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      Low-intensity extracorporeal shock wave therapy for III B chronic pelvic pain syndrome

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          Abstract

          Background

          To analyze the efficiency of low-intensity shock wave therapy (LI-ESWT) for patients with III B chronic pelvic pain syndrome (CPPS).

          Methods

          The study included an uncontrolled population of 32 patients who had suffered with CPPS for ≥3 months. LI-ESWT was performed without anesthesia via a perineal approach. The operation was carried out in four weeks by administering 12,000 shock waves. Using the Visual Analog Scale (VAS) and NIH-developed Chronic Prostatitis Symptom Index (NIH-CPSI), subsequent tests were performed at 1, 2, 4, and 12 weeks after the first LI-ESWT session.

          Results

          All patients who received the four week course as treatment responded actively on the pain VAS and the NIH-CPSI, and both were significantly improved (P<0.05). Compared with the baseline parameters, the NIH-CPSI total score and VAS exhibited substantial improvement at 4 and 12 weeks, where a total improvement at four weeks was reached. It is easy and safe to perform LI-ESWT without anesthesia on an outpatient basis.

          Conclusions

          LI-ESWT should be regarded as a promising new therapy for CPPS, as it is convenient to perform without any side-effects.

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          Most cited references26

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          Pain mechanisms: a new theory.

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            Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits.

            Despite the success in clinical application, the exact mechanism of shock wave therapy remains unknown. We hypothesized that shock wave therapy induces the ingrowth of neovascularization and improves blood supply to the tissues. The purpose of this study was to investigate the effect of shock wave therapy on neovascularization at the tendon-bone junction. Fifty New Zealand white rabbits with body weight ranging from 2.5 to 3.5 kg were used in this study. The right limb (the study side) received shock wave therapy to the Achilles tendon near the insertion to bone. The left limb (the control side) received no shock wave therapy. Biopsies of the tendon-bone junction were performed in 0, 1, 4, 8 and 12 weeks. The number of neo-vessels was examined microscopically with hematoxylin-eosin stain. Neovascularization was confirmed by the angiogenic markers including vessel endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) expressions and endothelial cell proliferation determined by proliferating cell nuclear antigen (PCNA) expression examined microscopically with immunohistochemical stains. The results showed that shock wave therapy produced a significantly higher number of neo-vessels and angiogenesis-related markers including eNOS, VEGF and PCNA than the control without shock wave treatment. The eNOS and VEGF began to rise in as early as one week and remained high for 8 weeks, then declined at 12 weeks; whereas the increases of PCNA and neo-vessels began at 4 weeks and persisted for 12 weeks. In conclusion, shock wave therapy induces the ingrowth of neovascularization associated with early release of angiogenesis-related markers at the Achilles tendon-bone junction in rabbits. The neovascularization may play a role to improve blood supply and tissue regeneration at the tendon-bone junction.
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              Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction.

              G Simons (2004)
              This article explores how myofascial trigger points (MTrPs) may relate to musculoskeletal dysfunction (MSD) in the workplace and what might be done about it. The cause of much MSD and pain is often enigmatic to modern medicine and very costly, just as the cause of MTrPs has been elusive for the past century, despite an extensive literature that is confusing because of restricted regional approaches and a seemingly endless variety of names. MTrPs are activated by acute or persistent muscle overload, which is characteristic of MSD in the workplace. MTrPs can involve any, and sometimes many, of the skeletal muscles in the body and are a major, complex cause of musculoskeletal pain. The clinical and etiological characteristics of MTrPs have been underexplored by investigators, leading to undertraining of health care professionals, underappreciation of their clinical importance. MTrPs have no gold standard diagnostic criterion, and no routinely available laboratory or imaging test. MTrPs require a specific non-routine examination and muscle-specific treatment for prompt relief when acute, and also resolution of perpetuating factors when chronic. After identifying a critical false assumption, electrodiagnostic studies are now making encouraging progress toward clarifying the etiology of MTrPs based on the 5- or 6-step positive-feedback model of the integrated hypothesis. Specific research needs are noted. MTrPs are treatable and they deserve increased attention and consideration by research investigators and clinicians.
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                Author and article information

                Journal
                Transl Androl Urol
                Transl Androl Urol
                TAU
                Translational Andrology and Urology
                AME Publishing Company
                2223-4683
                2223-4691
                June 2020
                June 2020
                : 9
                : 3
                : 1323-1328
                Affiliations
                [1]Department of Urology, Beijing Jishuitan Hospital , Beijing 100035, China
                Author notes

                Contributions: (I) Conception and design: All authors; (II) Administrative support: L Man; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: G Li; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Libo Man, MD. Department of Urology, Beijing Jishuitan Hospital, Xinjiekou East Street, West District, Beijing 100035, China. Email: lee_gz99@ 123456163.com .
                Article
                tau-09-03-1323
                10.21037/tau.2020.04.07
                7354340
                32676416
                1c5aa6bd-a92f-4512-865c-195d903d7255
                2020 Translational Andrology and Urology. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                History
                : 27 September 2019
                : 27 March 2020
                Categories
                Original Article

                chronic pelvic pain syndrome (cpps),chronic abacterial prostatitis,shock waves

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