Systematic Review of Alpha Blockers for the Treatment of Pain in Chronic Prostatitis
Anthony M. Carona, University of Houston College of Medicine
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a disruptive condition of uncertain etiology with an estimated prevalence of 2-10% of males worldwide and symptoms manifesting heterogeneously as pelvic pain, lower urinary tract symptoms, and overall decreased quality of life. CP/CPPS is associated with a high degree of healthcare utilization and substantial economic costs. Despite ongoing research, no definitive therapy has been established. Because of their effect on urinary symptoms, alpha blockers are frequently utilized in the management of CP/CPPS, while pain symptoms are managed with analgesics of various classes. Since relatively little research exists to support the long-term use of alpha blockers in the management of pelvic pain, further research is required. This review seeks to assess whether alpha blockers are more effective than placebo in reducing pain symptoms longitudinally in males with CP/CPPS.
A systematic search of randomized placebo-controlled trials evaluating alpha blockers and non-steroidal anti-inflammatory drugs in the treatment of CP/CPPS was conducted and captured all available studies (n = 680). After application of exclusion criteria, seven trials were identified as suitable for inclusion. All NSAID trials were excluded for not meeting criteria. Only studies reporting NIH-CPSI pain score (items 1-4) were included. Group means were calculated and compared with t-test to assess differences in pain reduction in alpha blocker and placebo groups at points 0-3 months and greater than 3 months of treatment.
Our analysis revealed a mean pain score decrease of 4.3 (+/- 1.2) points in those taking alpha blockers for 3 months or less compared to a decrease of 3.4 (+/- 1.3) points in the placebo group (p = 0.16). For those taking alpha blockers greater than 3 months, a mean decrease in pain of 4.1 (+/- 1.7) points was found compared to a decrease of 1.6 (+/-1.4) points in the placebo group (p = 0.0067).
Our review demonstrates a statistically significant decrease in pain score for those taking alpha blockers for greater than 3 months, whereas no benefit is noted when taken for 3 months or less compared to placebo. Given this information, the use of alpha blockers for the chronic management of pain symptoms in CP/CPPS is justified.
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