Which instruction should increase the comfort of a patient who is recovering from prostatitis?

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If your pain comes back before your next dose is due, let your doctor or nurse know. The dose might need changing.

You might find your pain doesn’t go away straight away when you take pain-relieving drugs. This is because they can take a while to be absorbed by the body and start working.

All medicines can cause side effects. We describe the most common side effects of pain-relieving drugs below. But you might not get all or any of these. If you do get side effects that won’t settle down, your doctor can change the amount or the type of drugs you take.

For more information about side effects, check the patient information leaflet included with your medicines or speak to your doctor or nurse at the hospital, or your GP.

Non-opioid drugs

These are mainly mild pain-relieving drugs. They include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. You can use them together with stronger pain-relieving drugs.

NSAIDs can help reduce inflammation that may be causing your pain. You should only take NSAIDs regularly if they’ve been prescribed for you. This is because taking them for a long time can cause side effects such as stomach irritation, stomach ulcers, kidney problems, and heart problems. You may not be able to take NSAIDs if you already have problems with your stomach, kidneys or heart.

Your doctor or nurse might prescribe medicines to reduce the risk of side effects from NSAIDs. Taking NSAIDs after food will also help to reduce stomach irritation. You should avoid smoking and drinking large amounts of alcohol, as these can increase the risk of stomach ulcers. Your doctor or nurse can give you more information about this.

Opioid drugs

You might need stronger pain-relieving drugs called opioids. These include strong opioids such as morphine and weaker opioids such as codeine and tramadol. You can take opioids in tablet and liquid form. You may be able to take slow-release opioids so that you don’t have to take them so often. If these aren’t suitable, some opioids such as fentanyl or buprenorphine are also available as a skin patch.

If you find it hard to swallow tablets or liquids, your doctor or nurse might suggest a continuous dose of opioids through a needle under the skin. This uses a small machine called a syringe pump or syringe driver. It means the drug stays at a constant level in your body so it doesn’t wear off. Syringe pumps can be used in hospital or in your home.

It’s possible to get sudden pain even if you’re already taking pain-relieving drugs. This is called breakthrough pain. If you experience this, your doctor or nurse may suggest a fast-acting opioid to help reduce the pain quickly.

Like all medicines, opioids can cause side effects.

• Difficulty emptying your bowels (constipation). Most people get this side effect of opioids, which can be very uncomfortable. Your doctor should give you medicines to make it easier to empty your bowels (laxatives). Drinking plenty of water, eating a high fibre diet and exercising, if possible, might also help to prevent constipation. If it doesn’t get better, speak to your doctor – but don’t stop taking the pain-relieving drugs.

• Sickness. You might feel sick or be sick for the first few days of taking opioids, but this usually improves. If you feel sick, your doctor can prescribe anti-sickness tablets to stop this or give you a different pain-relieving drug if the sickness doesn’t improve.

• Drowsiness. When you first start taking opioids you might feel drowsy or find it hard to concentrate. This usually improves after a few days, as your body gets used to the drug. Ask your doctor or nurse whether it is safe for you to drive when you are taking opioids.

• A dry mouth. Sipping cold water throughout the day can help. You can also try chewing gum or sucking boiled sweets or ice cubes.

Some men worry about becoming addicted to stronger opioids such as morphine. But if you’re taking morphine to relieve pain, it’s unlikely you’ll become addicted. You might not start with the strongest type of opioid, and the dose will be carefully controlled by your doctor. If you’re worried about taking opioids, speak to your doctor or nurse.

Other drugs for relieving pain

There are other types of drugs that can also be used to help treat pain. Which ones you are prescribed will depend on what is causing your pain.

Your doctor might suggest drugs that can also be used to treat other health problems. For example, drugs that can be used to manage epilepsy (such as gabapentin or pregabalin) or depression (such as amitriptyline) can help with nerve pain. If your doctor prescribes anti-depressants or anti-epileptics for your pain, it doesn’t mean they think you are depressed or have epilepsy. Different doses of these drugs are usually needed to treat depression or epilepsy.

A type of cream called capsaicin cream can also be used to help with nerve pain if you find it difficult to take tablets. A pain-numbing skin patch, such as a lidocaine patch, can also be used on painful areas.

Antibiotics can be prescribed if your pain is caused by an infection.

Muscle relaxants (such as diazepam) can also be used if you have muscle spasms. Muscle spasms can be painful or make other pain worse.

Talk to your doctor, nurse, or pharmacist about possible side effects before you start taking any new medicines.

Steroids

If your cancer has spread to the bones it could cause swelling and press on the nerves in the bone, causing pain. Steroids can help to reduce swelling around the cancer, and so reduce the pain. You might be able to take steroids in combination with pain-relieving drugs and other types of treatment. Lower doses of steroids can also be used to treat the cancer itself.

Like most medicines, steroids can cause side effects. Read more about steroids, including the possible side effects.

Who is the driver and who is the passenger in your recovery from Prostatitis/CPPS?

Well, if you feel that you only ever make progress in the treatment room then your recovery lies in the hands of your healthcare specialist and you are a passenger. If you feel you take the greatest steps towards your recovery away from the treatment room then you are the driver. I prefer my patients to be the driver on their road to recovery. A patient who feels they have a part to play in their recovery is a patient who feels empowered. This is hugely motivational and often the turning point in a patients full recovery. I view myself as a facilitator and educator to my patients and their road to recovery.

Having suffered with pelvic pain and a number of pelvic complications for many years I understand how frustrating progress can be. What helped me the most was having self-care techniques that I could do every single day, in the comfort of my own home. This revolutionised my recovery and transported me to my current healthy, fertile state.

Patients suffering with the following conditions, synonymous with CPPS and Type 3 Non Bacterial Prostatitis may find relief through self-massage of the pelvic floor:

• Pain at the tip of the penis
• Pain in the shaft of the penis
• Pain in the bladder
• Pain in the urethra
• Pain in the perineum
• A fullness in the prostate
• Post bowel movement pain and discomfort
• A golf ball in the rectum sensation

There are a number of trigger points located within the pelvic floor that, when released can provide relief from the above symptoms. A trigger point can be described as a hyper irritable, tight band of muscle fibre or fascia that when pressed on produces a predictable referral pattern. The TheraWand is a self-massage tool, specifically designed for massaging the muscles in and around the pelvic floor. Its ergonomic design allows the patient to comfortably treat his own pelvic floor away from the treatment room.

Self massage is integral to the self care programmes I give to my patients. Self massage works for a number of different reasons.

1. It connects a patient with an area that they have typically become disassociated with, whether this be the abdomen, the perineum or the pelvic floor muscles. We can become disassociated with areas of our body that have experienced pain for any lengthy period of time. Patients often describe these areas as “not being theirs” or “that part of my body.” Even asking patients to do simple pelvic movements I hear “I don’t know if I can find that part of my body.” Self-massage reconnects us to those areas. Providing our brains with new and vital information about these “abstract” areas of our body
2. It promotes haemodynamic’s, which essentially means blood flow. This process in itself has numerous benefits to areas effected by pain. Including reducing stagnation through inactivity or sitting too long, which can change the blood PH (or acidity) level. Increasing oxygen levels (which can also change blood PH levels). It also helps to bathe the tissues with nutrients and nourishment from the increased blood flow.
3. Massage has been found to reduce the production of cortisol (the stress hormone) whilst increasing levels of dopamine and serotonin (neurotransmitters necessary for a stable mood, reduced irritability and healthy immune system). A 2008 study by Li et al found that psychological obstacles like depression and anxiety play an important role in the pathogenesis, prognosis and development of CPPS.

Self-massage empowers a patient by allowing them to take steps toward their recovery. It reduces the feeling of helplessness often associated with chronic conditions. Providing patients with simple, yet effective self care techniques should be at the centre of all heath care specialist’s practices.

Below is a short instructional video on how to use the TheraWand to relax and treat pelvic floor muscles in patients with CPPS and Type 3, Non Bacterial Prostatitis.

Take control of your condition, take control of your life. Feel empowered and know that you drive your recovery. By taking small steps every day you move closer and closer to a life without pain.

Karl Monahan

The post Pelvic Floor Massage for Prostatitis and CPPS with a Therawand appeared first on The Pelvic Pain Clinic website