Laparoscopic Prostate Removal
for Severe, Treatment-Resistant
Chronic Prostatitis

                                                                            

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Pregabalin (Lyrica)

The causes of chronic prostatitis/chronic pelvic pain syndrome (CPSS) are not known. Likewise, the nature of the pain -- nociceptive, inflammatory, neuropathic -- is not known. In its duration and intensity, the pain of chronic prostatitis does seem to resemble the neuropatic pain of other chronic pain conditions, such as fibromyalgia, diabetic neuropathy, an post-herpetic neuralgia (PHN). For this reason, attention has been turned to the application of strategies that have worked for other chronic pain conditions that are thought to be mediated by neuropathic mechanisms.

Among the treatments that have worked for the neuropathic pain of fibromyalgia and other chronic pain conditions is the drug pregabalin (Lyrica), which binds the alpha-2 delta receptors in the central nervous system. Pregabalin is chemically related to gabapentin (Neurontin) and the naturally occuring analgesic and anti-convulsant neurotransmitter gamma-aminobutyric acid (GABA)

Patients periodically report use of pregabalin and gabapentin for chronic prostatitis. We are unaware of cases in which this has been therapeutic.

In 2010, a well-conducted, randomized clinical trial testing Lyrica against placebo has shown that it is not therapeutic. The trial involved 324 patients who had had symptoms for no less than 3 of 6 months. It was conducted across the 10 locations of the Chronic Prostatitis Collaborative Research Network (CPCRN). Each patient was treated for 6 weeks and in the first 4 weeks the pregabalin dose was escalated from 150 to 600 millgrams.

The primary study endpoint was a drop of symptoms of at least 6 points on the Chronic Prostatitis Symptom Index. The study found that:

  • The pregabalin and placebo groups responded in proportions of 47.2% and 35.8%, respectively
  • After adjustment for clinical site, the difference in response between the two groups was not statistically significant
  • Compared with placebo patients, pregabalin patients had greater reductions in the mean CPSI scores
  • There were no changes in: 
                   Sexual Health Inventory for Men
                   Medical Outcomes Study 12-Item Short Form Health Survey
                   Hospital Anxiety and Depression Scale scores

The authors concluded that pregabalin at the doses administered is not superior to placebo inducing a 6-point drop in CPSI. Whether it will be more effective in a different class of patients and/or at higher doses and/or if administered longer remains to be seen.

You can also read a summary about anti-depressants for chronic prostatitis.

 

 

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