Skip to main content
SpringerLink
Log in

Chronic pain in urological diseases: a clinical review

  • Review Article
  • Published:
Central European Journal of Medicine

Abstract

Chronic pain is the central problem in a variety of urological diseases. Pain is an unpleasant sensory and emotional experience associated with either actual or potential tissue damage, or described in terms of such damage. The aim of this research was to update knowledge about the ultrastructural, clinical, psychological and therapeutic aspects of chronic pain in urological diseases, in particular in chronic pelvic syndrome. In this paper we have revisited the most significant and discussed articles published in the last twenty five years, with particular references on the 2008 European Guidelines, searching key words (chronic pelvic pain syndrome, chronic pelvic pain, chronic prostatitis, interstitial cystitis, prostatodynia, urological disease) and data with a high level of evidence. The articles that we have analyzed show that pain is characterized by an initial tissue injury that can lead to sensitization, which is a decrease in the intensity of the stimulus needed to elicit a response by the nerve, involving the peripheral and central nervous systems. The chronic pain state is characterized by loss of inhibitory interneurons, establishment of aberrant excitatory synaptic connections and long-term potentiation of response due to changes in sensitivity of nerve synapses. Stress and hormones might also play a role in central sensitization. Pain also has a cognitive and emotional component. It is very difficult to treat, given the complex nature of the response and the interaction of physiological aspects

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Krieger J.N., Egan K.J., Ross S.O., Jacobs R., Berger R.E., Chronic pelvic pain represents the most prominent urogenital symptom of chronic prostatitis, Urology, 1996, 48, 715–721

    Article  PubMed  CAS  Google Scholar 

  2. Propert K.J., McNaughton-Collins M., Leiby B.J., O’Leary M.P., Kusek J., Litwin M.S., and the Chronic Prostatitis Collaborative Research Network, A prospective study of symptoms and quality of life in men with chronic prostatitis/chronic pelvic pain syndrome: the National Institutes of Health Chronic Prostatitis Cohort Study, J. Urol. 2006, 175, 619–23

    Article  PubMed  Google Scholar 

  3. Nickel J.C., Interstitial cystitis: a chronic pelvic pain syndrome, Med. Clin. North. Am., 2004, 88, 467–82

    Article  PubMed  Google Scholar 

  4. Weidner W., Fall M., Bjerklund Johansen T.E., Interstitial cystitis and prostatitis. Eur. Urol., 2002, 42–46

  5. Erickson B.R., Morgan K.C., Ordille S., Keay S.K., Xie S.X., Nonbladder related symptoms in patients with interstitial cystitis, J. Urol., 2001, 166, 557–562

    Article  PubMed  CAS  Google Scholar 

  6. Parson C.L., Interstitial cystitis: a chronic disease with ever-increasing recognition and prevalence, J. Urol., 2005, 173–176

  7. Parson C.L., Prostatitis, interstitial cystitis, chronic pelvic pain and urethral syndrome share a common pathophysiology: lower urinary dysfunctional epithelium and potassium recycling, Urology, 2003, 69, 76–82

    Google Scholar 

  8. Merskey H., Bogduk N., Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, IASP Press. 2002

  9. Foley K.M., Posner J.B., Pain and its management, In: Cecil Textbook of medicine. 18th edition. W. B. Saunders Company, 1988, 104–112

  10. Abrams P., Cardozo L., Fall M., Griffiths D., Rosier P., Ulmsten U., van Kerrebroeck P., Victor A., Wein A., The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society, Am. J. Obstet. Gynecol. 2002, 187, 116–126

    Article  PubMed  Google Scholar 

  11. Rouviere H., Delmas A., In: Anatomie humaine (vol 2), Paris, Masson, 1985, 557

    Google Scholar 

  12. Rauchenwald M., Desjardins C., Steers W.D., Autonomic innervation of the testis, Soc. Neurosci., 1993, 19, 509

    Google Scholar 

  13. Tracey I., Mantyh P.W., The cerebral signature for pain perception and its modulation, Neuron., 2007, 55, 377–391

    Article  PubMed  CAS  Google Scholar 

  14. Kingston J., Chadwick P., Meron D., Skinner T.C., A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity, J. Psychosom. Res., 2007, 62, 297–300

    Article  PubMed  Google Scholar 

  15. Kabat-Zinn J., Lipworth L., Burney R., The clinical use of mindfulness meditation for the self-regulation of chronic pain. J. Behav. Med., 1985, 8, 163–190

    Article  PubMed  CAS  Google Scholar 

  16. Chapman C.R., Pain perception and assessment, Minerva Anestesiol., 2005, 71, 413–417

    PubMed  CAS  Google Scholar 

  17. Grotle M., Vøllestad N.K., Brox J.I., Clinical course and impact of fear-avoidance beliefs in low back pain: prospective cohort study of acute and chronic low back pain: II., Spine, 2006, 31, 1038–1046

    Article  PubMed  Google Scholar 

  18. Sloan T.J., Gupta R., Zhang W., Walsh D.A., Beliefs about the causes and consequences of pain in patients with chronic inflammatory or noninflammatory low back pain and in pain-free individuals, Spine, 2008, 33, 966–972

    Article  PubMed  Google Scholar 

  19. Leonard M.T., Cano A., Pain affects spouses too: personal experience with pain and catastrophizing as correlates of spouse distress, Pain, 2006, 126, 139–146

    Article  PubMed  Google Scholar 

  20. Tripp D.A., Nickel J.C., Wang Y., Litwin M.S., McNaughton-Collins M., Landis J.R., National Institutes of Health-Chronic Prostatitis Collaborative Research Network (NIH-CPCRN) Study Group, Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome, J. Pain, 2006, 7, 697–708

    Article  PubMed  Google Scholar 

  21. Nickel J.C., Tripp D.A., Chuai S., Litwin M.S., McNaughton-Collins M., Landis J.R., et al, NIH-CPCRN Study Group, Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome, B.J.U. Int., 2008, 101, 59–64

    Google Scholar 

  22. Aubin S., Berger R.E., Heiman J.R., Ciol M.A., The association between sexual function, pain, and psychological adaptation of men diagnosed with chronic pelvic pain syndrome type III, J. Sex. Med., 2008, 5, 657–667

    Article  PubMed  Google Scholar 

  23. Heinberg L.J., Fisher B.J., Wesselmann U., Reed J., Haythornthwaite J.A.., Psychological factors in pelvic/urogenital pain: the influence of site of pain versus sex, Pain, 2004, 108, 88–94

    Article  PubMed  Google Scholar 

  24. Smith K.B., Pukall C.F., Tripp D.A., Nickel J.C., Sexual and relationship functioning in men with chronic prostatitis/chronic pelvic pain syndrome and their partners, Arch. Sex. Behav., 2007, 36, 301–311

    Article  PubMed  Google Scholar 

  25. Zhang W.Y., Li Wan Po A., Efficacy of minor analgesics in primary dysmenorrhoea: a systematic review, Br. J. Obstet. Gynaecol., 1998, 105, 780–789

    PubMed  CAS  Google Scholar 

  26. McCormack K., Twycross R., COX-2-selective inhibitors and analgesia, Pain Clinical Updates, 2002, 10

  27. Jones S.F., Power I., Postoperative NSAIDs and COX-2 inhibitors: cardiovascular risks and benefits, Br. J. Anaesth., 2005, 95, 281–284

    Article  PubMed  CAS  Google Scholar 

  28. Christie M.J., Vaughan C.W., Ingram S.L., Opioids, NSAIDs and 5-lipoxygenase inhibitors act synergistically in brain via arachidonic acid metabolism. Inflamm. Res., 1999, 48, 1–4

    Article  PubMed  CAS  Google Scholar 

  29. McQuay H., Opioids in pain management, Lancet, 1999, 353, 2229–2232

    Article  PubMed  CAS  Google Scholar 

  30. Baranowski A.P., Practical Applications and Procedures, In: Rice ASD, Warfield CA, Justins D, Eccleston C, eds. Pharmacological Diagnostic Tests in Clinical Pain Management. London: Arnold, 2003, 39–47

    Google Scholar 

  31. Radbruch L., Grond S., Lehmann K.A., A risk-benefit assessment of tramadol in the management of pain, Drug Saf., 1996, 15, 8-29

  32. Pryle B.J., Grech H., Stoddart P.A., Carson R., O’Mahoney T., Reynolds F., Toxicity of norpethidine in sickle cell crisis, B.M.J. 1992, 304, 1478–1479

    CAS  Google Scholar 

  33. Sagata K., Minami K., Yanagihara N., Shiraishi M., Toyohira Y., Ueno S., et al., Tramadol inhibits norepinephrine transporter function at desipraminebinding sites in cultured bovine adrenal medullary cells, Anesth. Analg., 2002, 94, 901–906

    Article  PubMed  CAS  Google Scholar 

  34. Desmeules J.A., Piguet V., Collart L., Dayer P., Contribution of monoaminergic modulation to the analgesic effect of tramadol, Br. J. Clin. Pharmacol., 1996, 41, 7–12

    Article  PubMed  CAS  Google Scholar 

  35. Hanno P.M., Amitriptyline in the treatment of interstitial cystitis, Urol. Clin. North. Am., 1994, 21, 89–91

    PubMed  CAS  Google Scholar 

  36. Pranikoff K., Constantino G., The use of amitriptyline in patients with urinary frequency and pain, Urology, 1998, 51(5A Suppl), 179–181

    Article  PubMed  CAS  Google Scholar 

  37. Chew D.J., Buffington C.A., Kendall M.S., DiBartola S.P., Woodworth B.E., Amitriptyline treatment for severe recurrent idiopathic cystitis in cats, J. Am. Vet. Med. Assoc., 1998, 213, 1282–1286

    PubMed  CAS  Google Scholar 

  38. Rowbotham M., Harden N. Stacey B., Bernstein P., Magnus-Miller L., Gabapentin for the treatment ofpostherpetic neuralgia: a randomized controlled trial, JAMA,1998, 280, 1837–1842

    Article  PubMed  CAS  Google Scholar 

  39. Backonja M., Beydoun A., Edwards K.R., Schwartz S.L., Fonseca V., Hes M., et al., Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial, JAMA, 1998, 280, 1831–1836

    Article  PubMed  CAS  Google Scholar 

  40. Price D.D., Mayer D.J., Mao J., Caruso F.S., NMDA-receptor antagonists and opioid receptor interactions as related to analgesia and tolerance, J. Pain Symptom. Manage., 2000, 19, S7–11

    Article  PubMed  CAS  Google Scholar 

  41. Mikkelsen S., Ilkjaer S., Brennum J., Borgbjerg F.M., Dahl J.B., The effect of naloxone on ketamineinduced effects on hyperalgesia and ketamine-induced side effects in humans, Anesthesiology, 1999, 90, 1539–1545

    Article  PubMed  CAS  Google Scholar 

  42. Guirimand F., Dupont X., Brasseur L., Chauvin M., Bouhassira D., The effects of ketamine on the temporal summation (wind-up) of the R(III) nociceptive flexion reflex and pain in humans, Anesth. Analg., 2000, 90, 408–414

    Article  PubMed  CAS  Google Scholar 

  43. Laurido C., Pelissier T., Perez H., Flores F., Hernandez A., Effect of ketamine on spinal cord nociceptive transmission in normal and monoarthritic rats, Neuroreport, 2001, 12, 1551–1554

    Article  PubMed  CAS  Google Scholar 

  44. Boas R.A., Covino B.G., Shahnarian A., Analgesic responses to i.v. lignocaine, Br. J. Anaesth., 1982, 54, 501–505

    Article  PubMed  CAS  Google Scholar 

  45. Ferrante F.M., Paggioli J., Cherukuri S., Arthur G.R., The analgesic response to intravenous lidocaine in the treatment of neuropathic pain, Anesth. Analg., 1996, 82, 91–97

    Article  PubMed  CAS  Google Scholar 

  46. Kovacs P., Gruber H., Piegger J., Bodner G., New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique, Dis. Colon. Rectum., 2001, 44, 1381–1385

    Article  PubMed  CAS  Google Scholar 

  47. McDonald J.S., Spigos D.G., Computed tomographyguided pudendal block for treatment of pelvic pain due to pudendal neuropathy, Obstet. Gynecol., 2000, 95, 306–309

    Article  PubMed  CAS  Google Scholar 

  48. Kim S.W., Paick J.S., Ku J.H., Percutaneios posterior tibial nerve stimulation in patients with chronic pelvic pain: a preliminary study, Urol. Int., 2007, 78, 58–62

    Article  PubMed  Google Scholar 

  49. Fall M., Lindstrom S., Transcutaneous electrical nerve stimulation in classic and nonulcer interstitial cystitis, Urol. Clin. North Am., 1994, 21, 131–139

    PubMed  CAS  Google Scholar 

  50. Mulholland S.G., Hanno P., Parsons C.L., Sant G.R., Staskin D.R., Pentosan polysulfate sodium for therapy of interstitial cystitis. A double-blind placebo-controlled clinical study, Urology, 1990, 35, 552–558

    Article  PubMed  CAS  Google Scholar 

  51. Holm-Bentzen M., Jacobsen F., Nerstrom B., Lose G., Kristensen J.K., Pedersen R.H., et al., A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease, J. Urol., 1987, 138, 503–507

    PubMed  CAS  Google Scholar 

  52. Ruud Bosch J.L., Groen J., Sacral nerve neuromodulation in the treatment of refractory motor urge incontinence, Curr. Opin. Urol., 2001, 11, 399–403

    Article  PubMed  CAS  Google Scholar 

  53. Janknegt R.A., Hassouna M.M., Siegel S.W., Schmidt R.A., Gajewski J.B., Rivas D.A., et al., Long-term effectiveness of sacral nerve stimulation for refractory urge incontinence. Eur. Urol. 2001, 39, 101–106

    Article  PubMed  CAS  Google Scholar 

  54. Paszkiewicz E.J. Siegel S.W., Kirkpatrick C., Hinkel B., Keeisha J., Kirkemo A,. Sacral nerve stimulation in patients with chronic, intractable pelvic pain, Urology, 2001, 57(6 Suppl 1), 124

    Article  PubMed  CAS  Google Scholar 

  55. Shaker H.S., Hassouna M., Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention,. J. Urol. 1998, 159, 1476–1478

    Article  PubMed  CAS  Google Scholar 

  56. Kemler M.A., Barendse G.A.., van Kleef M., de Vet H.C., Rijks C.P., Furnee C.A., van den Wildenberg F.A., Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy, N. Engl. J. Med., 2000, 343, 618–624

    Article  PubMed  CAS  Google Scholar 

  57. Chai T.C., Zhang C., Warren J.W., Keay S., Percutaneous sacral third nerve root neurostimulation improves symptoms and normalizes urinary HB-EGF levels and antiproliferative activity in patients with interstitial cystitis, Urology, 2000, 55, 643–646

    Article  PubMed  CAS  Google Scholar 

  58. Maher C.F., Carey M.P., Dwyer P.L., Schluter PL. Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis, J. Urol., 2001, 165, 884–886

    Article  PubMed  CAS  Google Scholar 

  59. Aboseif S., Tamaddon K., Chalfin S., Freedman S., Kaptein J., Sacral neuromodulation as an effective treatment for refractory pelvic floor dysfunction, Urology, 2002, 60, 52–56

    Article  PubMed  Google Scholar 

  60. Fric P., Probiotics and prebiotics — renaissance of a therapeutic principle, Cent. Eur. J. Med., 2007, 2, 237–270

    Article  Google Scholar 

  61. Weiner B.K. Spine update: the biopsychosocial model and spine care, Spine, 2008, 33, 219–223

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University “Federico II” of Naples, 80131, Naples, Italy

    Domenico Prezioso, Raffaele Galasso, Gennaro Iapicca, Emanuele Annunziata, Mario Di Martino & Fabrizio Iacono

Authors
  1. Domenico Prezioso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raffaele Galasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gennaro Iapicca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emanuele Annunziata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Di Martino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fabrizio Iacono
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Domenico Prezioso.

About this article

Cite this article

Prezioso, D., Galasso, R., Iapicca, G. et al. Chronic pain in urological diseases: a clinical review. cent.eur.j.med 3, 381–389 (2008). https://doi.org/10.2478/s11536-008-0066-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2478/s11536-008-0066-2

Keywords

Search

Navigation