title: Interstitial cystitis: bladder pain and beyond.
abstract: BACKGROUND
  Interstitial cystitis is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of a urinary tract infection. Interstitial cystitis occurs primarily in females including adolescents and its diagnosis is still one of exclusion. It is now recognized as a serious medical condition associated with significant disability.
  
  
  OBJECTIVE
  The aim of this paper was to review the pathogenesis and treatment of interstitial cystitis with emphasis on new pathogenetic trends and therapeutic modalities.
  
  
  METHODS
  About 713 mostly original papers were reviewed in Medline from 1990 to August. 2008. All authors independently reviewed the literature. Large, double-blind, placebo-controlled, clinical trials were few and the medical histories of the patients used varied considerably making conclusions difficult. Promising pilot trials turned out mostly negative on follow-up.
  
  
  RESULTS
  Increasing evidence of co-morbid diseases, neurogenic inflammation and the effect of stress are promising as new targets for pathophysiology. No new effective treatments have emerged. Oral pentosanpolysulfate, amitriptyline, hydroxyzine and quercetin, as well as intravesical heparin/bicarbonate/lidocaine solutions, are still used with variable success. Some pilot open-label trials presented encouraging findings.
  
  
  CONCLUSIONS
  Interstitial cystitis contributes substantially to chronic pelvic pain and to poor quality of life. Oral or intravesical administration of solutions containing sodium hyaluronate, chondroitin sulfate and quercetin to both reduce bladder inflammation and 'replenish' the glycosaminoglycan layer should be tried. There is a clear need for therapeutic modalities. New potential translational research areas are suggested.
authors.affiliation: Tufts University School of Medicine, Department of Pharmacology and Experimental Therapeutics, Experimental Therapeutics 136 Harrison Avenue, Boston, MA 02111, USA. theoharis.theoharides@tufts.edu
authors.forename: Theoharis C
authors.initials: TC
authors.lastname: Theoharides
authors.forename: Kristine
authors.initials: K
authors.lastname: Whitmore
authors.forename: Edward
authors.initials: E
authors.lastname: Stanford
authors.forename: Robert
authors.initials: R
authors.lastname: Moldwin
authors.forename: Michael P
authors.initials: MP
authors.lastname: O'Leary
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D018856:Cystitis, Interstitial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D017699:Pelvic Pain / Q000175:diagnosis / Q000453:epidemiology