Psychometric profiles and hypothalamic-pituitary-adrenal axis function in men with chronic prostatitis/chronic pelvic pain syndrome

Abstract

Purpose: Abnormal regulation of the hypothalamic-pituitary-adrenal axis and diurnal cortisol rhythms are associated with several pain and chronic inflammatory conditions. Chronic stress may have a role in the disorder of chronic prostatitis/chronic pelvic pain syndrome related to initiation or exacerbation of the syndrome. We tested the hypothesis that men with chronic pelvic pain syndrome have associated disturbances in psychosocial profiles and hypothalamic-pituitary-adrenal axis function.

Materials and methods: A total of 45 men with chronic pelvic pain syndrome and 20 age matched, asymptomatic controls completed psychometric self-report questionnaires including the Type A personality test, Perceived Stress Scale, Beck Anxiety Inventory and Brief Symptom Inventory for distress from physical symptoms. Saliva samples were collected on 2 consecutive days at 9 specific times with strict reference to time of morning awakening for evaluation of free cortisol, reflecting secretory activity of the hypothalamic-pituitary-adrenal axis. We quantified cortisol variations as the 2-day average slope of the awakening cortisol response and the subsequent diurnal levels.

Results: Men with chronic pelvic pain syndrome had more perceived stress and anxiety than controls (p <0.001). Brief Symptom Index scores were significantly increased in all scales (somatization, obsessive/compulsive behavior, depression, anxiety, hostility, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychoticism) for chronic pelvic pain syndrome, and Global Severity Index rank for chronic pelvic pain syndrome was 93rd vs 48th percentile for controls (p <0.0001). Men with chronic pelvic pain syndrome had significantly increased awakening cortisol responses, mean slope of 0.85 vs 0.59 for controls (p <0.05).

Conclusions: Men with chronic pelvic pain syndrome scored exceedingly high on all psychosocial variables and showed evidence of dysfunctional hypothalamic-pituitary-adrenal axis function reflected in augmented awakening cortisol responses. Observations suggest variables in biopsychosocial interaction that suggest opportunities for neurophysiological study of relationships of stress and chronic pelvic pain syndrome.

Fig. 1

Brief Symptom Index clinical profile for men with CPPS and controls (T scores and centile ranks) for the nine dimensional scales and the Global Severity Index.

Fig. 1

Brief Symptom Index clinical profile for men with CPPS and controls (T scores and centile ranks) for the nine dimensional scales and the Global Severity Index.

Fig. 2

Mean salivary free cortisol levels (± SEM) on two consecutive sampling days after morning awakening in men with CPPS and control men.

Fig. 2

Mean salivary free cortisol levels (± SEM) on two consecutive sampling days after morning awakening in men with CPPS and control men.

Fig. 3

Box plot shows awakening cortisol responses (wake + 30 minutes) and daytime decrease (wake + 12 hours) for men with CPPS (shaded bars) and controls (open bars). The dot indicates mean; line in box indicates median. Boundary closest to zero indicates 25^th percentile and farthest from zero indicates 75^th percentile. Whiskers indicate 90^th and 10^th percentiles.

Fig. 3

Box plot shows awakening cortisol responses (wake + 30 minutes) and daytime decrease (wake + 12 hours) for men with CPPS (shaded bars) and controls (open bars). The dot indicates mean; line in box indicates median. Boundary closest to zero indicates 25^th percentile and farthest from zero indicates 75^th percentile. Whiskers indicate 90^th and 10^th percentiles.

Fig. 3

Box plot shows awakening cortisol responses (wake + 30 minutes) and daytime decrease (wake + 12 hours) for men with CPPS (shaded bars) and controls (open bars). The dot indicates mean; line in box indicates median. Boundary closest to zero indicates 25^th percentile and farthest from zero indicates 75^th percentile. Whiskers indicate 90^th and 10^th percentiles.