Acupuncture Used as a Method of Peripheral Nerve Stimulation in Chronic Prostatitis: A Case Study

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is defined as chronic pelvic pain lasting for at least 3 months, often associated with lower urinary tract symptoms and/or sexual dysfunction [1]. Prostatitis is a common condition, with 35–50% of men affected by symptoms suggesting prostatitis during their lifetime. It is associated with negative psychological effects and substantial health care costs [2]. There are currently many approaches for its management, using both pharmacological and non‐pharmacological interventions, though there is a lack of evidence for the efficacy of these treatments. A systematic review [3] examined the evidence for 16 different pharmacological treatments of CP/CPPS. Ninety-nine studies included 9119 men. Treatment approaches included alpha-blockers, 5-alpha reductase inhibitors, antibiotics, anti-inflammatories, allopurinol and botulinum toxin injections. The authors found low‐ to very low‐quality evidence that these interventions cause a reduction in prostatitis symptoms, without an increased incidence of adverse events in the short term. They reported lack of evidence regarding the effects of these drugs on sexual dysfunction, quality of life, or anxiety and depression. The efficacy of acupuncture on CP/CPPS was examined in a systematic review and meta-analysis [4] of 10 published trials (n=770). Analysis revealed that acupuncture significantly reduced the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) score and provided pain relief, compared to standard medication, and reduced symptoms when compared to sham. Four acupuncture sessions were the minimum “dose” to reach clinical efficacy, and prolonged acupuncture sessions continuously improved urinary symptoms and quality of life. Peripheral Nerve Stimulation (PNS) is an effective tool for the treatment of chronic pain. Miniaturized devices that are less invasive than previous generations has brought this treatment modality into mainstream use. Recent clinical evidence suggests clinically significant and sustained reductions in pain can persist well beyond the PNS treatment period [5]. Acupuncture is a minimally invasive method of PNS. Acupuncture points have been shown to overlie major neuronal bundles, which correlate with cutaneous branches of major nerves [6]. These nerves converge and interact with visceral nociceptive inputs at the spinal cord level. This anatomical correlation provides the basis on which acupuncture applied to a specific region could treat a variety of conditions such as prostatitis, remote to the site of treatment.