A call for recognizing, legitimizing, and treating chronic visceral pain syndromes

Interstitial cystitis (IC) shares many features with other chronic nonmalignant visceral pain syndromes. In clinical practice, much emphasis has been placed on finding a specific etiology and specific pathological markers for the disease and on identifying specific events that precipitated IC. This conceptualization has influenced clinical treatment approaches for IC and has not resulted in significant progress in this area so far. An additional approach is suggested, based on the conceptualization of three hypotheses: (1) a spectrum of different insults can lead to chronic visceral pain in patients suffering from IC, (2) different underlying pathogenic pain mechanisms may require different pain treatment strategies for patients diagnosed with IC, and (3) multiple different pathogenic pain mechanisms may coexist in the same patient requiring several different pain treatment strategies (perhaps concomitantly) to successfully treat chronic visceral pain associated with IC. This concept is likely to lead to new insights into the pathophysiological mechanisms of IC and to novel treatment avenues for patients suffering from IC and—in a broader view—also for patients with other chronic visceral pain syndromes.