Male chronic pelvic pain

Chronic Pelvic Pain Syndrome
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forest_dobbs
Message 1 of 8 , Today at 9:32 AM
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Male patient 28 yo with chronic pelvic pain syndrome - pain on tip of penis and pain during orgasm, sometimes pain on urination. Onset was in 2014 from a hiking trip where he pulled an adductor muscle and the syndrome has never resolved. He has been seeing a Pelvic PT specialist and has been getting relief and the condition is mostly under control. Muscles most affected Superficial Transverse Peroneal and Pubococcygeous. He uses a therawand for intra-anal pelvic floor release. He notices the syndrome is worse with stress. When he goes on vacation with very little stress the symptoms completely go away. Medication - amitriptyline 25mg. Acupuncture has not been beneficial to date. If anyone has any resources or treatment ideas that may shed some light on this that would be wonderful.
23andMe will be run to look at methylation, MAO, COMT, etc. factors possibly contributing to increased pain presentation and patients difficulty to cope with stress and OCD behavior.
Normal Labs - ANA & IFA Panel, CRP, CMP, CBC with diff (although hematocrit is slightly elevated), Ferritin, Total Testosterone, Free Testosterone.
Abnormal Lab
Vitamin D,25-OH - 22ng/ml

Thank you and blessings.
Forest Dobbs
Seattle, WA



Virginia Oram, ND
Message 2 of 8 , Today at 11:48 AM
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Maya Abdominal Therapy may be helpful. See Arvigomassage.com for certified  practitioners.  He can learn to do it himself as self care daily too.
Virginia Oram ND
Eugene, OR



sherri jacobs
Message 3 of 8 , Today at 1:19 PM
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Consider looking at a low oxalate diet or testing for oxalates via organic acids test.. I use Great Plains.
Sherri Jacobs
Chas sc



dralpinewellness
Message 4 of 8 , Today at 6:17 PM
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I have mainly treated females with chronic pelvic pain. Some things I have noted:

1. Acupuncture can be less than efficacious if the three dimension aspect of the channel system is not considered. Sometimes the use of techniques that stimulate the luo-connecting channels, sinew channels, or divergent channels (as opposed to primary channels) can be helpful. There is an excellent paper on this topic in the recent Journal of Chinese Medicine (107, Feb 2015) by Jack Schaefer. I have also found extraordinary meridian treatment on the lower Ren channel (in addition to St 30 and K13) helpful, as well as moxa for Cold type conditions. You can teach the patient how to use moxa and then have them do it at home.

2. Compounded topicals can be of value with symptom control. Agents such as gabapentin, amitriptyline, cyclobenzaprine, etc. delivered as a suppository might be useful. Topical ketamine and diazepam are also helpful but we cannot prescribe them in WA State. A good resource here is a talk by Natalie Gustafson, Pharm D on Compounded Specialty Prescriptions in Women’s Primary Care, July 20, 2014. Tree Farm has it on CD.

3. Electrotherapy: frequency specific microcurrent (FSM) has been useful in some of the cases I have treated.

4. HeartMath: good set of tools for managing stress. You can simply review some of their techniques (Neutral, Freeze Frame, Heart Lock-in, etc.) and then teach it to your patients (they are not difficult to learn or teach) or you can spring for the software and training, which is around $1000 when they are offering the special package deal.

5. Breathwork: subclinical hypoxia from shallow breathing can contribute to muscle pain. Just teaching a basic breathing technique and having them do it for 10 min at bedtime can be a useful way to begin  to change less than optimal breathing habit.


Gary Piscopo, ND, LAc
East Wenatchee,  WA



Eric Blake
Message 5 of 8 , Today at 8:54 PM
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Hi Forest
I contributed 2 chapters on naturopathic approaches to the textbook:
Chronic Pelvic Pain and Dysfunction - practical physical medicine, a multidisciplinary pelvic pain management  textbook
http://www.amazon.com/Chronic-Pelvic-Pain-Dysfunction-Practical/dp/0702035327




Jill Evenson, ND
Message 6 of 8 , Today at 8:57 PM
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Interesting resource is the book 'A Headache In the Pelvis'.

In addition to the previously recommended Frequency-Specific Microcurrent, consider cold laser therapy.

Also rule out Bartonella and/or smoldering Chlamydia infection(s) if the picture fits - both have an affinity for the nerves of the pelvic floor.

Jill Evenson, ND
Wisconsin



Eric Yarnell
Message 7 of 8 , Today at 10:21 PM
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See my extensive prior posts on chronic prostatitis. Hopefully new textbook on the subject will be out this year or early next year.

Cheers,

Eric Yarnell, ND
Seattle, WA



forest_dobbs
Message 8 of 8 , Today at 10:36 PM
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Thank you everyone for your ideas and insight. I had no idea treating chronic pelvic pain would be this complicated. My head is spinning as I have gotten information from 3 other naturopathic chat groups on treatment ideas. It will take some time to simplify my treatment strategy.

To Both Erics, i look forward to referring to your books.

Blessings,
Forest dobbs, ND
Seattle, WA