Urologists have been largely unsuccessful in treating this malady. Just look at the polls we ran on the topic: the vast majority of men are very unhappy with the care they received for this ailment from their urologists. They have failed to cure us, to be blunt. Yes, quercetin was a step forward for many, but it only relieves pain, when it works, without getting to the cause of the problem (but see caveat below).
My best guess is that the cause of chronic pelvic pain is either pelvic myoneuropathy (muscle spasm exciting nerves that activate mast cells), or neuronal windup and central sensitization (see diagram below), or a combination of the two. Neuronal windup can take place as a result of, say, a prostate/bladder infection. The pain of that can set off a central sensitization. That sensitization cannot be relieved unless the pain feedback cycle is broken by (and here is the quercetin caveat) an agent that relieves the pain: tramadol, quercetin, heat, time itself, and anything that protects mast cells, and even (and this is where it gets confusing), something like pelvic floor massage, which could interfere with and help break the feedback loop even without muscle spasm being present!
If indeed muscle spasm is present, we need psychologists like David Wise (an ex-sufferer himself) to help us relax with concepts like Paradoxical Relaxation. We are an anxious bunch, for the most part. We do suffer a lot of stress and tension. This has been well documented, even by urologists, who see us as a very difficult group to treat, psychologically as well as medically. We always thought this was the "blame the patient" syndrome on their part, but they are correct inasmuch as we do, as a group, seem to be more prone to anxiety disorders, panic attacks and stress than the average person. And we need psychiatrists or our family MD so that we can get access to all medications that seem to help us, including muscle-relaxing benzos like Valium.
So the debate is just now getting underway. It's high time. The answer will become apparent in the next few years. Either urologists will win the day if something like a low temperature invasive procedure helps (WIT, TUMT), or the PT/psychologist camp will win out, leaving urologists the simple task of referring patients on. Or maybe a win-win situation will arise, if both camps have something to offer.
One of the ironies of all this is that the old sitz bath, recommended by urologists in days of yore and much derided by patients as a sign of urologists not knowing anything, has made a comeback. The other irony is that the old school urologist who would refer "prostatodynia" patients on to a psychiatrist was probably doing the right thing after all!
