Inspired by Zhu et al 2024.[1]
CP – chronic prostatitis
CPPS – chronic pelvic pain syndrome
RCT – randomised controlled trial
MA – manual acupuncture
NIH-CPSI – National Institute of Health Chronic Prostatitis Symptom Index– key to acronyms
This is secondary analysis of a large RCT published in August 2021 in Annals of Internal Medicine and highlighted on the BMAS Blog in the same month: Acupuncture for CP CPPS.
The original trial included 440 men randomised to MA or an off-point superficial sham. They had 20 sessions of MA or sham over 8 weeks and the primary outcome was the percentage of men with a 6 point or greater reduction on the NIH-CPSI. The NIH-CPSI is a 9-item questionnaire with domains for pain, urinary symptoms, and quality of life impact.[3] The total score is 43 and men in this study had to score at least 15 to be included.
Of the 440 from the original trial, just over half were ‘drinkers’ (n=224), so this is quite a substantial subgroup analysis. Obviously, we need to define a ‘drinker’. For the purpose of this analysis, a drinker was defined as anyone consuming more than 2 standard drinks daily or more than 4 on one occasion… really, just one occasion? Checking the references in the paper, I think this refers to the definition of binge drinking, but for men this should be 5 or more standard drinks within 2 hours according to JAMA.[4]
A standard drink is 12oz beer or 8oz to 9oz malt liquor or 5oz wine or 1.5oz distilled spirit. One US fluid ounce is 29.5735 millilitres, so that gives us a standard drink as 355ml beer or 237ml to 266ml malt liquor or 148ml wine or 44ml distilled spirit.
I had to look up malt liquor. It is a malt-based beer with added fermentable sugars giving a higher alcohol percentage, typically over 5%, but some reaching the level of wine (Founders DKML is 14.5%).
The results were very similar to those in the original trial including both drinkers and non-drinkers with roughly 60% responding in the acupuncture group and 40% in the sham group. The difference in percentage responders was slightly smaller in this subgroup of drinkers but that seems to be more related to the response in the sham group than that in the acupuncture group. Drinkers in the sham group seem to have responded about 3.5 percentage points higher than the entire cohort of drinkers and non-drinkers receiving sham in the original trial.
The authors suggest this slightly smaller difference in response is consistent with the findings of a large survey on the lifetime risk and prognosis of CP CPPS in Chinese men (n=4315).[5] But since the reported response to treatment in non-drinkers in this survey was almost 10% lower than the responder rate of drinkers in this trial, I do not see that these different data sets are at all comparable.
I am pleased to say that the lead author of the original trial in Annals of Internal Medicine is presenting at WFAS 2024 in London at the weekend.
References
1 Zhu L, Sun Y, Yan S, et al. Efficacy of acupuncture on drinkers with chronic prostatitis / chronic pelvic pain syndrome: secondary analysis of a randomized clinical trial. Acupunct Med. 2024;9645284241274158. doi: 10.1177/09645284241274158
2 Sun Y, Liu Y, Liu B, et al. Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized Trial. Ann Intern Med. Published Online First: 17 August 2021. doi: 10.7326/M21-1814
3 Litwin MS, McNaughton-Collins M, Fowler FJ, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999;162:369–75. doi: 10.1016/s0022-5347(05)68562-x
4 Patel AK, Balasanova AA. Unhealthy Alcohol Use. JAMA. 2021;326:196. doi: 10.1001/jama.2020.2015
5 Zhang J, Zhang X, Cai Z, et al. The Lifetime Risk and Prognosis of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in the Middle-Aged Chinese Males. Am J Mens Health. 2019;13:1557988319865380. doi: 10.1177/1557988319865380
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