How is pain managed in the treatment of chronic bacterial prostatitis (CBP)?

Updated: Jan 15, 2019
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids should theoretically improve inflammation within the prostate to help reduce symptoms, and studies suggest that these agents may be useful as adjunctive therapy for patients with chronic prostatitis.

Cyclooxygenase-2 inhibitors (eg, rofecoxib, celecoxib), which are used for treating other chronic inflammatory conditions, have been used by urologists for prostatitis, with some anecdotal success reported. High-dose rofecoxib was shown to improve symptoms, but this drug has been withdrawn from the market. [26] Celecoxib has been shown to provide significant symptomatic improvement in patients with CPPS, in a dose-dependent fashion, but benefits are limited to therapy duration. [50, 51]

One meta-analysis reported that NSAIDs (rofecoxib, celecoxib, and a corticosteroid) are 80% more likely to achieve a favorable response, compared with placebo. [48] However, another meta-analysis of only rofecoxib and celecoxib found no significant difference in response to NSAIDs versus placebo. [49] Overall, high-dose long-duration therapy with cyclooxygenase-2 inhibitors is not recommended for CBP. 

Pregabalin, a neuropathic pain medication, has been suggested for use in chronic prostatitis and CPPS. In a randomized, double-blind, placebo-controlled trial of 218 men by Pontari et al, 47.2% of men who received pregabalin had a decrease in NIH-CPSI total score; however, the decrease was not statistically significant, and pregabalin was not superior to placebo. [52]

Opioid analgesics have not been evaluated in chronic prostatitis but are unlikely to provide clinical benefit and pose a high risk of addiction.


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