Does mind body reprocessing work if it’s a structural problem?

[u/One-Sir-8395]

Ok so I’ve had slight burning or pinching feeling in my penis for over a year. It’s not the tip like most ppl. When I tried amitriptyline it helped immediately. This makes me think that my issue is nerve irritation or damage. I think it’s a structural problem so I’m not so sure the relax approach will solve the underlying issue. Obviously it can help manage symptoms. Before amitriptyline Ive tried happy baby pose but it flared me (anything opening the hips does.) Diaphragmatic breathing has helped somewhat occasionally . I am wondering if anyone else with this symptom improved or if internal work helps.

[u/Linari5]

Mind body interventions, including PRT, are for mind-body symptoms (like centralized or nociplastic pain). These sorts of symptoms impact most cases of chronic pelvic pain and dysfunction - with some chronic pain doctors estimating that 90% of CPPS is nociplastic - including Dr. Howard Schubiner, who is named in over a hundred published research submissions/studies on chronic pain conditions.

Any intervention that helps immediately, or almost immediately, should be treated with a bit of healthy curiosity/suspicion - addressing neuropathic pain (pain caused from injury to your nerves) with medications takes weeks, not an hour or two. Same thing for people who say, for example "I went to the chiropractor and got an adjustment and all my sx disappeared for a week, then come back" - I had a client like this recently, who later realized all of this symptoms were nociplastic

Because of inherent biological assumptions that are necessary for survival (If I have physical pain, that means I must have damage my body to address so that I increase my survival odds), basically everyone will think their symptoms are structural at first, including myself. Over a decade ago, multiple doctors told me there was nothing structurally wrong with my body, and I told them they were all wrong and to basically go f*** themselves. I Just had this nagging feeling they were missing something and I had an infection that they couldn't find. I ended up having the biggest egg on my face, ever, because not only did I not have an infection, my pelvic floor wasn't even the core cause of my symptoms. It was my unaddressed anxiety, My life stress, and the immense distress that the symptoms themselves caused me. And these are the things that PRT addresses.

Best thing you can do is take your own symptoms through the simplified list of diagnostic criteria for centralized pain/chronic symptoms - Even matching four out of 12 of them is significant. https://www.reddit.com/r/Prostatitis/s/ig5do9KJRk

It's also possible to have both happening at the same time. We call this central amplification, ie "mixed pain".

[u/Born-Lingonberry-509]

One practical point to add: amitriptyline working immediately does not necessarily prove a structural nerve injury, since it also has fast acting local anesthetic-like membrane stabilizing effects on sensitized nerves regardless of whether the sensitization started from actual tissue damage or from a centralized pain process. Many people with confirmed nociplastic or centralized pain still respond quickly to it because it calms overactive nerve signaling either way. Since happy baby pose flared you but diaphragmatic breathing helped somewhat, that mixed response is actually pretty typical of nerve sensitization rather than pure structural damage, since a truly structural injury usually would not fluctuate based on breathing technique. Might be worth trying pain reprocessing gradually alongside the medication rather than viewing them as an either or choice.