Meta- analysis of RCTs showed that only cyclosporine A provided a simultaneous great effect size of SMD on ICSI , pain , and frequency .
Amitriptyline at different dosages showed a great effect size of SMD on pain and urgency or on ICSI and frequency .
The results from the n RCTs showed that the most frequently adopted treatment is oral pentosan polysulfate and that the use of botulinum A toxin intradetrusorial injections in PBS/IC is increasing .
Limited evidence exists for the few treatments for PBS/IC .
The lack of definitive conclusions is due to the great heterogeneity in methodology , symptoms assessment , duration of treatment , and follow-up in both RCTs and n RCTs
CONTEXT Different types of behavioural , dietary , interventional , pharmacologic , and surgical therapies have been used to treat painful bladder syndrome/interstitial cystitis ( PBS/IC ) .
Because of the paucity of r and omised placebo-controlled studies on different treatments , an evidence -based management approach has not yet been developed .
OBJECTIVE To critically review and synthesize data from a wide range of current therapeutic approaches to PBS/IC , to quantify the effect size from r and omised controlled trials ( RCTs ) , and to reach clinical agreement on the efficacy of treatments for PBS/IC .
Effect of amitriptyline on symptoms in treatment naïve patients with interstitial cystitis/painful bladder syndrome.
PURPOSE Amitriptyline is frequently used to treat patients with interstitial cystitis/painful bladder syndrome . The evidence to support this practice is derived mainly from a small , single site clinical trial and case reports . MATERIAL S AND METHODS We conducted a multicenter , r and omized , double-blind , placebo controlled clinical trial of amitriptyline in subjects with interstitial cystitis/painful bladder syndrome who were naïve to therapy . Study participants in both treatment arms received a st and ardized education and behavioral modification program . The drug dose was increased during a 6-week period from 10 up to 75 mg once daily . The primary outcome was a patient reported global response assessment of symptom improvement evaluated after 12 weeks of treatment . RESULTS A total of 271 subjects were r and omized and 231 ( 85 % ) provided a global response assessment  at 12 weeks of followup . Study participants were primarily women ( 83 % ) and white ( 74 % ) , with a median age of 38 years . In an intent to treat analysis ( 271 ) the rate of response of subjects reporting moderate or marked improvement from baseline in the amitriptyline and placebo groups was 55 % and 45 % , respectively ( p = 0.12 ) . Of the subgroup of subjects ( 207 ) who achieved a drug dose of at least 50 mg , a significantly higher response rate was observed in the amitriptyline group ( 66 % ) compared to placebo ( 47 % ) ( p = 0.01 ) . CONCLUSIONS When all r and omized subjects were considered , amitriptyline plus an education and behavioral modification program did not significantly improve symptoms in treatment naïve patients with interstitial cystitis/painful bladder syndrome . However , amitriptyline may be beneficial in persons who can achieve a daily dose of 50 mg or greater , although this subgroup comparison was not specified in advance
Meta- analysis of RCTs showed that only cyclosporine A provided a simultaneous great effect size of SMD on ICSI , pain , and frequency .
Amitriptyline at different dosages showed a great effect size of SMD on pain and urgency or on ICSI and frequency .
The results from the n RCTs showed that the most frequently adopted treatment is oral pentosan polysulfate and that the use of botulinum A toxin intradetrusorial injections in PBS/IC is increasing .
Limited evidence exists for the few treatments for PBS/IC .
The lack of definitive conclusions is due to the great heterogeneity in methodology , symptoms assessment , duration of treatment , and follow-up in both RCTs and n RCTs
CONTEXT Different types of behavioural , dietary , interventional , pharmacologic , and surgical therapies have been used to treat painful bladder syndrome/interstitial cystitis ( PBS/IC ) .
Because of the paucity of r and omised placebo-controlled studies on different treatments , an evidence -based management approach has not yet been developed .
OBJECTIVE To critically review and synthesize data from a wide range of current therapeutic approaches to PBS/IC , to quantify the effect size from r and omised controlled trials ( RCTs ) , and to reach clinical agreement on the efficacy of treatments for PBS/IC .