Prostatitis, one of the most prevalent urological conditions afflicting men, often manifests with a pronounced pain syndrome. This discomfort can localize in the perineum, suprapubic region, scrotum, and may radiate to the rectum and sacrum. Such pain significantly diminishes patients' quality of life, disrupting sleep patterns and impairing work productivity. Consequently, adequate pain management emerges as a crucial component in the comprehensive treatment of prostatitis.
Which analgesic agents prove most efficacious in combating this ailment? We present a curated ranking of the top 9 medications, compiled based on testimonials from practicing urologists and andrologists.
Ibuprofen-FS
This non-steroidal anti-inflammatory drug (NSAID) boasts analgesic, antipyretic, and moderate anti-inflammatory properties. Ibuprofen acts by inhibiting the synthesis of prostaglandins, the primary mediators of inflammation and pain.
Ibuprofen-FS is available in the form of rectal suppositories, with dosages of 60 mg and 100 mg. Suppositories are particularly advantageous in prostatitis treatment, as they facilitate the direct delivery of the active ingredient to the prostate gland, ensuring rapid pain relief. Furthermore, rectal administration mitigates the risk of adverse gastrointestinal reactions.
Nurofen
Nurofen, a trade name for ibuprofen, also belongs to the NSAID family and exerts potent analgesic and anti-inflammatory effects. Its mechanism of action mirrors that of Ibuprofen-FS, involving the inhibition of cyclooxygenase (COX) – an enzyme essential for prostaglandin synthesis.
Nurofen rectal suppositories, available in 60 mg and 100 mg strengths, are widely employed in prostatitis therapy. The analgesic effect manifests within 20-30 minutes of suppository insertion and persists for 6-8 hours. Nurofen is generally well-tolerated, with side effects occurring infrequently.
Analgin
Analgin (metamizole sodium), an analgesic from the pyrazolone group, demonstrates pronounced pain-relieving and antipyretic properties, coupled with a moderate antispasmodic effect. Unlike NSAIDs, Analgin less frequently induces damage to the gastrointestinal mucosa.
In prostatitis treatment, Analgin is administered as micro-enemas using water or herbal decoctions. The contents of an ampoule are dissolved in ¼ — ½ cup of warm boiled water or chamomile or calendula infusion. This solution is introduced into the rectum after bowel evacuation. These enemas are administered 1-2 times daily, with the treatment course lasting 5-7 days. Analgin rapidly absorbs through the rectal mucosa, providing localized analgesic and anti-inflammatory effects.
Diclofenac
Diclofenac, a potent NSAID, finds extensive application in treating musculoskeletal disorders and various pain conditions, including prostatitis. It inhibits COX-2 to a greater extent than COX-1, ensuring high efficacy coupled with a reduced risk of adverse effects.
Diclofenac is available as rectal suppositories in 50 mg and 100 mg dosages. For prostatitis, suppositories are administered 2-3 times daily, with frequency reduced to once daily as acute symptoms subside. The treatment course typically spans 5-7 days. Patients often report significant pain reduction and improved well-being after the initial application. Additionally, diclofenac exerts anti-inflammatory effects, accelerating the resolution of prostatic infiltrates.
Indomethacin
Indomethacin, considered the «gold standard» among NSAIDs, delivers powerful analgesic and anti-inflammatory action. It non-selectively suppresses both COX-1 and COX-2 activity, which can lead to dyspeptic disorders. Therefore, rectal administration is preferred, allowing direct delivery to the inflammation site while minimizing systemic impact.
In prostatitis treatment, Indomethacin is prescribed as suppositories, 50-100 mg, 2-3 times daily. The treatment course lasts 5-10 days. Significant pain reduction and alleviation of dysuria often occur within the first few days of use. However, Indomethacin therapy necessitates monitoring of gastrointestinal status and renal function due to potential risks of erosive-ulcerative lesions and fluid retention.
Cetirizine
Cetirizine, a second-generation H1-histamine receptor blocker, not only exhibits potent antihistamine effects but also possesses anti-edematous and anti-inflammatory properties. In prostatitis treatment, Cetirizine is prescribed to reduce prostatic edema and suppress the allergic component of inflammation.
The analgesic effect of Cetirizine stems from decreased pressure on the prostatic capsule and surrounding tissues due to edema reduction. The drug is administered as enemas using water or herbal infusions. Ten drops of Cetirizine are dissolved in ¼ cup of warm boiled water or chamomile infusion. These micro-enemas are administered 1-2 times daily for 5-7 days.
No-spa
No-spa (drotaverine), a myotropic antispasmodic, selectively acts on the smooth muscles of pelvic organs, providing analgesic and relaxant effects. In prostatitis treatment, No-spa is employed as part of a comprehensive therapy for acute and chronic pain syndromes.
The drug's mechanism of action involves blocking phosphodiesterase-4 enzyme, leading to cAMP accumulation in cells and smooth muscle relaxation. Consequently, prostatic, seminal vesicle, and bladder tone decrease, reducing pressure on surrounding tissues and alleviating pain sensations.
No-spa is administered orally, 40-80 mg (1-2 tablets) 2-3 times daily before meals. The treatment course lasts 10-14 days. Generally well-tolerated, some patients may experience nausea, dizziness, or palpitations.
Cefecon-D
Cefecon D, a combination drug in the form of rectal suppositories, contains paracetamol in a 250 mg dosage. Paracetamol, an anilide group analgesic, provides pain relief, fever reduction, and moderate anti-inflammatory effects. Unlike NSAIDs, it does not damage the gastrointestinal mucosa or affect blood coagulation.
Paracetamol's mechanism of action involves inhibiting COX predominantly in the central nervous system, reducing prostaglandin synthesis in the spinal cord and brain. This leads to central analgesic and antipyretic effects. Additionally, paracetamol increases the pain threshold and activates descending serotonergic pathways, contributing to peripheral pain reduction.
In prostatitis treatment, Cefecon D is used to alleviate pain syndrome and normalize body temperature. Rectal administration ensures rapid paracetamol absorption and localized action on the prostate gland, swiftly reducing pain and accelerating the resolution of the inflammatory process.
Cefecon D is prescribed as one suppository 2-3 times daily. The treatment course lasts 5-7 days and can be extended to 10 days if necessary. While generally well-tolerated, rare cases of allergic reactions, nausea, or abdominal pain may occur.
It's important to note that Cefecon D provides only symptomatic relief and does not address the underlying cause of inflammation. Therefore, it should be used in conjunction with antibacterial, immunomodulatory, and other pathogenetic agents. Moreover, prolonged, uncontrolled use of high paracetamol doses may lead to liver damage.
Overall, Cefecon D represents an effective and relatively safe analgesic for prostatitis. It rapidly alleviates pain syndrome, reduces fever, and improves patient well-being. However, the drug should be used strictly as prescribed by a physician and under medical supervision.
Nimesulide
Nimesulide, a selective COX-2 inhibitor from the sulfonanilide group, delivers potent anti-inflammatory and analgesic effects comparable to diclofenac and indomethacin. Simultaneously, Nimesulide less frequently causes gastrointestinal mucosal damage and thrombocytopathy.
Nimesulide blocks the synthesis of primary pain and inflammation mediators at the site of injury, suppressing exudation and proliferation. As a result, pain syndrome is rapidly alleviated, prostatic tissue edema decreases, and the development of fibrotic changes is prevented.
In prostatitis treatment, Nimesulide is administered orally, 100 mg twice daily after meals. The treatment course spans 5-7 days. If necessary and well-tolerated, the drug regimen may be extended to 2-4 weeks under medical supervision.
Conclusion
Contemporary pharmacology boasts an extensive arsenal of effective and safe analgesics for prostatitis treatment. Practicing urologists particularly favor NSAIDs for rectal application, myotropic antispasmodics, and combination drugs with antibacterial components.
Patients may combine medications, using different ones in the morning and evening. If desired and in the absence of adverse effects on the rectum and heart, the treatment course can be extended. For low doses and mild but persistent pain syndrome, these drugs may be used for more extended periods. Any prolongation of the treatment duration must be agreed upon with the attending physician.
The selection of an optimal analgesic depends on the form of prostatitis (acute or chronic, bacterial or abacterial), the severity of pain syndrome, concomitant diseases, and individual patient sensitivity. Therefore, self-medication is inadmissible – only a qualified specialist should prescribe analgesics after thorough examination.
It is crucial not to ignore pain and discomfort associated with prostatitis. Timely and adequate pain management not only alleviates patient suffering but also prevents disease progression and the development of complications. Stay healthy!