Therapeutic target
- Improvement of symptomatology, i.e., primarily an improvement in urgency-frequency symptomatology (“urgency frequency”).
Therapy recommendations
- For pain management of chronic pelvic pain syndrome (CPPS): see the table below.
- Spasmolytics, alpha sympathomimetics if necessary.
- Another therapeutic option is intravesical injection of botulinum toxin A (BTXA); indications: neuropathic bladder; overactive bladder (OAB)Overall success rate in OAB patients 51%; symptom reduction was achieved in 46% of men without incontinence and in 55% of those with incontinence
- For colpitis senilis: local estrogen administration (estriol preferred)Note: The European Medicines Agency, after reexamining the risks, recommends using high-dose estradiol-containing vaginal creams (containing 100 micrograms of estradiol per gram of cream (0.01%)) only once and for a maximum of 4 weeks. The drug agency thereby refers to side effects such as hormone replacement therapy, ie endometrial cancer (uterine cancer), breast cancer (breast cancer), venous thromboembolism and stroke.
Active ingredients (main indication)
Pain management of chronic pelvic pain syndrome (CPPS) (modified from [guidelines: EAU guideline]).
| Active ingredient | Pain type | Evidence level* | Recommendation level* |
| Paracetamol | somatic pain | 1a | A |
| Non-steroidal anti-inflammatory drugs | Pelvic pain with inflammatory process (e.g., dysmenorrhea/regular pain) | 1a | A |
| Antidepressants (incl. tricyclic antidepressants, duloxetine, venlafaxine) | Neuropathic pain (nerve pain) | 1a | A |
| Anticonvulsants (gabapentin* * , pregabalin) | Neuropathic pain, fibromyalgia | 1a | A |
| Gabapentin | Women with CPPS (see above) | 2b | B |
| Capsaicin (topical) | Neuropathic pain | 1a | A |
| Opioids | Chronic, non-malignant pain | 1a | A |
* Evidence level and recommendation level according to “Oxford Centre for Evidence-based Medicine Levels of Evidence. “* * Gabapentin did not relieve chronic lower abdominal pain in women (“chronic pelvic pain syndrome”) of childbearing age more than placebo in a randomized trial.
