• Autonomic nervous system
• Neuropeptides
• Pelvic pain
• Prostatitis

• 20202BABL206031 Natural Science Foundation of Xinjiang Province
• 81860456 National Natural Science Foundation of China

• Autonomic nervous system
• Chronic pelvic pain syndrome
• Electromyography
• Extracorporeal shockwave therapy
• Myofascial release therapy

• Male
• Humans
• Chronic Pain/diagnosis
• Chronic Pain/therapy
• Chronic Pain/etiology
• Myofascial Release Therapy
• Extracorporeal Shockwave Therapy/adverse effects
• Extracorporeal Shockwave Therapy/methods
• Prostatitis/therapy
• Chronic Disease
• Pelvic Pain/diagnosis
• Pelvic Pain/therapy
• Pelvic Pain/etiology
• Treatment Outcome
• Randomized Controlled Trials as Topic

• YKK19163 Nanjing Medical Science and technology development Foundation

• Autonomic nervous system
• Spinal dysraphism
• Urinary bladder, Neurogenic
• Urodynamics

• UL1 TR001863 NCATS NIH HHS

• Autonomic function
• baroreceptor reflex sensitivity
• failed back surgery syndrome
• muscle sympathetic nerve activity
• spinal cord stimulation

• cortisol
• erectile dysfunction
• heart rate variability
• lower urinary tract symptoms
• prostatitis
• stress

• National Natural Science Foundation of China

• Chronic Disease
• Chronic Pain
• Electromyography
• Muscle Contraction
• Pelvic Floor
• Pelvic Floor Disorders

• chronic pain
• heart rate determination
• low back pain
• pain
• systematic review

• Adolescent
• Adult
• Aged
• Chronic Pain
• Cross-Sectional Studies
• Heart Rate
• Humans
• Low Back Pain
• Middle Aged
• Young Adult

Objective: It has been reported that autonomic nervous dysfunction is more prevalent in migraineurs. Heart rate variability (HRV) is a commonly used method to evaluate the cardiac autonomic nervous function modulation. However, HRV changes in migraine are still contradictory. The main objective of this study was to explore the potential HRV change patterns in episodic migraine (EM) and whether there were differences in HRV between EM ictal period and the interictal period.

Patients and Methods: We conducted a cross-sectional study including 18 patients with EM and 18 age- and sex-matched controls. The characteristics of demographics, some lifestyle factors, and psychological conditions were assessed at baseline. HRVs including time-domain analysis and frequency-domain analysis were performed in all participants. HRV analyses in migraine were recorded not only in the interictal period but also in the ictal period.

Results: All the HRV parameters showed a decreased trend in migraine than controls. Time-domain parameters standard deviation of all NN intervals in 24 h (SDNN) and triangular index were significantly lower in the migraine ictal period than controls separately (SDNN, 56.94 ± 22.09 ± 7.76 vs. 135.78 ± 35.16, p < 0.001; triangular index, 12.61 ± 3.20 vs. 22.11 ± 6.90, p < 0.001). Frequency-domain parameter low-frequency power was also lower in the migraine ictal period than controls (351.28 ± 206.71 vs. 559.61 ± 281.24, p = 0.02). SDNN was much lower in the migraine ictal period than migraine interictal period (56.94 ± 22.09 vs. 115.94 ± 46.88, p < 0.001). HRV changes during migraine interictal period did not differ from the control group. The correlation analysis revealed a negative correlation between visual analog scale and HRV parameters in the migraine ictal period (p = 0.04).

Conclusions: The present cross-sectional study indicates that HRV was significantly decreased in EM population especially during the migraine ictal period, which means unbalance of autonomic system in EM. Perhaps larger prospective cohort studies are wanted to validate these findings.

• autonomic nervous function
• cross-sectional study
• episodic migraine
• heart rate variability
• ictal period
• interictal period

Prostatodynia is the main symptom of chronic prostatitis and the main reason that patients go to the hospital for treatment. Although a variety of factors, including inflammatory immune response, nervous system sensitization, and psychological factors, have been shown to play important roles in the induction and development of chronic pain in prostatitis, the underlying cause of chronic prostatodynia maintenance in prostatitis patients remains unclear.

A mouse model of chronic prostatitis induced by carrageenan injection was used. The von Frey test was used to measure pain behavior. The microglial and astrocyte activations were immunohistochemically demonstrated with antibodies against Iba1 and GFAP. The expression of cytokine or signaling pathway was detected by enzyme-linked immunosorbent assay (ELISA) and Western blotting.

In this study, we provide several lines of evidence to demonstrate that activated spinal astrocytes contribute to the later phase (5 weeks after carrageenan injection) of carrageenan-induced prostatitis pain. First, activation of spinal astrocytes but not microglia was found in the spinal cord dorsal horn at 5 weeks. Second, intrathecal injection of the astroglial toxin L-2-Aminoadipate acid (L-AA) but not microglial inhibitor minocycline reduced mechanical allodynia at 5 weeks. Third, chronic prostatitis induced a profound and persistent upregulation of connexin-43 hemichannels in spinal astrocytes, and spinal injection of the connexin-43 inhibitor carbenoxolone (CBX) effectively reduced pain symptoms. Fourth, increased expression and release of chemokine C-X-C motif ligand 1 (CXCL1) in the spinal dorsal horn and intrathecal injection of a CXCL1 neutralizing antibody or the CXCR2 (a major receptor of CXCL1) antagonist SB225002 significantly reduced mechanical allodynia at 5 weeks.

In this study, we found that a novel mechanism of activated spinal astrocytes plays a crucial role in maintaining chronic prostatitis-induced persistent pain via connexin-43-regulated CXCL1 production and secretion.

• Astrocyte
• CXCL1
• Connexin43
• Microglia
• Prostatodynia

• Biofeedback, Psychology/instrumentation
• Biofeedback, Psychology/methods
• Exercise/physiology
• Fibromyalgia/complications
• Fibromyalgia/physiopathology
• Heart Rate/drug effects
• Heart Rate/physiology
• Humans
• Quality of Life/psychology
• Self-Management/methods
• Self-Management/psychology

• Autonomic dysfunction
• Autonomic nervous system
• Bladder neck dysfunction
• Dizziness
• LUTS
• Sympathetic tone

• chronic whiplash
• heart rate variability
• inhibitory control
• pain catastrophizing
• threat perception
• vagal activity

In this study, we compared the treatment outcomes for an α-blocker between 2 groups of men, one with high sympathetic activity (HSA) and another with low sympathetic activity (LSA) or normal sympathetic activity.

A total of 159 men (≥50 years of age) with lower urinary tract symptoms resulting from benign prostatic hyperplasia were analyzed. We assigned patients to groups according to their sympathetic activity, which was evaluated by heart ratevariability measurements. HSA was defined as a low frequency/high frequency ratio greater than 1.6. All patients received 10mg of alfuzosin once a day for 12 weeks. The primary end point was a change in the total International Prostate SymptomScore (IPSS) at 12 weeks from baseline.

Sixty-seven men were assigned to the HSA group and 92 men were assigned to the LSA group. The baseline characteristics were not significantly different between the 2 groups, and the response to alfuzosin was good in both groups. Themean total IPSS change was not different between the groups. Both groups were not significantly different with respect to the changes in maximal flow rate, IPSS voiding or storage symptom subscores, quality of life, and rates of adverse drug events. TheHSA group showed a similar willingness to continue treatment compared to the LSA group, although their treatment satisfaction rating was lower.

The therapeutic effects of alfuzosin did not differ in regards to the differences in sympathetic activity, but treatment satisfaction ratings were lower in the HSA group.

• Heart Rate
• Lower Urinary Tract Symptoms
• Prostatic Hyperplasia
• Sympathetic Nervous System

Introduction. Dysfunction of the autonomic nervous system is an important factor in the development of chronic pain. Fourth ventricle compression (CV-4) has been shown to influence autonomic activity. Nevertheless, the physiological mechanisms behind these effects remain unclear. Objectives. This study is aimed at evaluating the effects of fourth ventricle compression on the autonomic nervous system. Methods. Forty healthy adults were randomly assigned to an intervention group, on whom CV-4 was performed, or to a control group, who received a placebo intervention (nontherapeutic touch on the occipital bone). In both groups, plasmatic catecholamine levels, blood pressure, and heart rate were measured before and immediately after the intervention. Results. No effects related to the intervention were found. Although a reduction of norepinephrine, systolic blood pressure, and heart rate was found after the intervention, it was not exclusive to the intervention group. In fact, only the control group showed an increment of dopamine levels after intervention. Conclusion. Fourth ventricle compression seems not to have any effect in plasmatic catecholamine levels, blood pressure, or heart rate. Further studies are needed to clarify the CV-4 physiologic mechanisms and clinical efficacy in autonomic regulation and pain treatment.

Prostatitis comprises of a group of syndromes that affect almost 50% of men at least once in their lifetime and makeup the majority of visits to the Urology Clinics. After much debate, it has been divided into four distinct categories by National Institutes of Health namely (1) acute bacterial prostatitis; (2) chronic bacterial prostatitis; (3) chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) which is further divided into inflammatory and non-inflammatory CP/CPPS; and (4) asymptomatic inflammatory prostatitis. CP/CPPS has been a cause of great concern for both patients and physicians because of the lack of presence of thorough information about the etiological factors along with the difficult-to-treat nature of the syndrome. For the presented manuscript an extensive search on PubMed was conducted for CP/CPPS aimed to present an updated review on the evaluation and treatment options available for patients with CP/CPPS. Several diagnostic criteria’s have been established to diagnose CP/CPPS, with prostatic/pelvic pain for at least 3 mo being the major classifying symptom along with the presence of lower urinary tract symptoms and/or ejaculatory pain. Diagnostic tests can help differentiate CP/CPPS from other syndromes that come under the heading of prostatitis by ruling out active urinary tract infection and/or prostatic infection with uropathogen by performing urine cultures, Meares-Stamey Four Glass Test, Pre- and Post-Massage Two Glass Test. Asymptomatic inflammatory prostatitis is confirmed through prostate biopsy done for elevated serum prostate-specific antigen levels or abnormal digital rectal examination. Researchers have been unable to link a single etiological factor to the pathogenesis of CP/CPPS, instead a cluster of potential etiologies including atypical bacterial or nanobacterial infection, autoimmunity, neurological dysfunction and pelvic floor muscle dysfunction are most commonly implicated. Initially monotherapy with anti-biotics and alpha adrenergic-blockers can be tried, but its success has only been observed in treatment naïve population. Other pharmacotherapies including phytotherapy, neuromodulatory drugs and anti-inflammatories achieved limited success in trials. Complementary and interventional therapies including acupuncture, myofascial trigger point release and pelvic floor biofeedback have been employed. This review points towards the fact that treatment should be tailored individually for patients based on their symptoms. Patients can be stratified phenotypically based on the UPOINT system constituting of Urinary, Psychosocial, Organ-specific, Infectious, Neurologic/Systemic and symptoms of muscular Tenderness and the treatment algorithm should be proposed accordingly. Treatment of CP/CPPS should be aimed towards treating local as well as central factors causing the symptoms. Surgical intervention can cause significant morbidity and should only be reserved for treatment-refractory patients that have previously failed to respond to multiple drug therapies.

• Chronic prostatitis
• Antibiotics
• Myofascial trigger point
• Pelvic biofeedback
• Chronic pelvic pain syndrome
• Phytotherapy
• Nanobacteria
• Dysfunctional voiding
• Acupuncture

Heart rate variability (HRV) is a tool used to measure autonomic nervous function; however, there is no evidence that it can be used to define sympathetic hyperactivity in men with lower urinary tract symptoms (LUTS). We suspected that LUTS would differ between sympathetic hyperactive and hypoactive patients. Therefore, we measured HRV and divided the LUTS patients into two groups, a sympathetic hyperactive group and a sympathetic hypoactive group according to the low frequency/high frequency (LF/HF) ratio and made clinical comparisons between the groups.

A total of 43 patients with symptomatic LUTS (International Prostate Symptom Score [IPSS] over 8) and 49 healthy volunteers were enrolled. No subjects had diseases that could affect the autonomic nervous system, such as diabetes or hypertension. Electrocardiographic signals were obtained from subjects in the resting state and HRV indexes were calculated with spectral analyses. We divided the LUTS patients into two groups by an LF/HF ratio of 1.9, which was the median value in the healthy volunteers, and compared the differences in clinical characteristics, IPSS, prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) results. The parameters were compared by independent sample t-test by use of SPSS ver. 19.

There were no significant differences in age, serum PSA, or volume of the prostate between the 2 LUTS groups. However, analyzing IPSS questionnaires between two groups showed that there were significant differences in mean of Q2 score (frequency) and storage symptom score ([Q2+Q4+Q7]/3) (P<0.05).

We suggest that an imbalance of autonomic nervous system activity may be a factor that evokes varieties of symptoms in men with LUTS. LUTS patients with hypoactive sympathetic tone may suffer from frequency and storage symptoms.

• Autonomic nervous system
• Heart rate variability
• Lower urinary tract symptoms
• Prostatic hyperplasia