Efficacy of N-acetylcysteine as Add-on Therapy for the Management of Chronic Pelvic Pain Syndrome in Women

Objective: Considering supportive evidence on N-acetylcysteine (NAC) effectiveness in neuropathic pain syndromes, we conducted this study to evaluate its effect on women suffering from chronic pelvic pain syndrome (CPPS). Methods: In a randomized, double-blind study, 106 women with CPPS were assigned to receive NAC+amitriptyline or placebo+amitriptyline treatment. Amitriptyline was administrated at a dose of 25 mg/daily and NAC and placebo at 600 mg twice daily. The effect of treatment was assessed on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and its domain scores, including pain, urinary symptoms, and quality of life impact scores at weeks 4 and 8 after treatment. The global response was also assessed on the 7-point patient-reported global response assessment (GRA) scale at the end of the study. Results: By week 4, comparative improvements were noticed in the two groups' NIH-CPSI total score and domain scores. From week 4 to week 8, we noted the superior efficacy of NAC+amitriptyline treatment over placebo+amitriptyline in improving the NIH-CPSI total score and its domain scores, as the proportion of patients responding to treatment (the subjects with ≥ 6-point reduction in the total NIH-CPSI score), as well those reporting marked or moderate improvements in their overall symptoms on GRA was significantly more significant in patients receiving NAC+amitriptyline treatment relative to those receiving placebo+amitriptyline treatment. Conclusion: These findings provided preliminary evidence regarding the possible role of NAC as an adjunct therapy in the management of CPPS in women, which needs to be validated in future studies.