Skip to main content

Neuropathic & Pelvic Pain Pharmacotherapy

Systemic and topical drugs used or studied for chronic pelvic pain (CPP), pudendal neuralgia, post-surgical neuropathic pain, vulvodynia and provoked vestibulodynia, CP/CPPS and pelvic-floor myalgia, along with opioid-sparing analgesia and local anesthesia for urologic procedures. Each hub distinguishes established indications, off-label options, negative trials and formulation-specific safety.

For IC/BPS-specific oral and intravesical pharmacotherapy see Bladder Pain & IC/BPS. For pelvic-floor physical therapy and behavioral approaches see Pelvic Floor PT.

  • GabapentinoidsThe page covers gabapentin and pregabalin in pelvic pain, trial evidence, renal adjustment, CNS and respiratory risks, and individualized reassessment.
  • Tricyclic AntidepressantsAmitriptyline for IC/BPS and imipramine for childhood enuresis, with their evidence and risks.
  • SNRIsDuloxetine, venlafaxine and milnacipran. Distinct neuropathic-pain and psychiatric indications; duloxetine SUI evidence and European labeling; pelvic-pain uncertainty and urinary adverse effects.
  • NSAIDs & AnalgesicsNon-opioid pain control in urology, including opioid-sparing protocols after major surgery and kidney safety.
  • Topical Compounded AgentsCompounded topical creams for vulvodynia and vestibulodynia, and the limited evidence behind them.
  • Local AnestheticsLidocaine and other local anesthetics across office and operative urology, including toxicity management.
  • AntispasmodicsDrugs for bladder, stent and catheter spasm, and muscle relaxants as adjuncts for a hypertonic pelvic floor.