Volume 6, Number 1 | Spring 2011

Japanese Acupuncture - Current Research
Current Research of Acupuncture for Chronic
Prostatitis/Chronic Pelvic Pain Syndrome
Hisashi Honjo
Department of Clinical Acupuncture and Moxibustion,
Meiji University of Integrative Medicine,
Nantan, Japanaccounts

prostatitis.5

Currently, several studies of acupuncture for95%ofcases

withchronic

Therefore, CP/CPPS is diagnosedby the symptoms following exclusion of urinary
tract infection. To assess the symptoms inpatients with CP/CPPS a validated and reliable
symptom assessment tool in chronic prostatitis
has been used worldwide. The tool is theNational

IntroductionforInstitutes

Prostatitis

ofSymptom

HealthIndex

Chronic(NIH-CPSI)

lower urinary tract symptoms including urinary

developed by the NIH Chronic Prostatitis

frequency, urinary urgency, urinary incontinence

Collaborativeand genito-urinary pain or discomfort have reported.

(Appendix).6

ResearchNetworkin

1999

This article reviewed for the acupuncture treatment

This questionnaire is formed by 3 mainof chronic prostatitis/chronic pelvic pain syndrome.

headings as the pain or discomfort of symptoms

Prostatitis is a common disease in urological(locations, frequency and severity), the urinary

outpatients with an estimated account of about 2

symptoms (irritative and obstructive voiding

million visits per year in United States.1 Community-symptoms) and the impact of these symptoms on

based studies disclosed that the prevalence ofthe patient’s quality of life. Nine separate items

prostatitis-like symptoms ranged from 9.7% to 12% of

could be addressed the important issues ofmen.2,3 Chronic prostatitis/chronic pelvic pain

chronic prostatitis. The domain of pain orsyndrome is defined as a new category ofdiscomfort is rated on a scale of 0-21. The

prostatitis syndrome by the National Institutes ofurinary symptoms are rated on a score of 0-10

Health established an International Prostatitis

while the impact on quality of life is rated on aCollaborative Network in 1995.4 The classification

score of 0-12. Each of these three domains could

is described as follows:

be assessed independently. To take an instanceCategory I. Acute bacterial prostatitis

of clinical study in Japan using Japanese

Category II. Chronic bacterial prostatitis

version of the NIH-CPSI, the pain or discomfort

Category III. Chronic prostatitis/chronic pelvic

domain score was significantly higher in thepain syndrome

chronic prostatitis group than in the control

III A. Inflammatorygroup (9.79 vs. 0.72, respectively).7 Additionally,

III B. Non-inflammatory

a total score of NIH-CPSI that added the threeCategory IV. Asymptomatic inflammatory

domains and rated 0-43 could be evaluated theprostatitis

responsive measure of the treatment options,
including acupuncture treatment.

Chronic

prostatitis/chronicpelvic

pain

There are multiple treatment options forsyndrome (CP/CPPS) is a syndrome with long

CP/CPPS,history (at least 3 months or longer) of genito-antibiotics, anti-inflammatories, alpha-blockers,

urinary and pelvic pain or discomfort, associatedphytotherapeutics agents and other medical

withagents. Conservative therapy for the symptoms

irritative

symptoms

and/orandobstructive

sexualvoidingdysfunction,

andincluding

conservative

therapy,of CP/CPPS is mainly several suggestions for theThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

3

Volume 6, Number 1 | Spring 2011

patients about diet (avoid spicy food, acidic food,ultrasonography (TRUS) in conveniently screening

alcohol, caffeine), lifestyle (avoid psychologicalintrapelvic

stress and anxiety), activity (avoid long period ofresonance venography (MR venography) as well assitting and bicycling) and exercise (walking). By

clinicalthe NIH definition, Category Ⅲ CP/CPPS is non-prostatitis symptom index (NIH-CPSI) and thebacterial prostatitis, the majority of patients

international prostate symptom score (IPSS)

with CP/CPPS, however, have been treated bywere compared before and after the treatment.

antibiotics.8 Approximately 50% of patients withIn the results, pain and QOL scores of the NIH-CP/CPPS

CPSI

treatedwithantibiotics

showedvenoussymptoms

1week

congestion
usingafterandthethemagnetic

NIH

5thchronic

acupuncture

improvement of their symptoms. Alpha-blockers

decreased significantly (p < 0.05 and <0.01,

which are the most effective medical therapy torespectively), compared with the baseline in all

lower urinary tract symptoms related to benign

patients. The maximum width of the sonolucent

prostate hyperplasia (BPH) have been also usedzone 1 week after the 5th treatment alsofor the treatment of CP/CPPS.

decreased significantly (p < 0.01, compared with

Recently,

combinations of antibiotics and alpha-blockers

thebaseline,Figure

appeared to achieve the greatest improvement

Intrapelvic venous congestion demonstrated byin clinical symptom scores compared with

MR venography was significantly improved in 4

placebo, which reported by a systematic review

patients.

and meta-analysis.9 Anti-inflammatories would

Thus,

we1

believeandthatFigure2).

acupuncture

be one of the common agents for CP/CPPS as

treatment is effective for the symptoms ofwellCP/CPPS.

asphytotherapeutics(CernitinpollenFurthermore,otherresearcherextract) in Japan. After all, these medical agents

reported the same kind of results in the similar

are not effective for all patients with CP/CPPS.

therapeutic methods as our study. 12 In the study

Additionally, a 50% improvement in symptom

ninety-seven CP/CPPS patients received six

score could be considered as an excellent

sessions of acupuncture to the BL-33 acupoints

response to the therapy in CP/CPPS.10

once a week. Each patient compared NIH-CPSI
before and after the treatment and on 12th and24th weeks following the treatment. As theAcupuncture for CP/CPPS
We have performed acupuncture therapy forresults, there was a statistically significant

In this study, ten

decrease in all of the subscores evaluated at all

male patients with non-inflammatory chronic

periods compared with the baseline. Eighty-six

pelvic pain syndrome with intrapelvic venous

patients out of 93 (92.47%) were NIH-CPSI

congestion were treated by acupuncture. Eight

responders (more than 50% decrease in total

patients had previously received pharmacotherapy,NIH-CPSI score from baseline) at the end of thewhich was unsuccessful.

treatment.

the patients withCP/CPPS. 11

Acupuncture was

Theseresults

suggestthat

performed using disposable stainless needles,

acupuncture appears to be a safe and potentiallywhich were inserted into the bilateral BL-33 points

effective treatment in improving the symptoms

and rotated manually for 10 minutes. Theand quality of life of men clinically diagnosed

treatment was repeated every week for 5 weeks

with CP/CPPS.

without other therapeutic maneuvers. Transrectal
4

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 6, Number 1 | Spring 2011

BeforeAferFigure 1 (Modified by Int J Urol, 11:607, 2004.)
Figure 1 Changes in the findings of intrapelvic venous congestion by transrectal ultrasonography
before and after acupuncture
Transrectal sonograms of the prostate show the changes in a patient before and afteracupuncture. The arrows show the dilation of the sonolucent zone. The maximum width of thesonolucent zone is 4.5 mm before and 1.3 mm after acupuncture.

Figure 2 Changes in the maximum width of the sonolucent zone by transrectal ultrasonography
before and after acupuncture

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 6, Number 1 | Spring 2011

8. McNaughton-Collins M, MacDonald R Wilt TJ:

Conclusion
This article reveals the therapeutic effects ofDiagnosis and treatment of chronic abacterial

acupuncture for non-inflammatory chronic pelvic

prostatitis: a systematic review. Ann Intern Med,

pain syndrome. However, long-term effects still

133: 367-381, 2000.

remains unknown. Further studies are needed,

9. Anothaisintawee T, Attia J, Nickel JC et al:

therefore, to clarify the effects of acupunctureManagement of chronic prostatitis/ chronic

treatment for non-inflammatory chronic pelvic pain

pelvic pain syndrome: a systematic review andsyndrome in a larger number of patients in anetwork meta-analysis. JAMA, 305: 78-86, 2011.
10. Nickel JC: Practical therapeutic strategies forrandomized, placebo controlled trial.

the prostatitis patients: development of aReferences

treatment plan. In: Nickel JC, Bladon Medical

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11. Honjo H, Kamoi K, Naya Y, Ukimura O, Kojima

2. Nickel JC, Downey J, Hunter D et al: Prevalence

M, Kitakoji H, Miki T: Effects of acupuncture forof prostatitis-like symptoms in a population

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3. Roberts RO, Jacobson DJ, Girman CJ et al:Tasci A: Effectiveness of acupuncture in patients

Prevalence of prostatitis-like symptoms in awith category IIIB chronic pelvic pain syndrome:community based cohort of older men. J Urol,a report of 97 patients. Pain Med, 11: 518-23,

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7. Monden K, Tsugaya M, Ninomiya Y et al: AJapanese version of the National Institutes ofHealth Chronic Prostatitis Symptom Index(NIH-CPSI, Okayama version) and the clinicalevaluation of cernitin pollen extract for chronic
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6The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)