Talk:Chronic prostatitis/chronic pelvic pain syndrome

Disambiguation

Could this page replace or be megered with the main proststits article?

- No, because it's a different thing — Preceding unsigned comment added by 77.225.149.15 (talk) 19:53, 6 April 2012 (UTC)

Major new overview study published in top journal

The Journal of Urology (known as "the white journal" by urologists since it is one of the top medical journals in the world) has just published a major new study that looks back over 30 years of research into this field. You can read it here. I think this should be used as a starting point for any further editing of the page. If there is no objection, I shall use it as a reference for a lot of future changes. ► RATEL ◄ 14:38, 28 April 2008 (UTC)

NIH alfusozin study

Objection to posting findings of the study because not yet published in a journal. This was a large, multi-center, NIH run study whose findings have a direct impact on patient care today. Abstract is published in the Journal of Urology AUA edition. Not reasonable to wait on every bit of medical evidence to go through the 6-12 months it takes to be published in a journal if level of quality (patient numbers, study design, track record of investigators) is strong enough. Is this not more important than a list of famous dead people who may have had prostatitis based on newspaper accounts? I completely agree that minor abstracts should not be given the weight of peer reviewed journal articles and that not all journal articles are of equal weight. I would also support removing the information if no article is forthcoming. Nevertheless, I believe that deleting this edit sets the bar too high, and would call into question some of the other more speculative parts of the CPPS wiki entry. Wlosy (talk) 15:32, 21 May 2008 (UTC)

• Please read rules for reliable sources for medical articles. Thank you and keep contributing. ► RATEL ◄ 15:36, 21 May 2008 (UTC)

Failure of alfusozin does not mean other alpha blockers will fail also. Alfusozin is relatively selective for the alpha1a receptor subtype. Alpha receptors that control pain in the spinal cord may be other subtypes. Note that studies of less selective alpha blockers in CPPS (Cardura, Hytrin) while smaller in numbers, were all positive studies. Wlosy (talk) 22:03, 26 May 2008 (UTC)

Actually, the abstract ends with the conclusion:

This large NIH/NIDDK sponsored multicenter randomized placebo controlled North American trial will provide an evidence based foundation to help physicians decide whether or not to prescribe alpha-blockers for men with newly diagnosed CP/CPPS.

The inference that the study relates to all alpha blockers may justifiably be drawn. However, I see no problem leaving the edit you made, for now.► RATEL ◄ 22:40, 26 May 2008 (UTC)

Mepartricin

Im surprised this article doesnt mention this drug (and the [Mepartricin] article only describes it as a stomatological preparation). It has shown to be effective in treating CPPS and I can only confirm that from my personal experience. Evidence: http://www.goldjournal.net/article/S0090-4295%2803%2900885-9/abstract —Preceding unsigned comment added by 80.188.222.34 (talk) 16:45, 15 April 2010 (UTC)

==Name== I have never seen a page named like this chronic prostatitis and chronic pelvic pain syndrome are synonyms. Usually we use one or the other not both.Doc James (talk · contribs · email) 11:24, 29 May 2010 (UTC)

Recent changes

There are some SPA editors making huge changes, mostly deletions of long-standing sourced content, without reason, and simultaneous addition of unsourced material that amounts to SPAM while failing the tests of wikipedia is not a crystal ball and rules for sourcing of data in medical articles. The SPAs are Noodlebike (talk · contribs · deleted contribs · page moves · block user · block log) and Arkaroola (talk · contribs · deleted contribs · page moves · block user · block log). I notice the rules on edit warring were also breached. TickleMeister (talk) 09:03, 19 August 2010 (UTC)

Recent review

Review [1] Doc James (talk · contribs · email) 22:17, 25 January 2011 (UTC)

Unfortunately, because this field has seen quite large advances in knowledge in the last 12 years, a review that starts at 1974 will come up with some strange results. The finding that antibiotics are the most effective treatment, for instance, flies in the face of recent research that recommends against their use, since they are found to be no better than placebo (PMID 14550427 et al). See also PMID 18472971 PMID 17954024 and many more like them. RxWatch (talk) 00:24, 26 January 2011 (UTC)

Merge with Chronic prostatitis

Neither ICD 9 or 10 use this term. We routinely refer to the condition as chronic prostatitis.--Doc James (talk · contribs · email) 22:27, 25 January 2011 (UTC)

Chronic prostatitis is shorthand for CP/CPPS, and redirects to this article. RxWatch (talk) 00:25, 26 January 2011 (UTC)

You are correct. Thus I propose we move it to Chronic prostatitis as this is the ICD 9 term and both terms are frequently used interchangeably in reviews.--Doc James (talk · contribs · email) 00:34, 26 January 2011 (UTC)

ICD 9 is a little behind the terms the urological profession and researchers are using (see Table 2 here). But I don't have an objection to the name change, as long as we ripple it all over the database. RxWatch (talk) 00:46, 26 January 2011 (UTC)

Medline plus uses the term "Chronic nonbacterial prostatitis" That might work even better. Then change Chronic prostatitis to a disambig that lists these two terms? Doc James (talk · contribs · email) 01:09, 26 January 2011 (UTC)

Chronic nonbacterial prostatitis — gee, that's an oldie that nobody uses anymore. Do we have to conform to medline or ICD9, and can't we just stick to the NIDDK's definition? RxWatch (talk) 01:33, 26 January 2011 (UTC)

If you look at Pubmed there are recent reviews 2009 that use the term. I had never heard of CP/CPPS until I realised that it was the same as chronic prostatitis. Doc James (talk · contribs · email) 02:47, 26 January 2011 (UTC)

You are right that CP/CPPS is used more. It is just such a combersum term. Will leave it where it is per NIDDK. Doc James (talk · contribs · email) 02:51, 26 January 2011 (UTC)

I have noticed an unfortunate trend to longer (and more inclusive) names for diseases, institutions, departments of institutions, etc., necessitating an ever-increasing use of opaque initialisms.  :-( 108.48.209.190 (talk) 22:20, 3 March 2013 (UTC)

female prostate

This page is heavily geared towards men with chronic prostatis. I would create a separate page for chronic pelvic pain syndrome as it pertains to women. — Preceding unsigned comment added by Mjams (talk • contribs) 14:55, 1 October 2016 (UTC)

ummm see Skene's gland and articles linked at Skene's_gland#Clinical_significance Jytdog (talk) 18:42, 1 October 2016 (UTC)

New ref

seems good: http://www.mayoclinicproceedings.org/article/S0025-6196(16)30503-1/pdf%7C Best Regards, Barbara (WVS) (talk) 19:36, 6 November 2016 (UTC)

Brain

I have put the brain research section under the heading Research. This is an enigmatic syndrome and finally there is light at the end of the tunnel with this NIH/NIDDK funded research, so excluding it all would be stupid. Ratel (talk) 07:07, 26 March 2017 (UTC)

There are two issues with this. First, you have synthesized a mini-review here in WP, which you do not have the right to do as a Wikipedia editor. Second, if there are no reviews discussing this, it is UNDUE. If there are reviews, please summarize them here in WP, giving appropriate WEIGHT to various perspectives on this. The funding has nothing to do with it. Please also see User:Jytdog#NPOV_part_1:_secondary_sources. Jytdog (talk) 12:18, 26 March 2017 (UTC)

Not a synthesis, no attempt to make an argument or draw it all together, simply stating the individual findings in precis form. Perhaps you should re-look at what synthesis means?

Is WP really forbidden from enumerating research directions in conditions, especially conditions about which the medical profession openly acknowledges it knows almost nothing? I would expect a good encyclopedia to outline the directions of further research, not only into the brain but elsewhere too. This is groundbreaking research, reviews have not caught up yet; there are however these reviews PMID 26905019 PMID 27922040 and PMID 2692001 but I would expect more to be published soon. In summary, I will insert the material on the brain again, once I have access to the full paper PMID 26905019 as a source (which should occur soon).Ratel (talk) 22:18, 26 March 2017 (UTC)

Per WP:NPOV which is policy, we give WEIGHT per secondary sources. I went looking and found some brief discussions of this and will add some content based on those reviews. But WP is not cutting edge - our mission is "accepted knowledge" (per WP:NOTEVERYTHING, which is policy); "accepted knowledge" is not at all the same thing as "cutting edge", which we don't do in WP. Jytdog (talk) 22:44, 26 March 2017 (UTC)

Oh please, covering research in a condition with unknown etiology is hardly "cutting edge". Facepalm. Ratel (talk) 23:16, 26 March 2017 (UTC)

• The conclusion of PMID 26905019 is interesting and some of it could go into our article (my emphasis):

The neuroanatomical route of bladder pain is complex. Although the peripheral nervous system is responsible for the initial response to noxious stimuli, the CNS is responsible for the affective and autonomic disturbances that accompany bladder pain. In chronic diseases such as IC/BPS the CNS undergoes molecular, physiological and structural changes that result in pain despite a lack of noxious input from the periphery. Investigating these supraspinal changes will identify new therapeutic strategies to help patients with IC/BPS and other chronic pelvic diseases.

The fact that the brain can continue the pain independently is novel and important. Ratel (talk) 20:36, 27 March 2017 (UTC)

Section deleted with comment "source poor"

The section on pelvic floor musculature was deleted with the words "source poor". However, the source in question frequently cites primary sources, is a reliable secondary source, and is written by one of the leading researchers in this area at Stanford University.

You can see his publications about this issue here: https://profiles.stanford.edu/rodney-anderson?tab=publications

Furthermore, if there are other sources you prefer, go ahead and add them, but please don't just delete the whole section. This is a major theory of CPPS causation which was scarcely mentioned in the page until now. We cannot just delete all mention of it.

There are other theories of causation in the article now. Some of those theories ("food allergies") were developed on message boards and have little or no academic support. If we delete this section, then the most prominent and well-supported theories of causation will be removed from the article when fringe or unsupported theories remain.

The reliable sources policy appears to favor citing secondary sources, which is why I included that one. WP:MEDRS does not stipulate that the source must be a primary source.

Thomas pow s (talk) 18:43, 8 March 2019 (UTC)

Looking at this text. Harmony books is NOT a medical publisher. This is not a medical textbook. It is popular press. We need sources that meet WP:MEDRS. Also you need to provide page numbers, year of publication, Etc. But the first thing is a proper source. Doc James (talk · contribs · email) 04:35, 9 March 2019 (UTC)

User:Thomas pow s you need to use proper sources and get consensus. Doc James (talk · contribs · email) 06:07, 9 March 2019 (UTC)

Hi Doc James. You were just asked not to blank the entire section and delete the most prominent and well-reserached theory, while leaving fringe theories intact. You have not responded in any meaningful way to any of the material that was presented to you.

If the date of publication is missing, then fill it in, but do not just ignore what you were asked and then blank the entire section, and remove the most well-researched theory because of a missing date etc.

WP:MEDRS does not require a medical textbook.

Are you suggesting that this theory is fringe or unscientific? Did you click the link and read the research publications that I presented to you? If you think that the secondary source is not good enough, then can we use other sources you would find more acceptable? Would you like me to help you find those sources?

Answer these questions please, and do not just delete the entire section because of a missing date. Also, if you feel that WP:MEDRS absolutely requires a medical textbook, could you point out where that is indicated?

Thomas pow s (talk) 06:17, 9 March 2019 (UTC)

As the person who wishes to add the content in question, you need to come forwards with a decent reference. You have not done so. You have not even supplied sufficient details in the current reference to verify it. Doc James (talk · contribs · email) 06:29, 9 March 2019 (UTC)

Okay, let's take this one point at a time. Is this reference bad because the book publisher (Harmony) is unacceptable to you? If I fill in the date and page numbers, would it make any difference, or is anything published by Harmony unacceptable? There is no point in doing those things if the source is unacceptable anyway.

How about a bunch of primary sources, like the ones listed in the link I provided above, in addition to the book? Would that be okay?

Thomas pow s (talk) 06:38, 9 March 2019 (UTC)

Also, you are asking for consensus, but do you have consensus yourself? Can you point out where you obtained consensus? If I am violating consensus, then I apologize, and please point out where consensus was obtained.

Also, are these standards applied to all the other theories indicated in that section? Why are you deleting the most-supported theory, while fringe theories have been in the page for years while you've been editing and have entire sections devoted to them? I noticed that one of the major theories presented here has no sources whatsoever, has no relevant research, and indicates "Studies are lacking in this area". Why would we delete the best-supported theories while keeping that one? Thomas pow s (talk) 06:28, 9 March 2019 (UTC)

You need to use proper references per WP:MEDRS. Best Doc James (talk · contribs · email) 06:34, 9 March 2019 (UTC)

Doc James, you are offering flippant responses, while not responding at all to what was just said to you.

If I included a bunch of primary sources as well, as per above, would that be acceptable to you?

Thomas pow s (talk) 06:46, 9 March 2019 (UTC)

How about this source as well? It's a meta-analysis by the same author, published in the journal Urology. Would that be acceptable? Thomas pow s (talk) 07:27, 9 March 2019 (UTC)

That source is much better. It is a pubmed indexed secondary source in a reputable journal. Doc James (talk · contribs · email) 08:05, 9 March 2019 (UTC)

agree w/ Doc James on Meta/analysis--Ozzie10aaaa (talk) 12:02, 9 March 2019 (UTC)

Hi Ozzie, you say "agreed w/ Doc James", but the changes you made to the article were not what was agreed upon. Furthermore, there is a consensus, and someone wrote below that the inclusion of the book as well is acceptable. But then you deleted that source entirely, right after it was agreed that the inclusion of that source as well is acceptable.

Furthermore, I do not see why we would remove this section from where it was, and put it where you put it. I don't understand your reason for that.

This is the best-supported theory on the causation of CPPS. Why would we remove all mention of it from the "Cause" section? And leave the other theories of causation, some of which are fringe, obscure, supported by only a single source, and so on? Why would we remove all mention of the best-supported theory and leave the fringe or obscure theories intact? Readers will now get a drastically incorrect impression that the major theories of CPPS causation involve climate and food allergies (!!). I don't understand your reasoning here.

The very first sentence of WP:RS reads: "Wikipedia articles should be based on reliable ... sources, making sure that all majority and significant minority views in those sources are covered". However, you have just removed the most supported theory from the "causes" section, and left the fringe ones. Could you elaborate on why we should do that?

Thomas pow s (talk) 19:22, 9 March 2019 (UTC)

Im agreeing w/ the use of... Anderson, Rodney U.; Wise, David; Nathanson, Brian H. (October 2018). "Chronic Prostatitis and/or Chronic Pelvic Pain as a Psychoneuromuscular Disorder-A Meta-analysis". Urology. 120: 23–29. doi:10.1016/j.urology.2018.07.022. ISSN 1527-9995. Retrieved 9 March 2019.….--Ozzie10aaaa (talk) 19:52, 9 March 2019 (UTC)

Hi Ozzie, I asked you why you removed the best supported theory from the causes section while leaving the fringe theories intact. If you have no significant reason for this, then I will re-add something to the cause section.

Thomas pow s (talk) 19:59, 9 March 2019 (UTC)

as long as the text is supported by MEDRSWikipedia:Identifying_reliable_sources_(medicine),thank you--Ozzie10aaaa (talk) 20:21, 9 March 2019 (UTC)

Do you object if I also include the book reference, in addition to the agreed-upon source? Thomas pow s (talk) 22:19, 9 March 2019 (UTC)

book[2] does not conform to MEDRS...IMO--Ozzie10aaaa (talk) 23:07, 9 March 2019 (UTC)

(outdenting) Okay, great. I'll add that source to the section.

Do you think it's okay if I still include the book reference? It is by the same author. Thomas pow s (talk) 10:01, 9 March 2019 (UTC)

Of course it's okay to include the book reference, as it may help to verify the article content and provide a basis for further improvement; but it is vital that you supply the details of the book you are using – we need the page so that nobody has to read the whole book to verify the text, and we need the year to identify the edition because pagination often changes between editions. The only time you wouldn't need to provide an exact page number would be if you weren't using the book as a direct reference, but included it in a "Further reading" section. --RexxS (talk) 10:33, 9 March 2019 (UTC)

Harmony is not a suitable publisher. We should stick with high quality sources rather than that book. Doc James (talk · contribs · email) 03:11, 10 March 2019 (UTC)

Text in question

One theory is that CPPS is caused by chronic spasm in the pelvic floor musculature. This spasm causes tissue damage and sensitization of nearby nerves. The tissue damage cannot heal because the spasm is ongoing and prevents blood flow to the affected area, thereby preventing healing.

Treatment involves physical therapy to break the spasm, and also a program of "paradoxical relaxation" to prevent chronic tensing of the pelvic musculature which caused the spasm in the first place.

References

Were doe the ref support the text in question?

Not only do we need a decent reference which this is, the reference needs to actually support the text in question. I have read this reference and am not seeing the text that supports the following. User:Thomas pow s can you provide a direct quote from this source? Thanks Doc James (talk · contribs · email) 03:16, 10 March 2019 (UTC)

"One theory is that CPPS is caused by chronic tension in the pelvic floor musculature. This tension causes tissue damage and sensitization of nearby nerves. The tissue damage cannot heal because the tension is ongoing and prevents blood flow to the affected area, thereby preventing healing."

Anderson, RU; Wise, D; Nathanson, NH (October 2018). "Chronic Prostatitis and/or Chronic Pelvic Pain as a Psychoneuromuscular Disorder--A Meta-analysis". Urology. 120: 23–29. doi:10.1016/j.urology.2018.07.022. PMID 30056195.