Bladder pain syndrome (BPS) is the occurrence of persistent or recurrent pain perceived in the urinary bladder region, accompanied by at least one other symptom, such as pain worsening with bladder filling and day-time and/or night-time urinary frequency, in the absence of infection or other pathology. This chapter examines pharmacological and intravesical therapies outlined in the 2024 European Urology Guidelines. Treatments discussed include oral agents such as amitriptyline, antihistamines, and pentosan polysulphate, alongside intravesical options like lidocaine, hyaluronic acid, and heparin. Tailored, multimodal strategies are essential due to the heterogeneous nature of BPS and variability in patient response.