PSYCHOLOGICAL-PROBLEMS IN CHRONIC PROSTATITIS PATIENTS WITH PAIN

Objective: Men with chronic prostatitis are frequently seen in urological practice and are difficult to treat with standard antimicrobial medications. This pilot study was designed to take a different perspective in assessing chronic prostatitis patients with pain by evaluating them using a standard chronic pain clinic psychological approach. Design: Twenty men, 27% of the referred group of patients with chronic prostatitis and pain, completed the MMPI and a structured psychological interview. Their findings were compared to age- and education-matched men seeking treatment for chronic low back pain. Setting: Data were collected at the Pain Clinic within the Department of Anesthesiology at the University of Washington Medical Center. Patients: Patients were 20 men referred from a urology-based Prostatitis Clinic and 20 men referred to the Pain Clinic for chronic low back pain. Results and Conclusions: The two groups differed in the impact of their pain problem on their lives. Prostatitis patients were employed but reported that their symptoms greatly interfered with their sexual/romantic relationships. Back pain patients reported that their pain interfered primarily with work; most of these patients had long-term marital relationships, whereas few prostatitis patients did. Half of the prostatitis patients met criteria for major depression, but back pain patients were more somatically focused, depressed, and anxious. The constellation of relationship problems, disruptions in sexual functioning, levels of depression, along with failure of multiple previous medical treatments in men with chronic prostatitis indicates that continued antimicrobial therapy is unlikely to provide the ''cure'' these patients seek. Psychological evaluation, couples' counseling, individual counseling, and medications for depression all may play a role in a comprehensive approach to these patients. These results must be considered as preliminary and as representative of a possibly skewed sample of prostatitis patients since only those men who accepted the referral to a pain clinic psychologist for an evaluation were assessed. Clearly, they are likely to be among the patients who are most psychologically and sexually impaired by the chronic prostatitis and associated pain. A further study with less self-selection is indicated.