Chronic pelvic pain syndrome assessment: NIH-CPSI Questionnaire

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Chronic pelvic pain syndrome (CPPS) is one kind of syndrome which complaint dominantly in pain around anorectal, genital areas or even whole pelvic area of gentlemen. Before making diagnosis of this condition, urologist in-charge must complete all history taking, physical examination and proper investigations until making sure that the patients are literally suffering with a chronic pelvic pain syndrome. Chronic pelvic pain syndrome is a chronic disease which quite difficult to treat and need a very good understanding and relationship between patient and urologist.

Because of its complexity in symptoms so we have to record all symptoms aspect with a well-constructed tool. Today I will show you the world standard questionnaire on CPPS which is called NIH-CPSI or National Institute of Health – Chronic Prostatitis Symptom Index.

Name of patient	______________________________________
Date of doing the questionaire	______________________________________
Date of birth	______________________________________

Chronic pelvic pain syndrome questionaire.

PLEASE CIRCLE THE ANSWER WHICH REPRESENT YOUR CURRENT SYMPTOMS

Pain or Discomfort

1. In the last week, have you experienced any pain or discomfort in the following areas? (Choose YES or NO)

Area between rectum and testicles (perineum)	YES	NO
Testicles	YES	NO
Tip of the penis (not related to urination)	YES	NO
Below your waist, in your pubic or bladder area	YES	NO

2. In the last week have you experienced: (Choose YES or NO)

Pain or burning during urination?	YES	NO
Pain or discomfort during or after sexual climax (ejaculation)?	YES	NO

3. How often have you had pain or discomfort in any of these areas over the last week? (Choose one choice below)

a.            Never

b.            Rarely

c.            Sometimes

d.            Often

e.            Usually

f.            Always

4. Which number be describing your AVERAGE pain or discomfort on the days that you had it, over the last week? (Choose one choice below)

Urination

5. How often have you had the sensation of not emptying your bladder completely after you finished urinating, over the last week (Choose one choice below)

a.            Not at all

b.            Less than 1 time in 5

c.            Less than half a time

d.            About half of time

e.            More than half of time

f.            Almost always

6. How often have you had to urinate again less than two hours after you finished urinating, over the last week? (Choose one choice below)

a.            Not at all

b.            Less than 1 time in 5

c.            Less than half a time

d.            About half of time

e.            More than half of time

f.            Almost always

Impact of symptoms

7. How much have your symptoms kept you from doing the kind of things you would usually do, over the last week? (Choose one choice below)

a.            None

b.            Only a little

c.            Some

d.            A lot

8. How much did you think about your symptoms, over the last week? (Choose one choice below)

a.            None

b.            Only a little

c.            Some

d.            A lot

Quality of life

9. If you were to spend the rest of your life with symptoms just the way they have been during the last week, how would you feel about that? (Choose one choice below)

a.            Delighted

b.            Pleased

c.            Mostly satisfied

d.            Mixed

e.            Mostly dissatisfied

f.            Unhappy

g.            Terrible

Scoring the NIH Chronic Prostatitis Symptom Index Domains

Pain	______________________________________
Urinary symptoms	______________________________________
Quality of life	______________________________________

Chronic pelvic pain syndrome management needs several times of OPD visits for adjusting medication as no any single best treatment for every patients.

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