd AK. Screening for anxiety and depression: reassessing the utility of the Zung scales. BMC Psychiatry. 2017;17(1):329. https://doi.org/10.1186/s12888-017-1489-6.PubMedPubMedCentralCrossRef

20.

Nelson PR, Chen P, Battista DR, et al. Randomized trial to compare smoking cessation rates of snus, with and without smokeless tobacco health-related information, and a nicotine lozenge. Nicotine Tob Res. 2019;21(1):88–94. https://doi.org/10.1093/ntr/nty011.PubMedCrossRef

21.

Bajpayee P, Kumar K, Sharma S, et al. Prostatitis: prevalence, health impact and quality improvement strategies. Acta Pol Pharm. 2012;69(4):571–9.PubMed

22.

Nickel JC, Nyberg LM, Hennenfent M. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network. Urology. 1999;54(2):229–33. https://doi.org/10.1016/s0090-4295(99)00205-8.PubMedCrossRef

23.

Nickel JC, Alexander R, Anderson R, et al. Prostatitis unplugged? Prostatic massage revisited. Tech Urol. 1999;5(1):1–7.PubMed

24.

Zhang J, Zhang X, Cai Z, Li N, Li H. The lifetime risk and prognosis of chronic prostatitis/chronic pelvic pain syndrome in the middle-aged Chinese males. Am J Mens Health. 2019;13(4):1557988319865380. https://doi.org/10.1177/1557988319865380.PubMedPubMedCentralCrossRef

25.

Wei L, Champman S, Li X, et al. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China. BMJ Open. 2017;7(10):e017293. https://doi.org/10.1136/bmjopen-2017-017293.PubMedPubMedCentralCrossRef

26.

Cheah PY, Liong ML, Yuen KH, et al. Chronic prostatitis: symptom survey with follow-up clinical evaluation. Urology. 2003;61(1):60–4. https://doi.org/10.1016/s0090-4295(02)02081-2.PubMedCrossRef

27.

Wang Y, He L, Zhou Z, et al. The association between metabolic syndrome and the National Institutes of Health Chronic Prostatitis Symptom Index: results from 1673 men in China. Urology. 2013;82(5):1103–7. https://doi.org/10.1016/j.urology.2013.06.007.PubMedCrossRef

28.

Schaeffer AJ, Landis JR, Knauss JS, et al. Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J Urol. 2002;168(2):593–8.PubMedCrossRef

29.

McNaughton Collins M, Pontari MA, O'Leary MP, et al. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med. 2001;16(10):656–62. https://doi.org/10.1111/j.1525-1497.2001.01223.x.PubMedPubMedCentralCrossRef

30.

Pavone C, Caldarera E, Liberti P, et al. Correlation between chronic prostatitis syndrome and pelvic venous disease: a survey of 2,554 urologic outpatients. Eur Urol. 2000;37(4):400–3. https://doi.org/10.1159/000020185.PubMedCrossRef

31.

Gallo L. Effectiveness of diet, sexual habits and lifestyle modifications on treatment of chronic pelvic pain syndrome. Prostate Cancer Prostatic Dis. 2014;17(3):238–45. https://doi.org/10.1038/pcan.2014.18.PubMedCrossRef

32.

Randolph ME, Pinkerton SD, Bogart LM, Cecil H, Abramson PR. Sexual pleasure and condom use. Arch Sex Behav. 2007;36(6):844–8. https://doi.org/10.1007/s10508-007-9213-0.PubMedPubMedCentralCrossRef

33.

Anderson RU, Orenberg EK, Morey A, Chavez N, Chan CA. Stress induced hypothalamus-pituitary-adrenal axis responses and disturbances in psychological profiles in men with chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2009;182(5):2319–24. https://doi.org/10.1016/j.juro.2009.07.042.PubMedCrossRef

34.

Clemens JQ, Calhoun EA, Litwin MS, et al. Validation of a modified National Institutes of Health chronic prostatitis symptom index to assess genitourinary pain in both men and women. Urology. 2009;74(5):983–987.e9873. https://doi.org/10.1016/j.urology.2009.06.078.PubMedPubMedCentralCrossRef

Title: The risk factors related to the severity of pain in patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome
Authors: Jing Chen
Haomin Zhang
Di Niu
Hu Li
Kun Wei
Li Zhang
Shuiping Yin
Longfei Liu
Xiansheng Zhang
Meng Zhang
Chaozhao Liang
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Contraception
Prostatitis
Pain Syndromes
Anxiety
Published in: BMC Urology / Issue 1/2020
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/s12894-020-00729-9

At a glance: The STEP trials

Springer Medicine

The risk factors related to the severity of pain in patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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