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  • Review Article
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Traditional therapy for chronic pelvic pain does not work: what do we do now?

Nature Clinical Practice Urology volume 3, pages 145–156 (2006)Cite this article

Abstract

The dilemma of managing patients with chronic pelvic pain syndromes continues to frustrate physicians confronted with these complaints. Multiple diagnoses traditionally label this condition in men and women and, typically, implicate a pelvic-organ system when, in fact, very little objective evidence for a pathophysiologic process exists. Traditional therapies, consisting of antibiotics, anti-inflammatories, and muscle relaxants, simply do not work, and their lack of efficacy compared with placebo has been documented by randomized clinical trials in the US that were sponsored by the NIH. What do we do now? This review article attempts to describe the clinical efforts of several investigators and to put their patients' outcomes in perspective, and thereby suggest alternative therapies to help these patients.

Key Points

  • Traditional therapy for chronic pelvic pain (CPP) relies on conventional oral agents that have been used for many years without substantial evidence for efficacy

  • Carefully conducted, randomized, placebo-controlled trials show no efficacy for antibiotic therapy in nonbacterial pelvic pain syndromes

  • There is clear evidence that α-blocker therapy could be beneficial in male CPP syndrome

  • There is very little published evidence that CPP implies an inflammatory process, although emerging studies have demonstrated the upregulation of proinflammatory and inflammatory cytokines as well as neurotransmitters

  • Pilot exploration of therapeutic trials designed to inhibit neuromuscular transmission of painful stimuli seem promising, but randomized, controlled studies are necessary

  • CPP, like other chronic pain syndromes, seems to occur as a biopsychosocial phenomenon

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Authors and Affiliations

  1. Professor of Urology in the Department of Urology, Stanford University School of Medicine, Stanford, CA, USA

    Rodney U Anderson

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  1. Rodney U Anderson
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Correspondence to Rodney U Anderson.

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Anderson, R. Traditional therapy for chronic pelvic pain does not work: what do we do now?. Nat Rev Urol 3, 145–156 (2006). https://doi.org/10.1038/ncpuro0438

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  • DOI: https://doi.org/10.1038/ncpuro0438

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