The Therapeutic Potential of Acupuncture in Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) represents the most common type of CP, characterized by complex pathogenesis and a wide array of symptoms, making diagnosis and treatment challenging. Acupuncture, a widely used treatment for chronic and painful conditions, has demonstrated clinical efficacy in restoring prostate function and enhancing the quality of life for affected patients. This article critically examines the intricate pathogenesis of CP/CPPS and explores the related therapeutic mechanisms of acupuncture. Additionally, it summarizes the advancements made in the last decades regarding the use of acupuncture for treating CP/CPPS and elucidates potential effect pathways, laying the groundwork for further fundamental research.

Keywords

chronic prostatitis - chronic pelvic pain syndrome - acupuncture - mechanism

CRediT Authorship Contribution Statement

Y.Y. was responsible for conceptualization, formal analysis, investigation, visualization, and writing the original draft. X.P. was responsible for funding acquisition, supervision, writing review & editing. C.T. was responsible for methodology, validation, writing review and editing.

Publikationsverlauf

Eingereicht: 02. April 2023

Angenommen: 22. Mai 2023

Artikel online veröffentlicht:
27. September 2023

• References

• 1 Zhang MJ, Bin B, Shang XJ. et al. Expert consensus on the diagnosis and treatment of chronic prostatitis. Chin J Integr Tradit Wes Med 2015; 35 (08) 933-941
• 2 Rees J, Abrahams M, Doble A, Cooper A. Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int 2015; 116 (04) 509-525
• 3 Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs 2009; 69 (01) 71-84
• 4 Mao DD. Study on TCM Constitution, Syndrome Types of Chronic Prostatitis and Influencing Factors of NIH-CPSI. Huzhou: Huzhou Teachers College; 2020
• 5 Wan S. 60 cases of type III chronic prostatitis treated with chinese medicine by ultrasonic electric conductive drug delivery instrument. Henan Tradit Chin Med 2014; 34 (11) 2228-2229
• 6 Yu XJ, Gao QH. Guideline for the multidisciplinary diagnosis and treatment of chronic prostatitis with integrated traditional chinese and western medicine. Nat J Andr 2020; 26 (04) 369-376
• 7 Pena VN, Engel N, Gabrielson AT, Rabinowitz MJ, Herati AS. Diagnostic and management strategies for patients with chronic prostatitis and chronic pelvic pain syndrome. Drugs Aging 2021; 38 (10) 845-886
• 8 Zaidi N, Thomas D, Chughtai B. Management of chronic prostatitis (CP). Curr Urol Rep 2018; 19 (11) 88
• 9 Zheng XT, Chen SH, Yao WL. et al. Research progress on the etiology and pathogenesis of chronic prostatitis. Mod Diag Treat 2019; 30 (11) 1810-1814
• 10 Vykhovanets EV, Resnick MI, MacLennan GT, Gupta S. Experimental rodent models of prostatitis: limitations and potential. Prostate Cancer Prostatic Dis 2007; 10 (01) 15-29
• 11 Haverkamp JM, Charbonneau B, Crist SA. et al. An inducible model of abacterial prostatitis induces antigen specific inflammatory and proliferative changes in the murine prostate. Prostate 2011; 71 (11) 1139-1150
• 12 Liu Y, Chen XG, Liang CZ. Research progress on the immune mechanism of chronic prostatitis. Nati J Andr 2017; 23 (07) 652-655
• 13 Simons BW, Durham NM, Bruno TC. et al. A human prostatic bacterial isolate alters the prostatic microenvironment and accelerates prostate cancer progression. J Pathol 2015; 235 (03) 478-489
• 14 Murphy SF, Schaeffer AJ, Done J. et al. IL17 mediates pelvic pain in experimental autoimmune prostatitis (EAP). PLoS One 2015; 10 (05) e0125623
• 15 Breser ML, Lino AC, Motrich RD, Godoy GJ, Demengeot J, Rivero VE. Regulatory T cells control strain specific resistance to experimental autoimmune prostatitis. Sci Rep 2016; 6: 33097
• 16 Quick ML, Wong L, Mukherjee S, Done JD, Schaeffer AJ, Thumbikat P. Th1-Th17 cells contribute to the development of uropathogenic Escherichia coli-induced chronic pelvic pain. PLoS One 2013; 8 (04) e60987
• 17 Ye HY, Hou SK, Bai WJ, Deng QP. Expression and significance of IL-6 and IL-8 in prostatic fluid of patients with chronic prostatitis. Chin J Urol 2003; (04) 62-64
• 18 Hu XP, Bai WJ, Zhu JC, Wang XF. Bacterial and immunological study of chronic prostatitis. Chin J Urol 2002; (01) 29-31
• 19 Murphy SF, Anker JF, Mazur DJ, Hall C, Schaeffer AJ, Thumbikat P. Role of gram-positive bacteria in chronic pelvic pain syndrome (CPPS). Prostate 2019; 79 (02) 160-167
• 20 Zhang LG, Yu ZQ, Yang C. et al. Effect of Eriocalyxin B on prostatic inflammation and pelvic pain in a mouse model of experimental autoimmune prostatitis. Prostate 2020; 80 (16) 1394-1404
• 21 Done JD, Rudick CN, Quick ML, Schaeffer AJ, Thumbikat P. Role of mast cells in male chronic pelvic pain. J Urol 2012; 187 (04) 1473-1482
• 22 Su Y, Liang CZ. Research progress on the relationship between prostatic neuroendocrine cells and chronic prostatitis. Nat J Andr 2012; 18 (07) 631-634
• 23 Zheng XT, Chen D, Ying S, Ma L, Wang JH. Effect of white blood cell count in prostatic fluid on the degree of chronic prostatitis symptoms. Zhonghua Zhongyiyao Xuekan 2016; 34 (08) 1914-1916
• 24 Zhang BB, Bai AS. Progress in pathogenesis and treatment of chronic prostatitis. Chin J Diff Comp Cases 2014; 13 (03) 326-329
• 25 Bernoulli J, Yatkin E, Talvitie EM, Santti R, Streng T. Urodynamic changes in a noble rat model for nonbacterial prostatic inflammation. Prostate 2007; 67 (08) 888-899
• 26 Sugimoto M, Oka M, Tsunemori H, Yamashita M, Kakehi Y. Effect of a phytotherapeutic agent, Eviprostat®, on prostatic and urinary cytokines/chemokines in a rat model of nonbacterial prostatitis. Prostate 2011; 71 (04) 438-444
• 27 Helle KB. Regulatory peptides from chromogranin A and secretogranin II. Cell Mol Neurobiol 2010; 30 (08) 1145-1146
• 28 Huang J, Yao JL, Zhang L. et al. Differential expression of interleukin-8 and its receptors in the neuroendocrine and non-neuroendocrine compartments of prostate cancer. Am J Pathol 2005; 166 (06) 1807-1815
• 29 Lin D, Zhang M, Luo C, Wei P, Cui K, Chen Z. Targeting ferroptosis attenuates inflammation, fibrosis, and mast cell activation in chronic prostatitis. J Immunol Res 2022; 2022: 6833867
• 30 Liang CZ, Guo QK, Hao ZY. et al. K channel expression in prostate epithelium and its implications in men with chronic prostatitis. BJU Int 2006; 97 (01) 190-192
• 31 Fan S, Liang CZ, Hao ZY. et al. Expression and significance of TRPV5 in prostatic epithelial cells of patients with chronic prostatitis. Chin J Andr 2007; (10) 12-15
• 32 Roman K, Done JD, Schaeffer AJ, Murphy SF, Thumbikat P. Tryptase-PAR2 axis in experimental autoimmune prostatitis, a model for chronic pelvic pain syndrome. Pain 2014; 155 (07) 1328-1338
• 33 Pattabiraman G, Liu Z, Paul M, Schaeffer AJ, Thumbikat P. mMCP7, a mouse ortholog of δ tryptase, mediates pelvic tactile allodynia in a model of chronic pelvic pain. Front Pain Res (Lausanne) 2022; 2: 805136
• 34 Xu Y, Hong S, Zhao X. et al. Acupuncture alleviates rheumatoid arthritis by immune-network modulation. Am J Chin Med 2018; 46 (05) 997-1019
• 35 Li JJ, Chen RM, Liu L. et al. Effects of electroacupuncture on the immunoreactivevity of focal cutaneous CB2Receptor Positive Cells In Arthritis Rats. Acup Res 2007; (01) 9-15
• 36 Li A, Wang Y, Xin J. et al. Electroacupuncture suppresses hyperalgesia and spinal Fos expression by activating the descending inhibitory system. Brain Res 2007; 1186: 171-179
• 37 Huang C, Hu ZP, Jiang SZ, Li HT, Han JS, Wan Y. CCK(B) receptor antagonist L365,260 potentiates the efficacy to and reverses chronic tolerance to electroacupuncture-induced analgesia in mice. Brain Res Bull 2007; 71 (05) 447-451
• 38 Chen T, Zhang WW, Chu YX, Wang YQ. Acupuncture for pain management: molecular mechanisms of action. Am J Chin Med 2020; 48 (04) 793-811
• 39 Zhang C, Xia C, Zhang X, Li W, Miao X, Zhou Q. Wrist-ankle acupuncture attenuates cancer-induced bone pain by regulating descending pain-modulating system in a rat model. Chin Med 2020; 15 (01) 13
• 40 Jiang SW, Lin YW, Hsieh CL. Electroacupuncture at Hua Tuo Jia ji acupoints reduced neuropathic pain and increased GABAA receptors in rat spinal cord. Evid Based Complement Alternat Med 2018; 2018: 8041820
• 41 Chen Y, Li D, Li N. et al. Role of nerve signal transduction and neuroimmune crosstalk in mediating the analgesic effects of acupuncture for neuropathic pain. Front Neurol 2023; 14: 1093849
• 42 Lu SS, Wang JQ, Huang J. et al. Study on the anti-inflammatory and analgesic mechanism of acupuncture. J Clin Acup Moxib 2021; 37 (05) 1-4
• 43 Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology 2014; 120 (02) 482-503
• 44 Rittner HL, Brack A, Machelska H. et al. Opioid peptide-expressing leukocytes: identification, recruitment, and simultaneously increasing inhibition of inflammatory pain. Anesthesiology 2001; 95 (02) 500-508
• 45 Linley JE, Rose K, Ooi L, Gamper N. Understanding inflammatory pain: ion channels contributing to acute and chronic nociception. Pflugers Arch 2010; 459 (05) 657-669
• 46 Chen WH, Hsieh CL, Huang CP. et al. Acid-sensing ion channel 3 mediates peripheral anti-hyperalgesia effects of acupuncture in mice inflammatory pain. J Biomed Sci 2011; 18 (01) 82
• 47 Lu KW, Hsu CK, Hsieh CL, Yang J, Lin YW. Probing the effects and mechanisms of electroacupuncture at ipsilateral or contralateral ST36–ST37 acupoints on CFA-induced inflammatory pain. Sci Rep 2016; 6: 22123
• 48 Wang LN, Wang XZ, Li YJ. et al. Activation of subcutaneous mast cells in acupuncture points triggers analgesia. Cells 2022; 11 (05) 809
• 49 Wu SY, Chen WH, Hsieh CL, Lin YW. Abundant expression and functional participation of TRPV1 at Zusanli acupoint (ST36) in mice: mechanosensitive TRPV1 as an “acupuncture-responding channel”. BMC Complement Altern Med 2014; 14: 96
• 50 Wang HF, Chen L, Xie Y. et al. Electroacupuncture facilitates M2 macrophage polarization and its potential role in the regulation of inflammatory response. Biomed Pharmacother 2021; 140: 111655
• 51 Chen H, Shao X, Li L. et al. Electroacupuncture serum inhibits TNF–α–mediated chondrocyte inflammation via the Ras–Raf–MEK1/2–ERK1/2 signaling pathway. Mol Med Rep 2017; 16 (05) 5807-5814
• 52 Chen W, Zhang XN, Su YS. et al. Electroacupuncture activated local sympathetic noradrenergic signaling to relieve synovitis and referred pain behaviors in knee osteoarthritis rats. Front Mol Neurosci 2023; 16: 1069965
• 53 Lyu Z, Guo Y, Gong Y. et al. The role of neuroglial crosstalk and synaptic plasticity-mediated central sensitization in acupuncture analgesia. Neural Plast 2021; 2021: 8881557
• 54 Chen L, Xu A, Yin N. et al. Enhancement of immune cytokines and splenic CD4+ T cells by electroacupuncture at ST36 acupoint of SD rats. PLoS One 2017; 12 (04) e0175568
• 55 Zhao H, Dong F, Li Y. et al. Inhibiting ATG5 mediated autophagy to regulate endoplasmic reticulum stress and CD4⁺ T lymphocyte differentiation: Mechanisms of acupuncture's effects on asthma. Biomed Pharmacother 2021; 142: 112045
• 56 Dong M, Wang WQ, Chen J. et al. Acupuncture regulates the balance of CD4^+ T cell subtypes in experimental asthma mic. Chin J Integr Med 2019; 25 (08) 617-624
• 57 Ren S, Liu H, Wang X. et al. Acupoint nanocomposite hydrogel for simulation of acupuncture and targeted delivery of triptolide against rheumatoid arthritis. J Nanobiotechnology 2021; 19 (01) 409
• 58 Wang Y, Chen Y, Meng L. et al. Electro-acupuncture treatment inhibits the inflammatory response by regulating γδ T and Treg cells in ischemic stroke. Exp Neurol 2023; 362: 114324
• 59 Xue X, Liu Y, Wang SH. et al. [Effect of electroacupuncture intervention on relieving pain and inflammation by suppressing TLR4/NF-κB signaling in rats with primary dysmenorrhea]. Zhen Ci Yan Jiu 2023; 48 (01) 63-70
• 60 Zhang MJ, Chang DG, Bin B. et al. Diagnosis and treatment guide of integrated Chinese and western medicine for chronic prostatitis. Chin J Andr 2023; 37 (01) 3-17
• 61 Guideline for the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome. Nat J Andr 2022; 28 (06) 544-559
• 62 Chang XU, Na LI, Xiaoling WU. et al. Effect of electroacupuncture on inflammatory signal expression in local tissues of rats with chronic pelvic pain syndrome based on purinergic 2 × 7 receptor/NOD-like receptor pyrin domain-containing 3 signal pathway. J Tradit Chin Med 2022; 42 (06) 965-971
• 63 Liu AG, Li HZ, Yan XK. et al. [Effect of electroacupuncture at “Sanyin” acupoints on cellular immune function in rats with chronic abacterial prostatitis]. Zhen Ci Yan Jiu 2013; 38 (03) 192-197
• 64 Yan XK, Liu AG, He TY. et al. [Decreasing effect of electro-acupuncture at Sanyin points on inflammatory cytokines in autoimmune prostatitis rats]. Zhonghua Nan Ke Xue 2013; 19 (05) 451-455
• 65 Vane JR, Bakhle YS, Botting RM. Cyclooxygenases 1 and 2. Annu Rev Pharmacol Toxicol 1998; 38 (01) 97-120
• 66 Wu XL, Li N, Xu C. et al. [Effect of electroacupuncture on pain threshold and expression of pain-related factors cyclooxygenase-2, prostaglandin E2 and β-endorphin in rats with chronic pelvic pain syndrome]. Zhen Ci Yan Jiu 2022; 47 (06) 531-536
• 67 Xu C, Cheng K, Wu XL. et al. Expression profiling of L5–S2 spinal cord dorsal horn in a rat model of chronic pelvic pain syndrome uncovers potential mechanism of electroacupuncture mediated inflammation and pain responses. J Pain Res 2022; 15: 2067-2084
• 68 Tominaga M, Tominaga T. Structure and function of TRPV1. Pflugers Arch 2005; 451 (01) 143-150
• 69 Wu XL, Cheng K, Xu C. et al. Effect of electroacupuncture on cyclic adenosine monophosphate-protein kinase A-vanillic acid receptor subtype 1 of the transient receptor potential/PLK-protein kinase C-vanillic acid receptor subtype 1 of the transient receptor potential pathway based on RNA-seq analysis in prostate tissue in rats with chronic prostatitis/chronic pelvic pain syndrome. Front Neurosci 2022; 16: 938200
• 70 Metcalfe DD, Baram D, Mekori YA. Mast cells. Physiol Rev 1997; 77 (04) 1033-1079
• 71 Breedveld A, Groot Kormelink T, van Egmond M, de Jong EC. Granulocytes as modulators of dendritic cell function. J Leukoc Biol 2017; 102 (04) 1003-1016
• 72 Li ZH, Zhao XD, Ming SR, Li X, Hu JW, Chen YL. [Effect of electroacupuncture on the morphology of prostate and degranulation of mast cells in rats with chronic nonbacterial prostatitis]. Zhen Ci Yan Jiu 2023; 48 (01) 56-62
• 73 Kursunel MA, Esendagli G. The untold story of IFN-γ in cancer biology. Cytokine Growth Factor Rev 2016; 31: 73-81
• 74 Piotrowska A, Ciapała K, Pawlik K, Kwiatkowski K, Rojewska E, Mika J. Comparison of the effects of chemokine receptors CXCR2 and CXCR3 pharmacological modulation in neuropathic pain model—in vivo and in vitro study. Int J Mol Sci 2021; 22 (20) 11074
• 75 Qin Z, Guo J, Chen H, Wu J. Acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a GRADE-assessed systematic review and meta-analysis. Eur Urol Open Sci 2022; 46: 55-67
• 76 Sun Y, Liu Y, Liu B. et al. Efficacy of acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a randomized trial. Ann Intern Med 2021; 174 (10) 1357-1366