This application proposes that Stanford University School of Medicine, Department of Urology, participate as one of several National Clinical Centers in a cooperative effort to develop feasible clinical trials for the study of chronic prostatitis/chronic pelvic pain syndrome. The Principal Investigator intends to participate fully as a member of the steering committee in designing randomized controlled clinical trials and facilitate carrying them out in collaboration with other national center Pl's. The investigative group at Stanford will work in parallel with the centers conducting trials for investigation of interstitial cystitis. A simultaneous application for that effort is being submitted. While the precise pathophysiology and biologic basis of chronic pelvic pain, particularly associated with genitourinary dysfunction, have not been elucidated, a large number of men in the United States continue to suffer immeasurably for many years with this chronic disorder. Multimodal therapy exists as the only management approach and, for the most part, lacks sound scientific justification.
The specific aim of this project is to utilize clinical experience from the most experienced and knowledgeable physicians available to design clinical trials of treatment modalities that may provide a favorable therapeutic response among the many sub-groups of this population of patients. Investigation within these trials will stretch from pharmaceutical to complimentary holistic treatment methods, representing the best of ideas chosen by the participating centers. The Stanford Group intends to contribute experience and expertise with regard to managing chronic prostatitis/chronic pelvic pain syndrome utilizing a neurobehavioral therapy and proposes a clinical trial of targeted physiotherapeutic myofascial release of painful trigger points with progressive relaxation exercises. The psychophysiological vagaries among patients suffering from this disorder have long been appreciated, but poorly defined, and deserve a fresh look with a dedicated """"""""hands on"""""""" clinical effort conducted by several investigators simultaneously and with rigorous clinical research design.
