Pelviperineal Pain Research Articles

Racial Disparities in National Emergency Department Utilization and Admissions for Pelvic and Perineal Pain (2016–2019) [ID: 1376522

INTRODUCTION: Pelvic/perineal pain encompasses a wide spectrum of diseases. Despite its high prevalence, there are little national data on emergency department utilization for its management. METHODS: Analysis of data from the Nationwide Emergency Department Sample from 2016 to 2019 was performed. Women between 15 and 44 year old with a primary diagnosis of pelvic/perineal pain (PPP) were included (ICD-10 R10.2). Race was available for 2019 only. This study was deemed exempt by the University of Michigan IRB. RESULTS: There were 923,300 ED visits for PPP (0.672% of all ED visits) with an admission rate of 0.16% versus 6.60% for all other diagnoses (P<.001). ED visits for PPP cost $4.7 billion USD over the 4 years. The average cost per visit was $5,136, compared to $4,143 for other diagnoses (P<.001). Patients from the lowest income quartile by zip code accounted for 37% of ED visits. Medicaid was the largest single payment type representing 44.4% of visits. In 2019, White women represented 47% of visits but accounted for 69.4% of admissions. Admission rates were 0.2% for White patients and 0.1% for Black patients (P<.001). CONCLUSION: While visits for PPP represent a small percentage of total ED visits, they reveal potential racial disparities with White women being admitted at twice the rate of Black women. Studies are needed to elucidate the etiologies of pelvic pain within different demographic groups and the potential contributions of structural inequities so that a goal of equitable care for all patients can be achieved.

Neuroendocrine Carcinoma of the Prostate – a Case Report

"Poorly differentiated neuroendocrine carcinomas are rare. Most of them arise from the lung, and only 9% are found in extrapulmonary sites. In the prostate, neuroendocrine cells are more commonly present compared to other organs of the genitourinary tract. We present the case of a 67-year-old male patient who was investigated for constipation, loss of appetite and pelvic-perineal pain; a large prostatic mass was discovered upon further investigation. After a thorough work-up and multidisciplinary approach, the patient was diagnosed with de novo small cell neuroendocrine carcinoma of the prostate with multiple metastases. He underwent five cycles of chemotherapy with cisplatin and etoposide before we evaluated the therapeutic response by CT scan, which showed partial response according to RECIST v 1.1. Due to significant nephrotoxicity, the treatment was discontinued after the 6th cycle and a follow-up after three months was recommended. The rarity of this case made the diagnosis process challenging, but an accurate diagnosis was possible with the multidisciplinary team`s involvement. The treatment was initiated according to the international guidelines concerning extrapulmonary poorly differentiated neuroendocrine carcinomas/ large or small cell carcinomas. Although the evaluation showed partial response, small cell neuroendocrine carcinoma of the prostate is an aggressive tumor with a poor prognosis. "

Psychometric validation of Convergence criteria PP

The PP Convergences criteria group together 10 of the most significant clinical criteria for sensitization in the context of chronic pelvic pain. They are the result of a consensus of experts and represent to date the only clinical evaluation guide to identify patients with pelvic perineal pain in whom a pelvic sensitization component can be evoked. This work concerns the psychometric validation of these criteria. The aim is to answer 3 questions: 1) is the instrument reliable (i.e., sensitive, specific and accurate)?; 2) can we define a screening score for pelvic-perineal pain by sensitization from the CPP criteria?; 3) can combinations of criteria be defined to predict pelvic-perineal sensitization from the CPP criteria? In total, 308 patients with pelviperineal pain were recruited during their medical consultation. Fifteen expert physicians were asked to judge the presence or absence of the 10 CPP criteria and to make a diagnosis of the presence or absence of pelviperineal sensitization in their patient. ROC curve analysis indicated that a score of 5 was the closest to a perfect score with a sensitivity of 95% and a specificity of 87%. They also indicate that the CPP criteria have a very good sensitivity (97%) and specificity (91%) and present globally a good reproducibility on all the criteria (Kappa>0.6). Finally, the statistical analyses reveal that the most discriminating criterion for predicting sensitization is Q8 (pain persisting after sexual activity). The CPP criteria represent a very good screening tool for pelvic sensitization. The score of 5 corresponds to the score at which the patient has sufficient clinical criteria to be classified as sensitized. 4.

PREVALENCE AND RISK FACTORS OF PROSTATITIS LIKE SYMPTOMS AMONG MALES BETWEEN AGE 15-45 YEARS OLD IN TAIF GOVERNORATE, KSA

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the most frequent and mysterious disorder seen in the daily practice of urology, it is a chronic deactivate syndrome composed of pelviperineal pain of vague etiology, frequently accompanied by voiding plus sexual symptoms. Many studies have found multiple different factors rise risk of prostatitis consist of dietary factors, sexual factors, perineal factors, and sedentary lifestyle. Our aim is to assess the prevalence of prostatitis-like symptoms in males between age 15-45 years old in Taif gouvernante and risk factors related to prostatitis. Methodology: cross-sectional study targeting 409 males aged between 15 to 45 years old living in Taif governorate using a predesigned questionnaire, including demographic characteristics, Arabic Version of the National Institutes of Health Chronic Prostatitis Symptom Index, and risk factors of prostatitis. Results: In this study, we collected data from 409 participants, mostly aged between 21-25 years (64.1 %). In general, the mean score of pain, urinary symptoms, and impact of symptoms on QoL were 3.33 (3.75), 2.1 (2.36) and 3.0 (2.71). We found that marital status and smoking status had significant effect on pain score where divorced, widow and single participants had significant lower pain (P=0.008), and smokers had higher pain score. Some lifestyle is related to pain score. Conclusion: we found that participants in Al Taif city reported lower scores of prostatitis related symptoms. Some habits were related with incidence of prostatitis including consuming of alcohol and smoking as well as experience of GIT disorder. The pain score is increased as reported by participants by increasing stress, decrease in physical activity, sitting for long periods, and wear of tight clothes.

Estimate of the proportion of uncertain diagnoses of pudendal neuralgia in women with chronic pelvic-perineal pain: A systematic review with a descriptive data synthesis.

There is a gap between pudendal neuralgia (PN) due to pudendal entrapment syndrome and PN without pudendal entrapment syndrome. The latter could have atypical symptoms. Defining a rate of atypical PN from a clinical series of female patients with chronic pelvic-perineal pain. The atypical PN was defined as a pain not meeting clinical criteria for pudendal entrapment syndrome. The effect size was the rate of atypical PN. Such a rate was expected to be found among patients screened for enrollment in clinical series on pudendal neuropathic pain. A systematic search was performed looking for clinical series on PN. Studies must report information on female patients, pelvic-perineal pain, at least a clinical criterion for diagnosing the pudendal neurogenic origin of pain, the proportion of patients with pain not meeting the clinical criterion/a for diagnosing the pudendal entrapment pain. From 2637 references, nine studies were included for qualitative analysis. Three of them were not suitable for data synthesis: one assessed the rate of PN after hip arthroscopy; second enrolled miscellaneous patients, a third investigated patients with gynecological diseases. Six studies involved patients with suspicion of pudendal entrapment symptoms (205 patients observed), allowing data synthesis. One of these series was judged as being of good quality. The overall rate of atypical PN is 0.013 (95% confidence interval, 0.008-0.021), I2 0%. Further analysis suggests the risk of bias for all studies. Atypical PN in females is low when clinical criteria for pudendal entrapment syndrome are applied.

Incidence des troubles posturaux chez les patients souffrant d’algies pelvipérinéales chroniques

Pelvic-perineal pain often accompanied by pain of the perineum and pelvi-trochanteric muscles, we sought to observe the frequency of postural disturbances in relation to the pelvi-perineal muscles in patients who consult for pelvic perineal pain compared to a control population free of these pain. The prospective monocentric study was conducted during consultations of pelvic perineal pain in the urology department of Nantes and was based on 5clinical tests successively looking for the presence of thoraco-lumbar hinge syndrome, myofascial syndrome in the pelvic diaphragm, pelvic instability, pelvic-pedic quadrilateral dysfunction and paravertebral muscle hypertonia. A total of 51subjects were included in the study and divided into two populations: 26patients, 25controls. Thoraco-lumbar hinge syndrome was found in 28% of patients vs 4% of controls (P=0.024); myofascial syndromes were present in 68% of patients vs 25% of controls (P=0.005); pelvic instability concerned 76% of patients vs 33% of controls (P=0.002); the dysfunctions of the pelvic-pedic quadrilateral concerned 96% of the patients vs 58% of the controls (P=0.001); paravertebral muscle hypertonia was found bilaterally in 32% of patients vs 4% of controls (P=0.077) and unilaterally in 36% of patients vs 0% of controls (P=0.001). Patients with chronic pelvic perineal pain had significantly more posture problems than non-pain patients. It seemed relevant to us that the postural assessment was integrated into their usual clinical examination. 4.

Douleurs pelvipérinéales chroniques, demandes urgentes de soins et prise de décision

Some patients suffering from pelvi-perineal chronic pain express urgent, even vital, demands of care. The objective was to compare the profile and the psychological functioning of the patients, who have shown an imperious demand of care, in that of the patients who do not have an imperious demand of care. From the medical consultations for chronic pelviperineal pain, we realized a comparative study including 26 patients (experimental group) expressing an urgent demand of care (i.e., patients who, during the last 3months, called an emergency service concerning the pains for which they consult in the service) and 28 patients (control group) without an urgent demand of care (i.e., patient who, during the last 3months, did not call an emergency service concerning the pains for which they consult in the service). All the patients were tested through a cognitive task of decision-making (Iowa Gambling Task) and through explicit measures of pain and its main psychological associated factors (anxiety, depression, impulsivity an catastrophism). In the first place, the patients from the experimental group possess decision-making abilities equivalent to the patients of the control group; however, both groups of patients show, in the beginning of the test, a deficit in the decision-making (F(4.208)=3.4116; P=.009). Secondly, the measures to questionnaires reveal that the patients of the control group have less severe scores in the scales of depression (t(52)=-2.068; P<04), catastrophism (amplification: t(52)=-3.069; P<0035; powerlessness: t(52)=-2.866, P<.006) and impulsivity (positive urgency: t(52)=-2.246, P<029; lack of premeditation: t(52)=-2.175, P<035) than the patients of the experimental group. The use of explicit measures (questionnaire) and implicit measures (experimental task) allowed to objectify more precisely the differences between the chronic pain patients in urgent demand of care and the other chronic pain patients. This psychological specificity obliges us to approach differently the caring of these patients in particular by proposing adapted cognitivo-behavioral techniques. 3.

Bilan avant le traitement chirurgical d’un prolapsus génital : Recommandations pour la pratique clinique

The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique? This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]). It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology. Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.

Spinal cord stimulation in the treatment of chronic pain syndromes

The study objective was to estimate the efficacy of chronic epidural spinal cord stimulation in the treatment of patients with neuropathic pain syndrome. A system for chronic spinal cord stimulation (St. Jude) was implanted to 75 patients with neuropathic pain syndrome. Fifty three (70.7%) patients were diagnosed with failed back surgery syndrome (FBSS); 9 (12.0%) patients had complex regional pain syndrome type II; 4 (5.3%) patients had diabetic polyneuropathy of the lower limbs; 3 (4.0%) patients had idiopathic pelvic-perineal pain; 2 (2.7%) patients had spinal stroke pain; 2 (2.7%) patients had postherpetic intercostal neuralgia; 1 (1.3%) patient had stump pain; 1 (1.3%) patient had spinal cord injury pain. The treatment efficacy was evaluated using the visual analog scale (VAS) and DN4 questionnaire. The follow-up period ranged from 6 to 18 months. 136 patients underwent test stimulation at the Center in 2014. A significant reduction in pain was observed in 75 (55.1%) patients. These patients underwent the second stage of surgery that included implantation of permanent electrodes and a generator. The mean VAS score was 6.5 (maximum: 10; minimum: 5) before surgery, 3.2 at discharge, and 3.1 after 3 and 6 months. The VAS score amounted to 3.6 after 12 months. Complications in the form of pain at the generator implantation site and the need for removal of the system occurred in 2 patients (2.6%), electrode migration was observed in 4 (5.3%) cases. Chronic epidural spinal cord stimulation is an effective and safe technique for the treatment of drug-resistant chronic neurogenic pain syndromes.

L’éjaculation douloureuse

To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE). Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior. PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies. The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option.

Dor pélvica crônica não visceral: tratamento multidisciplinar. Relato de caso

JUSTIFICATIVA E OBJETIVOS: A prevalência de dor pélvica crônica no sexo feminino é de aproximadamente 4%, similar à prevalência da enxaqueca (2,1%), asma (3,7%) e dor lombar (4,1%). Seu diagnóstico e tratamento constitui um grande desafio para a equipe de saúde. Este estudo teve por objetivo mostrar a dificuldade no diagnóstico e tratamento de dor pélvica crônica e a importância da equipe multidisciplinar no alívio do quadro doloroso. RELATO DO CASO: Paciente de 45 anos, com quadro de dor pelviperineal há 6 anos, após histeroscopia para exérese de pólipo uterino. A dor que iniciou no pós-operatório imediato, de forte intensidade, evoluiu ao longo desse período sem melhora e motivou-a a buscar o Ambulatório de Dor Abdominal, Pélvica e Perineal Crônica do Centro Interdisciplinar de Dor do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo. CONCLUSÃO: O tratamento multidisciplinar que abrangeu o uso de fármacos, inativação dos pontos-gatilho (infiltração com anestésicos, agulhamento seco, acupuntura), fisioterapia, reeducação postural e suporte psicossocial, proporcionou melhora significativa da dor e da qualidade de vida da paciente.

Chemical Neurolysis of the Inferior Hypogastric Plexus for the Treatment of Cancer‐Related Pelvic and Perineal Pain

Various interventions, including the superior hypogastric plexus block and ganglion impar block, are commonly used for the treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block (performed using a trans-sacral approach under fluoroscopy and using a local anesthetics⁄steroid combination) for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described in 2007. Neurolysis of the inferior hypogastric plexus may be useful for the treatment of pelvic and perineal pain caused by cancer. To assess the feasibility, safety and efficacy of the newly introduced inferior hypogastric plexus block, performed using a trans-sacral approach, for the relief of cancer-related pelvic and perineal pain. A total of 20 patients with cancer pain in the pelvis and⁄or perineum were injected with 6 mL to 8 mL of 10% phenol bilaterally by passing a spinal needle through the sacral foramen to perform the inferior hypogastric block. Pain intensity (measured using a visual analogue scale), sleep score, activity score, psychological score and oral morphine consumption pre- and postprocedure were measured. Two of the 20 patients died during the follow-up period and were, therefore, excluded from the study. All patients presented with cancer-related pelvic, perineal or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.22±1.31 preprocedurally to 4.06±1.73 one week postprocedurally (P<0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 106.67±32.90 mg to 61.67±40.48 mg after one week (P<0.05). No complications or serious side effects were encountered during or after the block. The approach provides a good alternative technique for the treatment of low pelvic and perineal cancer-related pain. Additional studies are required for evaluation and refinement of the technique using other radiological techniques.

Les différentes techniques d’infiltration du nerf pudendal: intérêt diagnostique et/ou thérapeutique

This is a nerve disorder, which falls within the scope of chronic pelviperineal pain, caused by direct or indirect trauma or by a canal syndrome, concerning the following nerves: the thoracolumbar nerves (obturator, ilioinguinal, ilio-hypogastric and genitocrural) and the sacral nerves (pudendal and cluneal). The aim of nerve penetration is twofold: to confirm the proposed diagnosis through an anaesthetic block and to try to provide sustainable pain management. It is mainly performed under computerised tomography (ultrasound, CT scan) guidance, to be as selective as possible about the location and thus minimise complications. An assessment before and just after penetration is critical. Penetration of the nerve plays an integral role in the management of chronic pelviperineal pain.

P5.21 Efficacy of alpha lipoic acid in chronic pelvi-perineal pain due to sacral neuropathy: electrodiagnostic evaluation and comparison with new antiepileptic drug

P5.21 Efficacy of alpha lipoic acid in chronic pelvi-perineal pain due to sacral neuropathy: electrodiagnostic evaluation and comparison with new antiepileptic drug

Pudendal nerve neuromodulation with neurophysiology guidance: a potential treatment option for refractory chronic pelvi-perineal pain

Refractory chronic pelvi-perineal pain (RCPPP) is a challenging entity that has devastating consequences for patient's quality of life. Many etiologies have been proposed including pudendal neuralgia. Multiple treatment options are used but the reported results are sub-optimal and temporary. In this article, we present the technique of pudendal nerve neuromodulation with neurophysiology guidance as a treatment option for RCPPP. This technique is a two-step procedure that includes electrode implantation under neurophysiology guidance followed by the implantation of a permanent generator after a successful trial period. We report the cases of three women who underwent this procedure as a last-resort treatment option. After 2 years of follow-up, their symptoms are still significantly improved. No major complication occurred.

A Model of Cystitis Pain in the Mouse

Interstitial cystitis (IC) is a chronic pelvic-perineal pain syndrome of unknown etiology that mainly targets the lower urinary tract. It is characterized by urinary frequency and urgency, inflammation, stiffening of the bladder wall, and visceral pain. Pain is the most prominent feature of IC and current treatments provide limited relief. To facilitate the identification of novel therapeutic options for IC, efforts are being made to identify more predictive rodent models. A well-characterized rat model is based on administration of cyclophosphamide (CP). The protocol described in this unit replicates this model in mice, demonstrating that CP increases both spontaneous and evoked pain behaviors in this species. This mouse model can be used for understanding disease etiology as well as for the pharmacological evaluation of novel therapeutics for the treatment of IC pain.

Le périnée douloureux sous toutes ses formes. Apport de la médecine manuelle et ostéopathie. Étude clinique

No satisfactory therapy has yet been found to relieve many chronic pelviperineal pains such as Dyspareunia, Vulvodynia, Coccygodynia and other various pelvic pains, although these can be highly disruptive in everyday life. They may be brought on by an osteo-myo-fascial disorder, often undetected despite the possibility to effectively treat, this condition using manual medicine in the gynaecologist's office. A framed clinical examination protocol as well as a therapeutic one are offered in this novel approach still rarely implemented in gynaecology. Such treatment is documented in six typical clinical cases and a global study on 86 patients with disruptive chronic pelviperineal pain, showing 71% satisfactory results following two manual medicine sessions. These very encouraging results need to be confirmed on a larger scale in order to establish an appropriate teaching protocol.

Physiopathologie des douleurs pelvi-périnéales

The pathophysiology of pelvic and perineal pain is complex and misunderstood. Knowledge of the pelvic floor anatomy and comprehension of the neurophysiological aspects of pain are necessary. An organ-specific approach must be replaced by an understanding of the mechanisms of pain control at the local, regional and central levels. Interstitial cystitis, vulvar pain, chronic pelvic pain in men, musculoskeletal pain, levator ani syndrome and proctalgia fugax are the most frequent pelvic and perineal pain syndromes encountered in clinical practice. Irritable bowel syndrome is often associated with these syndromes and should be considered as a pelvic-perineal pain syndrome. Peripheral and central hypersensitisation resulting from chronic nociceptive stimulation seems to be the common link between these clinical syndromes. Inflammatory, immunological, genetic, neurological, neuroendocrine and psychological factors have been implicated in the aetiology of chronic pelvic-perineal pain.

Economic impact of chronic prostatitis

There are four types of prostatitis, including type I (acute bacterial prostatitis), type II (chronic bacterial prostatitis), type III (chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS), and type IV (asymptomatic inflammatory prostatitis). These prostatitis conditions account for approximately 2 million office visits each year to primary care physicians and urologists. The annual cost to treat prostatitis is approximately $84 million. Compared with control subjects, men with prostatitis incur significantly greater costs, predominantly due to increased outpatient visits and pharmacy expenses. CP/CPPS is the most common type of prostatitis. The condition is characterized by chronic, idiopathic pelviperineal pain. Due to the lack of effective treatments for CP/CPPS, the per-person costs associated with the condition are substantial and are similar to those reported for peripheral neuropathy, low back pain, fibromyalgia, and rheumatoid arthritis. Costs appear to be higher in men with more severe symptoms. Indirect costs (eg, work and productivity loss) are incurred by many patients with CP/CPPS. Identification of effective treatments for CP/CPPS would be expected to substantially reduce the costs associated with the condition.

Pharmacological validation of a model of cystitis pain in the mouse

Interstitial cystitis (IC) is a chronic pelvic-perineal pain syndrome of unknown etiology that mainly targets the lower urinary tract. Pain is the most prominent feature of IC and current therapies provide limited relief. Novel treatment options for IC could be identified if more predictive animal models were available. A rat model based on administration of cyclophosphamide (CP) mimics the symptoms of IC and has been well characterized. However, experiments in mice have not consistently reported both the spontaneous and evoked pain behaviors. The current series of studies demonstrate that CP (200-400mg, i.p.) increased both spontaneous and evoked pain behaviors in mice. Additionally, clinically relevant compounds: morphine (1-10mg/kg), ketorolac (1-5.6mg/kg) and duloxetine (3-30mg/kg) all significantly reversed pain behaviors. In contrast, gabapentin (56mg/kg) had no effect. Thus, CP-induced cystitis in mice may be used to evaluate novel therapeutics for the treatment of pain due to interstitial cystitis.