Zusammenfassung
Das chronische Schmerzsyndrom des Beckens („chronic pelvic pain syndrome“, CPPS) ist gemäß den Richtlinien der „European Association of Urology“ charakterisiert als ein nicht-maligner Schmerz, der in Bezug auf die Strukturen des weiblichen oder männlichen Beckens über einen Zeitraum von mindestens 6 Monaten wahrgenommen wird, ohne dass eine Infektion oder offensichtliche anderweitige Pathologie vorliegt. Das CPPS beeinträchtigt die Lebensqualität von Millionen von Menschen weltweit und hat einen ähnlich großen Einfluss wie andere chronische Krankheiten, z. B. Diabetes mellitus, Morbus Crohn oder kongestive Herzinsuffizienz. Trotz mehrerer etablierter Erstlinientherapien stellt die Behandlung des CPPS eine große Herausforderung dar, da viele Patienten therapierefraktär bleiben. Unkonventionelle Behandlungsmethoden wie Neurostimulation, Neuromodulation und Akupunktur können beim CPPS eine ausgezeichnete Wirkung zeigen und haben ein vorteilhaftes Nebenwirkungsprofil. So sollten diese vielversprechenden Therapieverfahren im klinischen Alltag vermehrt eingesetzt werden.
Abstract
Chronic pelvic pain syndrome (CPPS) is defined by the European Association of Urology guidelines as a non-malignant pain perceived in structures related to the pelvis of either women or men for at least 6 months without proven infection or other obvious pathology. It affects the quality of life of millions of people worldwide and has an impact similar to that reported for other chronic diseases, such as diabetes mellitus, Crohn’s disease and congestive heart failure. The treatment of CPPS remains a challenge despite several established first line therapies because many patients are therapy refractory. Unconventional treatments, such as neurostimulation, neuromodulation and acupuncture may be highly successful for treating CPPS and have a favorable adverse event profile. Thus, these promising therapeutic alternatives should be considered more often in daily clinical practice.
Literatur
Engeler D, Baranowski AP, Elneil S et al (2012) EAU guidelines on chronic pelvic pain. http://www.uroweb.org/guidelines
Fall M, Baranowski A, Elneil S et al (2010) EAU guidelines on chronic pelvic pain. Eur Urol 57(1):35–48
Krieger J, Nyberg L Jr, Nickel J (1999) NIH consensus definition and classification of prostatitis. JAMA 282(3):236–237
NIDDK (2007) Multi-disciplinary approach to the study of chronic pelvic pain (MAPP) research network. http://www.grants.nih.gov
International Association for the Study of Pain (2008) Pain – clinical updates, in chronic pelvic and urogenital pain syndromes. Informa Healthcare, New York
International Association for the Study of Pain (2003) Pain – clinical updates, in how prevalent is chronic pain? Informa Healthcare, New York
The British Pain Society (2006) FAQ – What is the definition of chronic/persistent pain? http://www.britishpainsociety.org/media_faq.htm
American Urological Association (2011) Guideline – Diagnosis and treatment of IC and BPS. AUA, Linthicum, MD, USA
American College of Obstetricians and Gynecologists (2004) Chronic pelvic pain. Obstet Gynecol 103(3):589–605
Potts JM, Payne CK (2012) Urologic chronic pelvic pain. PAIN 153(4):755–758
Anothaisintawee T, Attia J, Nickel J (2011) Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA 305(1):78–86
Rodríguez M, Afari N, Buchwald D (2009) Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol 182(5):2123–2131
McNaughton Collins M et al (2001) Quality of life is impaired in men with chronic prostatitis the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med 16(10):656–662
Wenninger K, Heiman JR, Rothman I et al (1996) Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol 155(3):965–968
Sibert L, Rigaud J, Delavierre D et al (2010) Chronic pelvic pain: epidemiology and economic impact. Prog Urol 20(12):872–885
Marszalek M, Patard JJ, Carini M et al (2009) Chronic pelvic pain and lower urinary tract symptoms in both sexes: analysis of 2,749 participants of an urban health screening project. Eur Urol 55(2):499–508
Nickel JC, Downey J, Ardern D et al (2004) Failure of a monotherapy strategy for difficult chronic prostatitis/chronic pelvic pain syndrome. J Urol 172(2):551–554
Shoskes DA, Katz E (2005) Multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep 6(4):296–299
Fenton BW, Palmieri PA, Boggio P et al (2009) A preliminary study of transcranial direct current stimulation for the treatment of refractory chronic pelvic pain. Brain Stimul 2(2):103–107
Stojanovic M (2001) Stimulation methods for neuropathic pain control. Curr Pain Headache Rep 5(2):130–137
Herzog J, Weiss PH, Assmus A et al (2006) Subthalamic stimulation modulates cortical control of urinary bladder in Parkinson’s disease. Brain 129(12):3366–3375
Herzog J, Weiss PH, Assmus A et al (2008) Improved sensory gating of urinary bladder afferents in Parkinson’s disease following subthalamic stimulation. Brain 131(1):132–145
Kessler TM, Burkhard FC, Z’Brun S et al (2008) Effect of thalamic deep brain stimulation on lower urinary tract function. Eur Urol 53(3):607–612
Hosobuchi Y (1986) Subcortical electrical stimulation for control of intractable pain in humans. J Neurosurg 64(4):543–553
Sikiru L, Shmaila H, Muhammed S (2008) Transcutaneous electrical nerve stimulation (TENS) in the symptomatic management of chronic prostatitis/chronic pelvic pain syndrome – a placebo-control randomized trial. Int Braz J Urol 34(6):708–713
Kim SW, Paick JS, Ku JH (2007) Percutaneous posterior tibial nerve stimulation in patients with chronic pelvic pain: a preliminary study. Urol Int 78(1):58–62
Balken MR van, Vandoninck V, Messelink BJ et al (2003) Percutaneous tibial nerve stimulation as neuromodulative treatment of chronic pelvic pain. Eur Urol 43(2):158–163
Pannek J, Nehiba M (2003) Erste Ergebnisse der peripheren Neuromodulation nach Stoller (SANS) bei Blasenfunktionsstörungen. Urologe A 42(11):1470–1476
Balken MR van, Verguns H, Bemelmans BLH (2006) Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation. Int J Impot Res 18(5):470–475
Wöllner J, Hampel C, Kessler TM (2012) Sacral neuromodulation. BJU Int 110(1):146–159
Aboseif S, Tamaddon K, Chalfin S et al (2002) Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction. Urology 60(1):52–56
Cardarelli S, Flaborea L, Caleffi G et al (2012) Efficacy of sacral neuromodulation on urological diseases: a multicentric research project. Rivista Urol 79(2):90–96
Comiter CV (2003) Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study. J Urol 169(4):1369–1373
Elhilali MM, Khaled SM, Kashiwabara T et al (2005) Sacral neuromodulation: long-term experience of one center. Urology 65(6):1114–1117
Everaert K, Devulder J, De Muynck M et al (2001) The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Inter Urogynecol J Pelvic Floor Dysfunct 12(1):9–14
Everaert K, Kerckhaert W, Caluwaerts H et al (2004) A prospective randomized trial comparing the 1-stage with the 2-stage implantation of a pulse generator in patients with pelvic floor dysfunction selected for sacral nerve stimulation. Eur Urol 45(5):649–654
Kessler TM, Buchser E, Meyer S et al (2007) Sacral neuromodulation for refractory lower urinary tract dysfunction: results of a nationwide registry in Switzerland. Eur Urol 51(5):1357–1363
Kessler TM, Burkhard FC, Madersbacher H et al (2008) Safety of prolonged sacral neuromodulation tined lead testing. Curr Med Res Opin 24(2):343–347
Maher CF, Carey MP, Dwyer PL, Schluter PL (2001) Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis. J Urol 165(3):884–886
Martellucci J, Naldini G, Carriero A (2012) Sacral nerve modulation in the treatment of chronic pelvic pain. Int J Colorectal Dis 27(7):921–926
Otto W, Nowrotek A, Burger M et al (2012) Sacral neuromodulation as second-line treatment strategy for lower urinary tract symptoms of various aetiologies: experience of a German high-volume clinic. Aktuelle Urol 43(3):162–166
Peters KM, Feber KM, Bennett RC (2005) Sacral versus pudendal nerve stimulation for voiding dysfunction: a prospective, single-blinded, randomized, crossover trial. Neurourol Urodyn 24(7):643–647
Peters KM, Feber KM, Bennett RC (2007) A prospective, single-blind, randomized crossover trial of sacral vs pudendal nerve stimulation for interstitial cystitis. BJU Int 100(4):835–839
Peters KM, Konstandt D (2004) Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis. BJU Int 93(6):777–779
Pham K, Guralnick ML, O’Connor RC (2008) Unilateral versus bilateral stage I neuromodulator lead placement for the treatment of refractory voiding dysfunction. Neurourol Urodyn 27(8):779–781
Powell CR, Kreder KJ (2010) Long-term outcomes of urgency-frequency syndrome due to painful bladder syndrome treated with sacral neuromodulation and analysis of failures. J Urol 183(1):173–176
Scheepens WA, de Bie RA, Weil EH, van Kerrebroeck PE (2002) Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction. J Urol 168(5):2046–2050
Siegel S, Paszkiewicz E, Kirkpatrick C et al (2001) Sacral nerve stimulation in patients with chronic intractable pelvic pain. J Urol 166(5):1742–1745
Zabihi N, Mourtzinos A, Maher MG et al (2007) Short-term results of bilateral S2–S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful baldder syndrome, and chronic pelvic pain. Int Urogynecol J Pelvic Floor Dysfunct 19(4):553–557
Lavano A, Volpentesta G, Aloisi M et al (2004) Use of chronic sacral nerve stimulation in neurological voiding disorders. J Neurosurg Sci 48(4):157–159
Parsons CL (2007) The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis. Urology 69(Suppl 4):9–16
Peters KM, Killinger KA, Boguslawski BM et al (2010) Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn 29(7):1267–1271
Capodice JL, Bemis DL, Buttyan R et al (2005) Complementary and alternative medicine for chronic prostatitis/chronic pelvic pain syndrome. Evid Based Complement Alternat Med 2(4):495–501
NIN Consensus Development Panel on Acupuncture (1998) Acupuncture. JAMA 280(17):1518–1524
Deadman P, Baker K, Al-Khafaji M (1998) A manual of acupuncture. J Chin Med, ISBN-10: 0951054678
Ellis A, Wiseman N, Boss K (1991) Fundamentals of Chinese acupuncture. Paradigm Pubns, Brookline, Massachusetts, USA
Haake M, Müller HH, Schade-Brittinger C et al (2007) German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med 167(17):1892–1898
Bundesministerium für Gesundheit (2006) Bekanntmachung eines Beschlusses des Gemeinsamen Bundesausschusses über eine Änderung der Richtlinie Methoden vertragsärztliche Versorgung in Anlage I „Anerkannte Untersuchungs- oder Behandlungsmethoden“ und in Anlage II „Methoden, die nicht als vertragsärztliche Leistungen zu Lasten der Krankenkassen erbracht werden dürfen“. Akupunktur
Capodice JL et al (2007) A pilot study on acupuncture for lower urinary tract symptoms related to chronic prostatitis – chronic pelvic pain. Chin Med 2(1):1
Chen R, Nickel JC (2003) Acupuncture ameliorates symptoms in men with chronic prostatitis/chronic pelvic pain syndrome. Urology 61(6):1156–1159
Honjo H et al (2004) Effects of acupuncture for chronic pelvic pain syndrome with intrapelvic venous congestion – preliminary results. Int J Urol 11(8):607–612
Lee SH, Lee BC (2009) Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology 73(5):1036–1041
Lee SWH et al (2008) Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Am J Med 121(1):79.e1–79.e7
Tugcu V et al (2010) Effectiveness of acupuncture in patients with category IIIB chronic pelvic pain syndrome—a report of 97 patients. Pain Med 11(4):518–523
Lee SH, Lee BC (2011) Use of acupuncture as a treatment method for chronic prostatitis/chronic pelvic pain syndromes. Curr Urol Rep 12(4):288–296
Posadzki P et al (2011) Acupuncture for chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a systematic review. J Androl 33(1):15–21
Suh LK, Lowe FC (2011) Alternative therapies for the treatment of chronic prostatitis. Curr Urol Rep 12(4):284–287
Westesson KE, Shoskes DA (2010) Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat? Curr Urol Rep 11(4):261–264
Chen R, Nickel JC (2004) Acupuncture for chronic prostatitis – chronic pelvic pain syndrome. Curr Urol Rep 5:305–308
Stux G (2007) Akupunktur. Springer, Berlin Heidelberg New York
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Walter, M., Sammer, U. & Kessler, T. Chronisches Schmerzsyndrom des Beckens. Urologe 51, 1683–1691 (2012). https://doi.org/10.1007/s00120-012-3037-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00120-012-3037-9