This chapter focuses on pain in the bladder, urethra, and prostate. Interstitial cystitis is treated with heparinoids (e.g. pentosan polysulfate), botulinum toxin, or intravesical Bacillus Calmette-Guerin. There is some evidence for NSAID utility in prostatitis, but treatment for chronic prostatitis and male chronic inflammatory pelvic pain syndrome entails long-term therapy with drugs such as alpha-blockers and immuno-modulators. Antibiotics form the mainstay of urethritis treatment, with pain relief expected within seven days of instituting treatment. The best-known urinary tract anesthetic for acute care use is phenazopyridine. Ibuprofen does not reduce the dysuria or rectal pain associated with radiation therapy for prostatic cancer. However, there is some evidence for occasional NSAID utility in relieving non-infectious chronic prostatitis during the absence of other evidence for NSAIDs or other analgesics, patients with refractory pain from infectious cystitis, urethritis, or prostatitis may require opioids for relief.

Interstitial cystitis (IC) is characterized by pain in the region of the bladder and pelvic musculature, and variable motor and sensory dysfunctions of the bladder. The most prevalent symptoms of IC are urinary frequency, urgency and suprapubic, perineal pain. IC can be classified into the two categories of Hunner's ulcer and nonulcer, based on cystoscopic findings. This chapter highlights research contradictions regarding IC, along with research findings relating to the therapeutic effectiveness of various treatment modalities in IC. The lack of specific pathognomonic markers for the diagnosis of IC has resulted in a host of plausible hypotheses for its etiology. To be diagnosed with IC, patients must undergo cystoscopic examination under general anesthesia with hydrodistention of the bladder and bladder biopsy. Antihistamines are critical to managing IC in people with hay fever, sinusitis or food allergies. One major breakthrough in therapy is the use of heparin-like drugs.

This chapter describes major research directions in the study of each of the nine functional somatic syndromes and highlights the overlapping dimensions. The fact that a substantial proportion of chronic fatigue syndrome (CFS) patients have concurrent symptoms sufficient for a diagnosis of major depression has prompted the investigation of the serotonin function with the new method of d-fenfluramine challenge. A genetic factor responsible for the family aggregation of fibromyalgia has been demonstrated among patients attending the rheumatology clinic of the University Hospital, Beer Sheva, Israel. The presence of chronic pelvic pain in patients with irritable bowel was associated with a significantly higher likelihood of childhood sexual abuse, panic disorder and a lifetime history of somatization disorder. A prominent biological abnormality of patients with premenstrual syndrome is serotonergic deficiency. There is substantial evidence that mast cell activation plays an important role in the production of abnormalities associated with interstitial cystitis (IC).