Pain areas and mechanosensitivity in patients with chronic pelvic pain syndrome: a controlled clinical investigation

Abstract

Objective: A thorough clinical assessment including physical examination is crucial in a diagnostic work-up, including in patients with chronic pelvic pain syndrome (CPPS). This study investigated the prevalence of pain areas and the mechanosensitivity of peripheral nerves in patients with CPPS and compared the findings with a healthy control group.

Materials and methods: Healthy volunteers and patients diagnosed with CPPS were assessed with physical examinations and neurodynamic testing.

Results: The CPPS group (n = 26) and the control group (n = 28) showed no statistical differences between males and females for age and body mass index (Mann–Whitney U test). The patients in the CPPS group were significantly older and had a significantly higher weight compared to controls. Healthy volunteers did not show any pain area or mechanosensitivity of the examined peripheral nerves of the lumbosacral plexus. Patients with CPPS showed a variety of pain from different musculoskeletal origins. Neurodynamic testing demonstrated significant mechanosensitivity in at least one nerve of the lumbosacral plexus in 88% of the patients with CPPS, suggesting minor nerve injuries. Pudendal nerve mechanosensitivity was found in 85% of patients, while 42% had multiple nerves involved. Unilateral or bilateral pudendal channel palpatory pain was present in 62% of the CPPS group and not in controls.

Conclusions: This study shows musculoskeletal pain and a high prevalence of minor nerve injuries in CPPS patients, indicating the presence of abnormal impulse generation sites that can help in understanding the clinical picture in CPPS patients and guiding their treatment.

Keywords:

• Chronic pain
• chronic pelvic pain syndrome
• lower urinary tract symptoms
• neuropathic pain
• prostatitis
• pudendal neuralgia

Acknowledgements

The authors want to thank the whole team of the Pelvic Clinic, Antwerp University Hospital, for making this research possible. The authors would also like to thank Dr Wouters K, Phd. Bio. Stats.

Disclosure statement

No potential conflict of interest was reported by the authors.