Highlights & Basics
- Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS; also known as primary prostate pain syndrome, chronic pelvic pain syndrome in men, or chronic nonbacterial prostatitis) typically presents as persistent pelvic pain of at least 3 months' duration centered around the prostate. Patients may report pain occurring in pelvic areas outside the prostate, such as the rectum, perineum, penis, testicles, abdomen, lower back, and the inguinal region.
- The diagnosis is clinical so taking a detailed history and ruling out other pathologies are fundamental to the diagnosis. Investigations may also be helpful for phenotypic description.
- Assess the severity of pain and associated symptoms, their progression, and response to treatment using reliable and validated symptom-scoring tools.
- Combinations of pharmacologic and nonpharmacologic interventions administered through a multimodal, multidisciplinary approach have a higher chance of improving the patient's condition, especially if tailored to the individual. Treatment options include physical therapy, psychological therapy, analgesia, antibiotics, and alpha-blockers.
- Patient education promotes self-management and improves treatment adherence and engagement.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
EAU Classification of Chronic Pelvic Pain Syndromes
Phenotyping of pelvic pain using the UPOINT classification
The anatomy of the normal prostate. Note the anatomical appearance of the prostate and surrounding tissues is normal in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
Diagnostic algorithm for diagnosing chronic pelvic pain; *Specific disease-associated pelvic pain caused by bacterial infection, cancer, drug-induced pathology, primary anatomical or functional disease of the pelvic organs, and neurogenic disease must be ruled out
Cystoscopy in a 65-year old patient with bladder pain syndrome type 3C - corresponding to "classical'' interstitial cystitis - larger mucosal hemorrhages (Hunner's lesions) seen after diagnostic cystoscopic hydrodistension
Citations
Engeler D, Baranowski AP, Borovicka J, et al; European Association of Urology. EAU guidelines on chronic pelvic pain. March 2022 [internet publication].[Full Text]
Rees J, Abrahams M, Doble A, et al. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015 Oct;116(4):509-25.[Abstract][Full Text]
Franco JV, Turk T, Jung JH, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2018 May 12;(5):CD012551.[Abstract][Full Text]
Franco JVA, Turk T, Jung JH, et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int. 2020 Apr;125(4):490-6.[Abstract]
1. Loeser JD, Arendt-Nielsen L, Baron R, et al; International Association for the Study of Pain. Classification of chronic pain, second edition (revised). 2012 [internet publication].[Full Text]
2. Krieger JN, Riley DE, Cheah PY, et al. Epidemiology of prostatitis: new evidence for a world-wide problem. World J Urol. 2003 Jun;21(2):70-4.[Abstract]
3. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999 Jul 21;282(3):236-7.[Abstract]
4. Engeler D, Baranowski AP, Borovicka J, et al; European Association of Urology. EAU guidelines on chronic pelvic pain. March 2022 [internet publication].[Full Text]
5. Shoskes DA, Nickel JC, Rackley RR, et al. Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis. 2009;12(2):177-83.[Abstract]
6. Rees J, Abrahams M, Doble A, et al. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015 Oct;116(4):509-25.[Abstract][Full Text]
7. World Health Organization. International classification of diseases, 11th revision (ICD-11). January 2022 [internet publication].[Full Text]
8. Schaeffer AJ. Epidemiology and evaluation of chronic pelvic pain syndrome in men. Int J Antimicrob Agents. 2008 Feb;31 Suppl 1:S108-11.[Abstract]
9. Mehik A, Hellström P, Lukkarinen O, et al. Epidemiology of prostatitis in Finnish men: a population-based cross-sectional study. BJU Int. 2000 Sep;86(4):443-8.[Abstract]
10. Krieger JN, Lee SW, Jeon J, et al. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008 Feb;31 Suppl 1(suppl 1):S85-90.[Abstract]
11. Clemens JQ, Meenan RT, O'Keeffe Rosetti MC, et al. Incidence and clinical characteristics of National Institutes of Health type III prostatitis in the community. J Urol. 2005 Dec;174(6):2319-22.[Abstract]
12. Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA. 2011 Jan 5;305(1):78-86.[Abstract][Full Text]
13. Pontari MA, Ruggieri MR. Mechanisms in prostatitis/chronic pelvic pain syndrome. J Urol. 2004 Sep;172(3):839-45.[Abstract]
14. Daniels NA, Link CL, Barry MJ, et al. Association between past urinary tract infections and current symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome. J Natl Med Assoc. 2007 May;99(5):509-16.[Abstract]
15. Pontari MA. Etiology of chronic prostatitis/chronic pelvic pain syndrome: psychoimmunoneurendocrine dysfunction (PINE syndrome) or just a really bad infection? World J Urol. 2013 Aug;31(4):725-32.[Abstract]
16. Hochreiter WW, Duncan JL, Schaeffer AJ. Evaluation of the bacterial flora of the prostate using a 16S rRNA gene based polymerase chain reaction. J Urol. 2000 Jan;163(1):127-30.[Abstract]
17. Leskinen MJ, Rantakokko-Jalava K, Manninen R, et al. Negative bacterial polymerase chain reaction (PCR) findings in prostate tissue from patients with symptoms of chronic pelvic pain syndrome (CPPS) and localized prostate cancer. Prostate. 2003 May 1;55(2):105-10.[Abstract]
18. Chung SD, Lin HC. Association between chronic prostatitis/chronic pelvic pain syndrome and anxiety disorder: a population-based study. PLoS One. 2013 May 15;8(5):e64630.[Abstract][Full Text]
19. Huang X, Qin Z, Cui H, et al. Psychological factors and pain catastrophizing in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a meta-analysis. Transl Androl Urol. 2020 Apr;9(2):485-93.[Abstract][Full Text]
20. Riegel B, Bruenahl CA, Ahyai S, et al. Assessing psychological factors, social aspects and psychiatric co-morbidity associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men - a systematic review. J Psychosom Res. 2014 Nov;77(5):333-50.[Abstract]
21. Hochreiter WW, Nadler RB, Koch AE, et al. Evaluation of the cytokines interleukin 8 and epithelial neutrophil activating peptide 78 as indicators of inflammation in prostatic secretions. Urology. 2000 Dec 20;56(6):1025-9.[Abstract]
22. Alexander RB, Brady F, Ponniah S. Autoimmune prostatitis: evidence of T cell reactivity with normal prostatic proteins. Urology. 1997 Dec;50(6):893-9.[Abstract]
23. Chen L, Bian Z, Chen J, et al. Immunological alterations in patients with chronic prostatitis/chronic pelvic pain syndrome and experimental autoimmune prostatitis model: a systematic review and meta-analysis. Cytokine. 2021 May;141:155440.[Abstract]
24. Hetrick DC, Ciol MA, Rothman I, et al. Musculoskeletal dysfunction in men with chronic pelvic pain syndrome type III: a case-control study. J Urol. 2003 Sep;170(3):828-31.[Abstract]
25. Shoskes DA, Berger R, Elmi A, et al. Muscle tenderness in men with chronic prostatitis/chronic pelvic pain syndrome: the chronic prostatitis cohort study. J Urol. 2008 Feb;179(2):556-60.[Abstract]
26. Kirby RS, Lowe D, Bultitude MI, et al. Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis. Br J Urol. 1982 Dec;54(6):729-31.[Abstract]
27. Dimitrakov J, Joffe HV, Soldin SJ, et al. Adrenocortical hormone abnormalities in men with chronic prostatitis/chronic pelvic pain syndrome. Urology. 2008 Feb;71(2):261-6.[Abstract]
28. Clemens JQ, Mullins C, Kusek JW, et al. The MAPP research network: a novel study of urologic chronic pelvic pain syndromes. BMC Urol. 2014 Aug 1;14:57.[Abstract][Full Text]
29. Zhang J, Liang C, Shang X, et al. Chronic prostatitis/chronic pelvic pain syndrome: a disease or symptom? Current perspectives on diagnosis, treatment, and prognosis. Am J Mens Health. 2020 Jan-Feb;14(1):1557988320903200.[Abstract][Full Text]
30. Rodríguez MA, Afari N, Buchwald DS, et al. Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol. 2009 Nov;182(5):2123-31.[Abstract]
31. Landis JR, Williams DA, Lucia MS, et al. The MAPP research network: design, patient characterization and operations. BMC Urol. 2014 Aug 1;14:58.[Abstract][Full Text]
32. Roumeguère T, Sfeir J, El Rassy E, et al. Oxidative stress and prostatic diseases. Mol Clin Oncol. 2017 Nov;7(5):723-8.[Abstract]
33. Kullisaar T, Türk S, Punab M, et al. Oxidative stress - cause or consequence of male genital tract disorders? Prostate. 2012 Jun 15;72(9):977-83.[Abstract]
34. Raphael KG, Widom CS, Lange G. Childhood victimization and pain in adulthood: a prospective investigation. Pain. 2001 May;92(1-2):283-93.[Abstract]
35. Vehof J, Zavos HMS, Lachance G, et al. Shared genetic factors underlie chronic pain syndromes. Pain. 2014 Aug;155(8):1562-8.[Abstract]
36. Hu JC, Link CL, McNaughton-Collins M, et al. The association of abuse and symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome: results from the Boston Area Community Health survey. J Gen Intern Med. 2007 Nov;22(11):1532-7.[Abstract]
37. Hilden M, Schei B, Swahnberg K, et al. A history of sexual abuse and health: a Nordic multicentre study. BJOG. 2004 Oct;111(10):1121-7.[Abstract]
38. Pavone C, Caldarera E, Liberti P, et al. Correlation between chronic prostatitis syndrome and pelvic venous disease: a survey of 2,554 urologic outpatients. Eur Urol. 2000 Apr;37(4):400-3.[Abstract]
39. Yoon BI, Han DS, Ha US, et al. Clinical courses following acute bacterial prostatitis. Prostate Int. 2013;1(2):89-93.[Abstract][Full Text]
40. Clemens JQ, Brown SO, Kozloff L, et al. Predictors of symptom severity in patients with chronic prostatitis and interstitial cystitis. J Urol. 2006 Mar;175(3 pt 1):963-6; discussion 967.[Abstract]
41. Vicari E, La Vignera S, Arcoria D, et al. High frequency of chronic bacterial and non-inflammatory prostatitis in infertile patients with prostatitis syndrome plus irritable bowel syndrome. PLoS One. 2011 Apr 8;6(4):e18647.[Abstract][Full Text]
42. Turk DC, Dworkin RH, Allen RR, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003 Dec;106(3):337-45.[Abstract]
43. Wagenlehner FM, van Till JW, Magri V, et al. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2013 May;63(5):953-9.[Abstract]
44. Sutcliffe S, Colditz GA, Goodman MS, et al. Urological chronic pelvic pain syndrome symptom flares: characterisation of the full range of flares at two sites in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. BJU Int. 2014 Dec;114(6):916-25.[Abstract]
45. Dybowski C, Löwe B, Brünahl C. Predictors of pain, urinary symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS): a prospective 12-month follow-up study. J Psychosom Res. 2018 Sep;112:99-106.[Abstract]
46. Springer KW, Sheridan J, Kuo D, et al. The long-term health outcomes of childhood abuse. An overview and a call to action. J Gen Intern Med. 2003 Oct;18(10):864-70.[Abstract]
47. Gerlinger C, Schumacher U, Faustmann T, et al. Defining a minimal clinically important difference for endometriosis-associated pelvic pain measured on a visual analog scale: analyses of two placebo-controlled, randomized trials. Health Qual Life Outcomes. 2010 Nov 24;8:138.[Abstract][Full Text]
48. Litwin MS, McNaughton-Collins M, Fowler FJ Jr, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999 Aug;162(2):369-75.[Abstract]
49. Mebust W, et al. Symptom evaluation, quality of life and sexuality. In: Cockett ATK, Khoury S, Aso Y, et al. The 2nd International Consultation on Benign Prostatic Hyperplasia. Channel Islands: Scientific Communication International Ltd, 1994.
50. Holt JD, Garrett WA, McCurry TK, et al. Common questions about chronic prostatitis. Am Fam Physician. 2016 Feb 15;93(4):290-6.[Abstract]
51. Magistro G, Wagenlehner FM, Grabe M, et al. Contemporary management of chronic prostatitis/chronic pelvic pain syndrome. Eur Urol. 2016 Feb;69(2):286-97.[Abstract]
52. National Institute for Health and Care Excellence. Lower urinary tract symptoms in men: management. June 2015 [internet publication].[Full Text]
53. Yang CC, Miller JL, Omidpanah A, et al. Physical examination for men and women with urologic chronic pelvic pain syndrome: a MAPP (Multidisciplinary Approach to the Study of Chronic Pelvic Pain) network study. Urology. 2018 Jun;116:23-9.[Abstract]
54. Wyndaele JJ, Van Eetvelde B. Reproducibility of digital testing of the pelvic floor muscles in men. Arch Phys Med Rehabil. 1996 Nov;77(11):1179-81.[Abstract]
55. Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus. 2009 Feb;26(2):E9.[Abstract][Full Text]
56. Lefaucheur JP, Labat JJ, Amarenco G, et al. What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome? Neurophysiol Clin. 2007 Aug-Sep;37(4):223-8.[Abstract]
57. Wrenn K. Dysuria, frequency, and urgency. In: Walker HK, Hall WD, Hurst JW (eds). Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston: Butterworths; 1990. Chapter 181.[Abstract][Full Text]
58. Anderson RU, Wise D, Sawyer T, et al. Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training. J Urol. 2006 Oct;176(4 pt 1):1534-8; discussion 1538-9.[Abstract]
59. Davis SN, Binik YM, Amsel R, et al. Is a sexual dysfunction domain important for quality of life in men with urological chronic pelvic pain syndrome? Signs "UPOINT" to yes. J Urol. 2013 Jan;189(1):146-51.[Abstract]
60. Liang CZ, Zhang XJ, Hao ZY, et al. Prevalence of sexual dysfunction in Chinese men with chronic prostatitis. BJU Int. 2004 Mar;93(4):568-70.[Abstract]
61. Nickel JC, Ardern D, Downey J. Cytologic evaluation of urine is important in evaluation of chronic prostatitis. Urology. 2002 Aug;60(2):225-7.[Abstract]
62. Lipsky BA. Managing urinary tract infections in men. Hosp Pract (1995). 2000 Jan 15;35(1):53-9; discussion 59-60; quiz 144.[Abstract]
63. Wallner LP, Clemens JQ, Sarma AV. Prevalence of and risk factors for prostatitis in African American men: the Flint Men's Health Study. Prostate. 2009 Jan 1;69(1):24-32.[Abstract]
64. Pinson AG, Philbrick JT, Lindbeck GH, et al. Fever in the clinical diagnosis of acute pyelonephritis. Am J Emerg Med. 1997 Mar;15(2):148-51.[Abstract]
65. Fairley KF, Carson NE, Gutch RC, et al. Site of infection in acute urinary-tract infection in general practice. Lancet. 1971 Sep 18;2(7725):615-8.[Abstract]
66. Brill JR. Diagnosis and treatment of urethritis in men. Am Fam Physician. 2010 Apr 1;81(7):873-8.[Abstract]
67. Babjuk M, Burger M, Capoun O, et al. European Association of Urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). Eur Urol. 2022 Jan;81(1):75-94.[Abstract]
68. Worcester EM, Coe FL. Clinical practice. Calcium kidney stones. N Engl J Med. 2010 Sep 2;363(10):954-63.[Abstract]
69. Uribarri J, Oh MS, Carroll HJ. The first kidney stone. Ann Intern Med. 1989 Dec 15;111(12):1006-9.[Abstract]
70. Quigley EM, Fried M, Gwee KA, et al. World Gastroenterology Organisation global guidelines irritable bowel syndrome: a global perspective update September 2015. J Clin Gastroenterol. 2016 Oct;50(9):704-13.[Abstract][Full Text]
71. Abdelmoteleb H, Rashed F, Hawary A. Management of prostate abscess in the absence of guidelines. Int Braz J Urol. 2017 Sep-Oct;43(5):835-40.[Abstract][Full Text]
72. Nickel JC. Prostatitis. Can Urol Assoc J. 2011 Oct;5(5):306-15.[Abstract]
73. National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. April 2021 [internet publication].[Full Text]
74. Doggweiler R, Whitmore KE, Meijlink JM, et al. A standard for terminology in chronic pelvic pain syndromes: a report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn. 2017 Apr;36(4):984-1008.[Abstract]
75. Bolton V, Brittain M. Patient information provision: its effect on patient anxiety and the role of health information services and libraries. Health Libr Rev. 1994 Jun;11(2):117-32.[Abstract]
76. Windgassen S, McKernan L. Cognition, emotion, and the bladder: psychosocial factors in bladder pain syndrome and interstitial cystitis (BPS/IC). Curr Bladder Dysfunct Rep. 2020 Mar;15(1):9-14.[Abstract]
77. Franco JV, Turk T, Jung JH, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Cochrane Database Syst Rev. 2018 May 12;(5):CD012551.[Abstract][Full Text]
78. Giubilei G, Mondaini N, Minervini A, et al. Physical activity of men with chronic prostatitis/chronic pelvic pain syndrome not satisfied with conventional treatments--could it represent a valid option? The physical activity and male pelvic pain trial: a double-blind, randomized study. J Urol. 2007 Jan;177(1):159-65.[Abstract]
79. National Institute for Health and Care Excellence. Neuropathic pain in adults: pharmacological management in non-specialist settings. September 2020 [internet publication].[Full Text]
80. Franco JVA, Turk T, Jung JH, et al. Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int. 2020 Apr;125(4):490-6.[Abstract]
81. Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new frugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804.[Abstract][Full Text]
82. Nickel JC, Forrest JB, Tomera K, et al. Pentosan polysulfate sodium therapy for men with chronic pelvic pain syndrome: a multicenter, randomized, placebo controlled study. J Urol. 2005 Apr;173(4):1252-5.[Abstract]
83. Moore RA, Derry S, Wiffen PJ, et al. Overview review: comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. Eur J Pain. 2015 Oct;19(9):1213-23.[Abstract][Full Text]
84. Medicines and Healthcare products Regulatory Agency. Elmiron (pentosan polysulfate sodium): rare risk of pigmentary maculopathy. Drug safety update. September 2019 [internet publication].[Full Text]
85. US Food & Drug Administration. Elmiron®-100 MG (pentosan polysulfate sodium) capsules prescribing information. June 2020 [internet publication].[Full Text]
86. Zhao WP, Zhang ZG, Li XD, et al. Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA). Braz J Med Biol Res. 2009 Oct;42(10):963-7.[Abstract][Full Text]
87. Pontari MA, Krieger JN, Litwin MS, et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010 Sep 27;170(17):1586-93.[Abstract][Full Text]
88. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005454.[Abstract][Full Text]
89. Derry S, Bell RF, Straube S, et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev. 2019 Jan 23;1(1):CD007076.[Abstract][Full Text]
90. Wiffen PJ, Derry S, Bell RF, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017 Jun 9;6(6):CD007938.[Abstract][Full Text]
91. Chang SC, Hsu CH, Hsu CK, et al. The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: a systemic review and meta-analysis. Neurourol Urodyn. 2017 Feb;36(2):474-81.[Abstract]
92. Qin Z, Wu J, Zhou J, et al. Systematic review of acupuncture for chronic prostatitis/chronic pelvic pain syndrome. Medicine (Baltimore). 2016 Mar;95(11):e3095.[Abstract][Full Text]
93. Skaudickas D, Telksnys T, Veikutis V, et al. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome. Open Med (Wars). 2020 Jul 1;15(1):580-5.[Abstract][Full Text]
94. Zimmermann R, Cumpanas A, Miclea F, et al. Extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome in males: a randomised, double-blind, placebo-controlled study. Eur Urol. 2009 Sep;56(3):418-24.[Abstract]
95. Mykoniatis I, Pyrgidis N, Sokolakis I, et al. Low-intensity shockwave therapy for the management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis. BJU Int. 2021 Aug;128(2):144-52.[Abstract]
96. Brünahl CA, Klotz SGR, Dybowski C, et al. Physiotherapy and combined cognitive-behavioural therapy for patients with chronic pelvic pain syndrome: results of a non-randomised controlled feasibility trial. BMJ Open. 2021 Dec 14;11(12):e053421.[Abstract][Full Text]
97. European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. March 2019 [internet publication].[Full Text]
98. US Food & Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. July 2018 [internet publication].[Full Text]
99. US Food & Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. FDA Drug Safety Communication. December 2018 [internet publication].[Full Text]
100. Parsons BA, Goonewardene S, Dabestani S, et al. The benefits and harms of botulinum toxin-A in the treatment of chronic pelvic pain syndromes: a systematic review by the European Association of Urology Chronic Pelvic Pain Panel. Eur Urol Focus. 2022 Jan;8(1):320-38.[Abstract]
101. Kurita M, Yamaguchi H, Okamoto K, et al. Chronic pelvic pain and prostate inflammation in rat experimental autoimmune prostatitis: effect of a single treatment with phosphodiesterase 5 inhibitors on chronic pelvic pain. Prostate. 2018 Nov;78(15):1157-65.[Abstract]
102. Tawfik AM, Radwan MH, Abdulmonem M, et al. Tadalafil monotherapy in management of chronic prostatitis/chronic pelvic pain syndrome: a randomized double-blind placebo controlled clinical trial. World J Urol. 2022 Oct;40(10):2505-11.[Abstract][Full Text]
103. Herati A, Pil E, Li O, et al. Use of adjuvant rectal diazepam with oral tadalafil for treatment of chronic prostatitis/chronic pelvic pain syndrome. Research Square. 2023 April 18 [Preprint].[Full Text]
104. Cottrell AM, Schneider MP, Goonewardene S, et al. Benefits and harms of electrical neuromodulation for chronic pelvic pain: a systematic review. Eur Urol Focus. 2020 May 15;6(3):559-71.[Abstract]
105. McNaughton Collins M, Pontari MA, O'Leary MP, et al. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med. 2001 Oct;16(10):656-62.[Abstract]
106. McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain. 2003 Nov;106(1-2):127-33.[Abstract]
107. Dowell D, Ragan KR, Jones CM, et al. CDC Clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95.[Abstract][Full Text]
108. Ossipov MH, Lai J, Vanderah TW, et al. Induction of pain facilitation by sustained opioid exposure: relationship to opioid antinociceptive tolerance. Life Sci. 2003 Jun 27;73(6):783-800.[Abstract]
