Development of a CPPS Tender Point Score

RE Berger1 I Rothman,1 M Ciol,3 A Decks,1 J Turner,2 JC Lee,1 MS Frest1

Departments of Urology, 2Psychiatry and
Behavioral Sciences, and 3Health Services,
University of Washington, Seattle, WA

Introduction The American College of Rheumatology has described the Manual Tender Point Survey (MTPS) as a tool to diagnose and evaluate fibromyalgia. The MTPS consists of 18 pressure points and 3 control points on the body. We used and expanded this tool for use in the study of male chronic pelvic pain syndrome (CPPS).

Methods We evaluated 16 men with CPPS and 32 controls. We expanded the MTPS to include an external pelvic tender point scale (10 points) and an internal pelvic tender point scale (7 points). Each point was pressed on with 4 kg of pressure by the investigator's finger. Investigators pre-calibrated their finger pressure with a dolorimeter.

Results Men with CPPS had significantly higher MTPS scores (p=.01, Mann-Whitney U), external pelvic tender point scale scores (p=.01 Mann-Whitney U), and internal pelvic tender point scale scores (p=.02 Mann-Whitney U)) than controls. Men with CPPS had higher pain scores than controls on palpation of the prostate (p=.02) and internal pelvic muscles (p=.01). Men with CPPS had more tender MTPS points (mean 4.3 vs. 1.8, p=.03), more tender external pelvic points (mean 4.2 vs. 1.6, p=.007), and positive internal tender points (mean 3.7 vs.1.6, p=.02)) than controls. Two men with CPPS and one control met the criteria for having fibromyalgia (11/18 sites painful). Men with CPPS and controls had equal lack of responses to pressure at control sites (p=.89).). There was no relationship between the concentration of leukocytes in EPS and pelvic pain or prostatic bogginess.

Conclusions Men with CPPS report more pain on palpation of the pelvis internally and externally than do men without CPPS. Men with CPPS report more pain in palpation of non-pelvic areas than do men without CPPS. CPPS may be part of a more generalized pain disorder.

(Supported by the Paul G. Allen Foundation for Medical Research)