Here's are some quotes from a recent review article by Anthony Schaeffer of U Chicago on CPPS/IC. He's a well-known clinician who wrote a 2006 review on CPPS in the New England Journal of Medicine.
Genitourinary pain syndromes, prostatitis, and lower urinary tract symptoms.
Le BV, Schaeffer AJ.
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
The overlap of pain and urinary voiding symptoms is common for urologic patients. The etiology of these syndromes is frequently multifactorial and due to disorders of the bladder and/or prostate. The evaluation and treatment of these syndromes continues to evolve. Here we summarize the general approach to evaluation and treatment of these pain syndromes.
There are no formal guidelines for the management of CPPS and no proven therapies.Though category III prostatitis has been broken down into inflammatory (IIIa) and noninflammatory (IIIb) prostatitis based on the presence or absence of leukocytes in expressed prostatic fluid, this has not proven to be of much clinical utility. Numerous trials have failed to demonstrate efficacy of antimicrobials, alpha-blockers, anti-inflammatories, phytotherapy, biofeedback, thermal therapies, and pelvic floor training. A recently completed multicenter, randomized, double-blinded, placebo-controlled trial looking at alfuzosin for the treatment of chronic prostatitis–pelvic pain syndrome showed no benefit over placebo.
If a patient has significant LUTS, goal-directed therapy should be considered and alpha-blockers may offer some benefit. Pelvic floor physical therapy may also be beneficial. Newer classes of medications, such as pregabalin used in the treatment of fibromyalgia and postherpetic neuralgia, show some promising preliminary data in this population as well.
After discussing IC and CPPS, he has a section on what he calls "pelvic floor pain syndrome".
Pelvic floor pain syndrome
Pelvic floor pain syndrome (PFPS) goes by many different names including levator ani syndrome and pelvic floor dysfunction, though it should not be confused with laxity of the pelvic floor in women. It is a condition characterized by pelvic/anorectal pain arising from spasm of the pelvic floor muscles. There is significant overlap between this condition, CPPS (category III prostatitis), and interstitial cystitis. As many as 50% of patients with CPPS report myofascial pain with palpation. Up to 87% of women with a diagnosis of interstitial cystitis may demonstrate symptoms consistent with PFPS. Though PFPS has been recognized to contribute to many of the above conditions and can exacerbate LUTS, treatment and research into this condition as a separate clinical entity have been limited. Evaluation consists of a history, genitourinary physical, urinalysis, and urine culture. The most notable findings on examination are myofascial trigger points, which are defined by Simons and colleagues as tender spots created by injury at the motor end plate as a result of acute, repetitive, or sustained muscle overloading. Muscles of the pelvis must be examined carefully, with each muscle palpated separately, to gain some idea about their tenderness or spasm. Diagnosis is made based on positive examination findings with or without urinary symptoms.
Treatment of PFPS consists of combination of biofeedback exercises, physical therapy, and pain medications. No randomized controlled trials on PFPS have been conducted, but response rates with the combinations described above have noted response rates of 32% noting marked improvement and another 30% having modest improvement in symptoms.
