Talk:Chronic prostatitis/chronic pelvic pain syndrome

Were doe the ref support the text in question?

Not only do we need a decent reference which this is, the reference needs to actually support the text in question. I have read this reference and am not seeing the text that supports the following. User:Thomas pow s can you provide a direct quote from this source? Thanks Doc James (talk · contribs · email) 03:16, 10 March 2019 (UTC)

"One theory is that CPPS is caused by chronic tension in the pelvic floor musculature. This tension causes tissue damage and sensitization of nearby nerves. The tissue damage cannot heal because the tension is ongoing and prevents blood flow to the affected area, thereby preventing healing."

Anderson, RU; Wise, D; Nathanson, NH (October 2018). "Chronic Prostatitis and/or Chronic Pelvic Pain as a Psychoneuromuscular Disorder--A Meta-analysis". Urology. 120: 23–29. doi:10.1016/j.urology.2018.07.022. PMID 30056195.

Doc James, here is a verbatim quote from the paper in question: "prostatitis ... more accurately diagnosed [as] pelvic floor dysfunction. This alternative paradigm suggests pelvic pain arises from chronic pelvic floor irritation initiated by anxiety-provoked chronic muscular guarding of the pelvic floor leading to pelvic floor hypertonicity. This behavioral complex perpetuates a self-feeding cycle of pelvic tissue irritation, tension, pain...".

Here is another paper, entitled Patients with Pelvic Floor Muscle Spasm Have a Superior Response to Pelvic Floor Physical Therapy. Included in that paper is the following text: "Patients with chronic pelvic pain syndrome have a high incidence of pelvic floor spasm, which can be treated with pelvic floor physical therapy."

If I include both these sources, can I re-add the material to the "Causes" section? Thanks...

Thomas pow s (talk) 07:01, 10 March 2019 (UTC)

This paper is a primary source[1]

We have the review. Doc James (talk · contribs · email) 07:20, 10 March 2019 (UTC)

Hi Doc James,

I don't quite understand what you're saying here. I provided a verbatim quotation from the source, as you requested, in which it clearly supports the material in question. Did you see that quotation above? You responded with "we have the review". What does that mean?

Also, do you mean that the primary source is unacceptable? Are primary sources absolutely ruled out?

I'm sorry, but I just can't determine what you're getting at here.

Is it okay if I go ahead and re-add the material?

Thomas pow s (talk) 07:28, 10 March 2019 (UTC)

Yes I am reviewing. This would be the quote "This alternative paradigm suggests pelvic pain arises from chronic pelvic floor irritation initiated by anxiety-provoked chronic muscular guarding of the pelvic floor leading to pelvic floor hypertonicity. This behavioral complex perpetuates a self-feeding cycle of pelvic tissue irritation, tension, pain, and anxiety."

Doc James (talk · contribs · email) 07:32, 10 March 2019 (UTC)

So how about "One proposal is that CP/CPPS is a psychological as well as a neuromuscular disorder. The suggestion is that anxiety results in long term contraction of the pelvic floor muscles which results in pain." as a summary? Doc James (talk · contribs · email) 07:34, 10 March 2019 (UTC)

Frankly, I think it gives the wrong impression. The initial sentence indicates that it is a psychological disorder. The most obvious interpretation of calling it a psychological disorder is that it is imaginary or neurotic, like delusional parasitosis. The theory in question states that it is caused by pelvic floor muscular tension and spasm, which causes tissue irritation and damage. Granted, the spasm may originally have been caused by tension from anxiety, but that is not the same as saying it is a psychological disorder. As an analogy, if I crash my car and break my face on the windshield, it is not a psychological disorder even if my reckless driving ultimately had psychological causes.

Furthermore, I don't think the words "proposal" and "suggestion" should be used to describe the theory.

How about: "One theory is that CPPS is caused by chronic tension in the pelvic floor musculature. Long-term contraction of the pelvic floor muscles results in tissue irritation, spasm, damage, and pain. This chronic tension of the pelvic floor muscles is often the result of muscular guarding, caused by anxiety. It can become a self-reinforcing cycle, whereby pain and anxiety caused by the condition can cause further pelvic floor muscle tension, thereby worsening the condition."

Would that be okay?

I also think we should include the other reference I provided. WP:MEDRS explicitly says: "Primary sources may be presented together with secondary sources."

Thomas pow s (talk) 08:28, 10 March 2019 (UTC)

Furthermore, I think we should re-add the section formatting which was deleted. That way, the format of the text will match the format for all the other theories in the section.

Thomas pow s (talk) 08:44, 10 March 2019 (UTC)

It is not accepted that psychological disorders are "imaginary".

The question is how should we summarize "This alternative paradigm suggests pelvic pain arises from chronic pelvic floor irritation initiated by anxiety-provoked chronic muscular guarding of the pelvic floor leading to pelvic floor hypertonicity. This behavioral complex perpetuates a self-feeding cycle of pelvic tissue irritation, tension, pain, and anxiety."

It states that it starts with "anxiety provoked chronic muscular guarding" so we should start with that. Doc James (talk · contribs · email) 06:43, 11 March 2019 (UTC)

It is not accepted that psychological disorders are imaginary

That's not at all what I said. The example I gave was delusional parasitosis. The parasites are imaginary, not the psychological disorder. In this case, it's a physical illness with tissue damage causing the symptoms. That's what I meant.

It states that it starts with "anxiety provoked chronic muscular guarding" so we should start with that.

That is already present in the proposed summary above, in the third sentence. Do you mean it must be the first sentence? That doesn't read well, in my opinion.

You and I are just going back and forth now. Maybe we should get a few other people involved. Ratel, what do you think? Do you think the text should be as I suggested above? Do you have a better suggestion? What does everyone else think? I'll reproduce the proposed text here: "One theory is that CPPS is caused by chronic tension in the pelvic floor musculature. Long-term contraction of the pelvic floor muscles results in tissue irritation, spasm, damage, and pain. This chronic tension of the pelvic floor muscles is often the result of muscular guarding, caused by anxiety. It can become a self-reinforcing cycle, whereby pain and anxiety caused by the condition can cause further pelvic floor muscle tension, thereby worsening the condition."

Thomas pow s (talk) 22:44, 11 March 2019 (UTC)

This is a key point in the article and so quite important. Can we see competing texts here please? Use a table for greater clarity, as in:

Psychoneuromuscular Theory

Source	Thomas Pow	Doc James
"prostatitis [is] more accurately diagnosed [as] pelvic floor dysfunction. This alternative paradigm suggests pelvic pain arises from chronic pelvic floor irritation initiated by anxiety-provoked chronic muscular guarding of the pelvic floor leading to pelvic floor hypertonicity. This behavioral complex perpetuates a self-feeding cycle of pelvic tissue irritation, tension, pain, and anxiety."	One theory is that CPPS is caused by chronic tension in the pelvic floor musculature. Long-term contraction of the pelvic floor muscles results in tissue irritation, spasm, damage, and pain. This chronic tension of the pelvic floor muscles is often the result of muscular guarding, caused by anxiety. It can become a self-reinforcing cycle, whereby pain and anxiety caused by the condition can cause further pelvic floor muscle tension, thereby worsening the condition.	One proposal is that CP/CPPS is a psychological as well as a neuromuscular disorder. The suggestion is that anxiety results in long term contraction of the pelvic floor muscles which results in pain. The pain results in further anxiety and thus worsening of the condition.

Copy and paste the table text into your replies. Thank you. Ratel (talk) 01:19, 12 March 2019 (UTC)

Okay, I copied it into the table. Thomas pow s (talk) 03:32, 12 March 2019 (UTC)

I've added in Doc James' text (I think). He is welcome to change it. On the face of it, perhaps it's too short? Ratel (talk) 11:59, 12 March 2019 (UTC)

I have added the source. The "irritation" being described is not something that is visible in a microscope as far as I am aware. Doc James (talk · contribs · email) 12:13, 12 March 2019 (UTC)

I will briefly re-iterate my concerns with the alternative text. First, we cannot call the condition a "psychological disorder", because it is not a psychological disorder. As an analogy, consider the example a person whose depression drives him to drink, and he eventually develops cirrhosis of the liver. The cirrhosis is not a psychological disorder, even if the patient would never have had it but for behavior driven by a psychological disorder.

Second, we should not describe this theory using terms like "suggestion" and "proposal". This is by far the best supported theory on this condition. At worst we should use neutral terms (like "theory") to describe it.

Finally, I don't think that my proposed text should be re-ordered so the statement about anxiety comes first. I want a topic sentence for the paragraph which is concise, and which immediately describes the distinguishing characteristics of this disorder. In this kind of paragraph, the sentences should be arranged in descending order of importance, not chronological order ("it all starts with anxiety..."). Any more than an article about cirrhosis should start with material about how patients have had addiction problems for years. Note that the meta-analysis article does not start with statements about anxiety; it first describes the condition as "pelvic floor dysfunction" and then goes into anxiety later. The text I proposed does describe the anxiety and muscular guarding in the third sentence, so that material is not omitted or hidden.

Thomas pow s (talk) 20:29, 13 March 2019 (UTC)

I think both versions do convey the idea theory pretty well. It is, after all, almost certainly a psychoneuromuscular condition, an interplay between brain, muscles and peripheral nerves. The Thomas Pow version is a bit more descriptive and less tentative, so I guess I'd support that. Ratel (talk) 22:07, 13 March 2019 (UTC)

It is not really a "Pelvic floor muscular disorder" all by itself. The theory is that it involves an interplay of factors. Doc James (talk · contribs · email) 09:31, 14 March 2019 (UTC)

Are you objecting to the section title here? What section title do you prefer? How about "neuromuscular disorder"? How about "pelvic floor neuromuscular disorder"?

The first sentence of the quotation from the review says: "more accurately diagnosed [as] pelvic floor dysfunction.". Can we call it "pelvic floor dysfunction"?

Personally, I vote for "pelvic floor dysfunction" since that is what the first sentence of the review article says when discussing the cause.

Thomas pow s (talk) 09:48, 14 March 2019 (UTC)

Okay added that heading Doc James (talk · contribs · email) 12:00, 14 March 2019 (UTC)

Doc James, thanks for the agreement on the section title. I'm glad we were able to reach an agreement upon that.

However, the text itself must match what was decided upon by consensus above during discussion.

I am definitely willing to discuss this issue further and compromise, if you feel there is something wrong with that text or some change should be made to it. However, I think we would need to reach a new consensus here before deleting the text which has been inserted.

Thomas pow s (talk) 20:34, 14 March 2019 (UTC)

Were was "the text itself ... decided upon by consensus above during discussion"? Doc James (talk · contribs · email) 08:03, 15 March 2019 (UTC)

Just above, I asked for other editors' input. Ratel set up a table then voted as follows: "The Thomas Pow version is a bit more descriptive and less tentative, so I guess I'd support that". That is two votes in favor of one version, and one vote in favor of yours. It is about half a page above. The edit is entitled "pow version yes" in the edit history.

I am quite willing to discuss this issue further and compromise. However, you need to explain why you do not want the version I proposed, which changes you'd like made to it, and why. You should also respond to the objections I put to you above, if you still prefer your version.

Please do not just revert the agreed upon text without discussing it here and obtaining a new consensus.

Thomas pow s (talk) 09:39, 15 March 2019 (UTC)

That is not a consensus. We can try a WP:RfC. Doc James (talk · contribs · email) 10:19, 15 March 2019 (UTC)

(outdenting) Hi Doc James. I am asking you again to participate in the discussion and provide some kind of meaningful response or objection. I am trying repeatedly to engage you in some kind of compromise or discussion.

Thomas pow s (talk) 10:24, 15 March 2019 (UTC)

Additional primary source for the pelvic floor muscular section

Does anyone object if I add this source to that section as well? WP:MEDRS says: "Primary sources may be presented together with secondary sources."

Thomas pow s (talk) 09:26, 14 March 2019 (UTC)

There are lots of reviews. No we do not need to use primary sources. Doc James (talk · contribs · email) 09:32, 14 March 2019 (UTC)

agree, primary sources should not be added--Ozzie10aaaa (talk) 14:45, 14 March 2019 (UTC)