【摘要翻译】男性慢性盆腔疼痛综合症的痛觉敏感增强：为什么症状难以治疗？

文题：男性慢性盆腔疼痛综合症的痛觉敏感增强：为什么症状难以治疗？
作者：CLAIRE C. YANG, JAY C. LEE, BRENDA G. KROMM, MARCIA A. CIOL, RICHARD E. BERGER
杂志全名： Journal of Urology
年份，卷（期）: 起止页码： 2003, 170: 823-827
PMID：
英文摘要：
Purpose: Male chronic pelvic pain syndrome (CPPS) is a chronic and debilitating symptom complex, and inconsistent outcomes of antibiotic and anti-inflammatory treatments have created an interest in investigating the neurological mechanisms of CPPS pain. Because chronic pelvic pain likely results in hyperexcitability of dorsal horn neurons, ie central sensitization, thermal algometry may be useful in the assessment of CPPS. We evaluated men with and without CPPS to determine if there were differences between the 2 groups in their responses to noxious heat stimuli.
Materials and Methods: We recruited 66 healthy men without CPPS and 36 men with a history of CPPS for the study. Mean age of CPPS subjects was 43.1 years (range 18 to 62) and mean age of controls was 35.1 (range 21 to 61). All subjects with pain completed a National Institutes of Health-Chronic Prostatitis Symptom Index. We conducted thermal sensory tests with a small thermode programmed to deliver 2 series of 4 rapid bursts of noxious heat stimuli to the perineum and the anterior thigh. The subjects reported sensation on a computerized visual analog scale (COVAS) with a manual sliding lever. The average peak COVAS values and time to peak values from thigh and perineum of each series of thermal bursts were compared between CPPS and controls.
Results: The mean pain score on questionnaires was 9.7 (4 or greater indicating significant pain), mean urinary score was 4.7 (range 0 to 10) and mean quality of life impact score was 7.3 (range 3 to 13). Compared to controls men with CPPS reported higher mean peak COVAS values in the perineum. There was no difference between groups in the peak COVAS value on the thigh.
Conclusions: Men with CPPS have altered heat sensation/pain sensitization in the perineum compared to controls. This finding is another that supports the resemblance of CPPS to other chronic pain syndromes and may help explain why CPPS is often refractory to treatment. Further investigations into male CPPS should focus on the mechanisms inducing and maintaining pain in an effort to treat this condition effectively.
中文译文：目的：男性慢性盆腔疼痛综合症（CPPS）是一组慢性且使人衰弱的症状，它对抗生素和抗炎治疗的结果不确定，因此探索CPPS疼痛的神经机制很有必要。慢性盆腔疼痛可能引起背角神经元的过度兴奋，例如中枢性敏感，所以热-痛觉计可能在评估CPPS中有一定作用。我们对CPPS及正常男性进行了这种评估，以确定他们对有害热刺激的反应是否有差异。
材料和方法：有CPPS病史男性36例，平均年龄43.1岁（18-62），对照为正常健康男性66例，平均年龄35.1岁（21-61）。有疼痛症状者完成NIH-CPSI评分。热敏感试验应用小的热电极放置于会阴和股前区，发放2组各4次热刺激。试验对象的感觉通过计算机可视的刻度条（COVAS）以手动调节的方式确定。比较两组病人分别在会阴和股前区每组刺激的COVAS平均峰值和峰时间。
结果：NIH-CPSI问卷的平均疼痛评分9.7（大于4提示明显疼痛），平均排尿评分4.7（0-10），平均生活质量评分7.3（3-13）。CPPS组较对照组会阴部的COVAS峰值为高，两组股前区的COVAS峰值无差别。
结论：男性CPPS患者会阴部的热/痛敏感性发生了变化。该结果支持CPPS和其他慢性疼痛综合症类似的观点，并且有助于解释为何CPPS难以治疗。进一步研究应着眼于导致并维持疼痛的机制以有效的治疗该疾病。