Acupuncture For Severe Chronic Perineal Pain
W. Watere, MD, PhD
A 42-year-old man with severe chronic perineal pain was unable to sit and work. Acupuncture treatment began 3 months after his first symptoms. He received 2 treatments and then once weekly for 21 sessions. At the end of treatment, the patient recovered completely, was able to sit, and returned to work as a postal employee.
Perineal Pain, Acupuncture, Qi-Stagnation, Heat-Excess, Hyperhydrosis
Chronic perineal pain is an uncommon problem, its pathogenesis unclear, and its treatment difficult. The etiology of chronic perineal pain is perhaps due to chronic abacterial prostatitis, autoimmune disease, psychosomatic disorder, or other disease. This patient's pain began gradually, was internal, and finally, he was unable to sit, was depressed and scared.
A 42-year-old man (1.8 m, 80 kg), a postal employee, presented to our TCM-Centre, Elisabeth Hospital, Recklinghausen, Germany, with severe chronic perineal pain and hyperhydrosis, especially head, forehead, hand plains, and foot soles. Due to pain, the patient was unable to sit, unable to work for 3 months, and was depressed and fearful. He had bronchial asthma with no complaints under medication. The patient smoked 20 cigarettes daily; he reported no alcohol usage. During a 3-month period (summer 2002), he had consulted a urologist, internist, neurologist, psychiatrist, and radiologist.
The patient's tongue had a red body with thick yellow coat. Abdomen, lung, heart, backbone, and extremities were normal. No dysreflexia, impaired sensibility, inguinal lymphoma, or edema were detected. In the pelvic and perineal region, no trigger points were discovered and sensation was normal. The patient's blood pressure was 140/80 mm Hg; pulse, 104/min. His electrocardiogram, electroencephalogram, cerebrospinal fluid, MRI of lumbar vertebrae and pelvis, abdomen CT, and laboratory findings were normal except hypercholestrolemia.
Chronic perineal pain with unknown pathogenesis; suspected non-specific prostatitis or psychosomatic disorder.
The patient had been treated with nonsteroidal anti-inflammatories, analgesics, and antidepressants; no antibiotics. Conventional medical treatment was ineffective. Therefore, his general practitioner physician referred him for acupuncture treatment.
Acupuncture Treatment: TCM-Diagnosis6
1) Heat-excess, 2) Qi-stagnation
Eliminate heat, remove Qi-stagnation, and calm mind and spirit
Selected Acupuncture Points1-4
GV 14 (Dazhui), LI 4 (Hegu), LI 11 (Quchi), HT 7 (Shenmen), PC 6 (Neiguan), GV 20 (Baihui), CV 4 (Guanyuan), CV 6 (Qihai), ST 36 (Zusanli) and KI 3 (Taixi)
Interval of Treatment and Retention Time
The patient was treated with acupuncture 2 times at first; after reduction of pain, he was treated once weekly for a total of 21 sessions. Needles (Hwato 0.25 x 40 mm, single use, sterile needles) were left in place for 30 minutes each session. Patient consent was obtained.
Acupuncture treatment began 3 months after the patient's first symptoms. After 6 sessions, his perineal pain and hyperhydrosis decreased. After receiving 12 treatments, he was able to sit again and returned to work. After 21 acupuncture treatments, the patient completely recovered. Eight weeks after treatment, the patient reported being pain-free. He was instructed to return for further treatment if symptoms recurred.
Conventional medical management was ineffective for severe chronic perineal pain in this patient. Traditional Chinese Medicine (TCM) and its holistic philosophy regards the patient as a whole human being: a unity of body, mind, and spirit, and the Qi. Thus, in this case, acupuncture was successful.
Chronic perineal pain is rare, its etiology unclear, and modern medical management is ineffective. In this case, acupuncture was successful. Within 21 acupuncture treatments, the patient's perineal pain gradually decreased as well as the thick yellow coat of his tongue. Conversely, his De Qi perception and intensity gradually increased. This occurrence was an indication that the elimination of heat excess and removal of the Qi stagnation was a slow process. Therefore, 21 sessions were necessary.
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Dr W. Watere specializes in Internal Medicine, Physical Medicine and Rehabilitation, and Acupuncture, and is Chief of TCM-Center, Elisabeth Hospital, Recklinghausen, Germany. He is a Fellow of German Academy of Medical Postgraduate Training, and German Acupuncture Society Düsseldorf.
W. Watere, MD, PhD*
Zentrum für TCM, Elisabeth Hospital
Röntgen Strasse 10,
45661 Recklinghausen, Germany
Phone: 49-2361-601 366 • Fax: 49-2361-601 380
E-mail: firstname.lastname@example.org • Website: www.akupunktur-watere.de
*Correspondence and reprint requests