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Best Approach to Managing Bladder Pain: Patient Centered and Collaborative Approach

Speer LM, Mushkbar S, Erbele T. Chronic Pelvic Pain in Women. Am Fam Physician. 2016 Mar 1;93(5):380-7.

In this article, aimed at providing practical recommendations for family physicians to follow, the authors argue for a collaborative, patient centered approach to managing chronic pelvic pain in women with interstitial cystitis/bladder pain syndrome (IC/BPS) and other conditions. In particular, they recommend engaging the patient via a “biopsychosocial approach” that includes treatment of IC/BPS, depression, and any other diagnosed and related disease process. In terms of specific drugs, they say that there is limited evidence supporting the treatment of chronic pelvic pain with gabapentin (Neurontin), nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors (SSRIs). They recommend behavioral therapy and call it an “integral” part of treatment, as well as pelvic floor physical therapy, which may be helpful for many patients. They call hysterectomy a treatment of “last resort” and warn that only about a half of patients report significant improvement after the procedure.