Purpose-Abnormal regulation of the HPA axis and diurnal cortisol rhythms are associated with several pain and chronic inflammatory conditions. Chronic stress may play a role in the disorder of CP/CPPS related to initiation or exacerbation of the syndrome. We tested the hypothesis that men with CPPS have associated disturbances in psychosocial profiles and HPA axis function.Methods-45 men with CPPS and 20 age-matched, asymptomatic controls completed psychometric self-report questionnaires: Type A personality test; Perceived Stress Scale, Beck Anxiety Inventory; and Brief Symptom Inventory [BSI] for distress from physical symptoms. Saliva samples were collected on two consecutive days at 9 specific times with strict reference to time of morning awakening for evaluation of free cortisol reflecting secretory activity of the HPA axis. We quantified cortisol variations as 2-day average slope of the awakening cortisol response and the subsequent diurnal levels.Results-CPPS men had more perceived stress and anxiety than controls (p < 0.001). BSI scores were significantly elevated in all scales (somatization, obsessive/compulsive behavior, depression, anxiety, hostility, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychoticism) for CPPS; Global Severity Index rank for CPPS was 93 rd versus 48 th centile for controls (p < 0.0001). CPPS men had significantly elevated awakening cortisol responses, mean slope of 0.85 versus 0.59 for controls (p < 0.05).Conclusions-CPPS men scored exceedingly high on all psychosocial variables and showed evidence of dysfunctional HPA axis function reflected in augmented awakening cortisol responses. Observations suggest variables in biopsychosocial interaction that suggest opportunities for neurophysiologic study of relationships of stress and CPPS.
Men with pelvic pain have significant disturbances in psychological profiles compared to healthy controls and evidence of altered hypothalamic-pituitary adrenal axis function in response to acute stress. These central nervous system observations may be a consequence of neuropsychological adjustments to chronic pain and modulated by personality.
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