Abstract
The use of antidepressant drugs for the management of chronic pelvic pain has been supported in the past. This study aimed to evaluate the available evidence for the efficacy and acceptability of antidepressant drugs in the management of urological chronic pelvic pain. Studies were selected through a comprehensive literature search. We included all types of study designs due to the limited evidence. Studies were classified into levels of evidence according to their design. Ten studies were included with a total of 360 patients. Amitriptyline, sertraline, duloxetine, nortriptyline, and citalopram are the antidepressants that have been reported in the literature. Only four randomized controlled trials (RCTs) were identified (two for amitriptyline and two for sertraline) with mixed results. We conclude that the use of antidepressants for the management of chronic urological pelvic pain is not adequately supported by methodologically sound RCTs. From the existing studies amitriptyline may be effective in interstitial cystitis but publication bias should be considered as an alternative explanation. All drugs were generally well tolerated with no serious events reported.
Highlights
Chronic pelvic pain is a complex, poorly understood health problem with prevalence rates ranging from 2.7% to 5.7% [1, 2].The European Association of Urology defines chronic pelvic pain as a nonmalignant pain, perceived in structures related to the pelvis of either men or women and constant or recurring over a period of ≥6 months
Ten studies were included in this review and their characteristics are summarized in Table 1 [11,12,13,14,15,16,17,18,19,20]
Five studies investigated the efficacy of amitriptyline and two studies investigated sertraline
Summary
Chronic pelvic pain is a complex, poorly understood health problem with prevalence rates ranging from 2.7% to 5.7% [1, 2]. The European Association of Urology defines chronic pelvic pain as a nonmalignant pain, perceived in structures related to the pelvis of either men or women and constant or recurring over a period of ≥6 months. Chronic pelvic pain is better viewed as a functional syndrome involving multiple sites, aetiologies and mechanisms. The International Continence Society has defined this syndrome as persistent or recurrent episodic pelvic pain associated with symptoms suggesting lower urinary tract, sexual, bowel, or gynaecological dysfunction, without evidence of infection or other obvious pathology [4]. Concerning the urological system it can be bladder pain syndrome/interstitial cystitis, urethral pain syndrome, prostate pain syndrome, scrotal pain, or penile pain syndrome [3]
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