Chronic pelvic pain (CPP) is a biopsychosocial phenomenon, with genetic and psychological factors thought to play a significant role. Pharmacological approaches are therefore just one of the many available components in the management of CPP. Indeed, used in isolation, the efficacy of pharmacological agents for CPP is often disappointing. This is partly because CPP comprises disparate types of pain (e.g., visceral, musculoskeletal, neuropathic), resulting from a range of a range of different pathologies. For this reason, the expression "pain killer" should be avoided, perhaps better described as a “pain reliever”.

A discussion with the patient should take place prior to undergoing a trial of a pharmacological agent, outlining the rationale of using this particular medication in improving symptoms and functioning, side effects, and that failure to achieve improvement will require moving to other options.  

Pharmacological options for the management of CPP include hormone therapy, palmitoyl derivatives, magnesium, fish oil products, paracetamol, anti-inflammatory drugs, tricyclic anti-depressants (low-dose), anti-convulsants, opioids and botulinum toxin. The rationale, indication(s), efficacy and side effect profile for these treatments will be discussed.

It is important to recognize that the management of CPP is most often multidisciplinary. In particular, cognitive behavioral therapy for CPP achieves perhaps the best long-term outcomes and should not be underestimated.