Pelvic pain research focuses on role of central nervous system, phenotypes

February 1, 2010

Magnus Fall, MD, PhD, discusses the EAU guidelines and new research directions in chronic pelvic pain.

Q Let's start with the latest EAU guidelines on chronic pelvic pain. Have the guidelines been published?

Q One can easily see that the guidelines represent a tremendous amount of work on the part of you and your colleagues. Do they differ substantially from the 2004 guidelines published in European Urology, and if so, how?

Q In North America, we tend to group chronic penile, scrotal, perineal, and pelvic pain in men under the category of nonbacterial prostatitis/chronic pelvic pain syndrome (NIDDK type III). Do you agree with this, and is there any logical reason to group together all of these pain syndromes?

Q You are working with Drs. Andrew Baranowski, JØrgen Nordling, and others in trying to develop a new taxonomy for urogenital pain, and it seems very complex. Do you see this as primarily a research tool, or will it help clinicians in their everyday practice?

A I think it is actually important both for research and for clinical practice. For research purposes, we need a taxonomy that is uniform and that could help to categorize patients in a way that when you read an article, you understand what it is about and what type of condition is being investigated. For clinical purposes, it is important because if your taxonomy and terminology leads your decision making in the wrong direction, you may use tests or treatments that are useless or even harmful.

Q ESSIC caused quite a stir a few years ago by endorsing a change in the name of the syndrome from interstitial cystitis to bladder pain syndrome (BPS). Were you surprised by this?

A It is a little surprising that that paper caused such an upset because this nomenclature appeared early. This term has been adopted from the 2002 International Continence Society terminology report where the term painful bladder was used, while IC remains but indicates a more specific entity, and this terminology was also used in the International Consultation on Incontinence 2005 edition. The name was changed to bladder pain syndrome to be consistent with other chronic pain terminology and was used in the 2003 European guidelines as well as in the ESSIC paper. It has to be accepted that terminology is changing all the time as we learn more, and we have to make changes according to the knowledge we acquire.