Abnormal pedal thermoregulation in interstitial cystitis

Abstract

Isolated cold stress tests were used to evaluate the thermoregulatory capacity in the feet of 19 patients with interstitial cystitis (IC) and of 11 healthy volunteer control subjects. Mean pedal skin temperature fell more rapidly in the IC group as compared with controls; significant differences were found at 10-min (P = 0.002) and 20-min (P = 0.0008) cooling. Mean skin temperature remained lower in the IC group throughout the study. Sixteen feet (42%) in the IC group and five (22%) of the control feet failed to return to within 2 degrees C of baseline temperature during the 20-min recovery period. These findings may reflect abnormal vasomotor control in the IC group and, if so, may be indicative of increased spinal sympathetic activity in interstitial cystitis.

Lumbar sympathetic block for pain relief in two patients with interstitial cystitis

“…The abnormality of vasomotor control in IC patients might be indicative of increased spinal sympathetic activity in IC. 6 Others reported that bladder blood flow at capacity measured by laser Doppler flowmetry is significantly impaired in IC patients. 7 In addition, norepinephrine was found to be elevated in urine from patients with IC compared with urine from normal controls.…”

“…Other recent reports have shown that sympathetic nerve activity is increased in the patients of IC. [5][6][7][8] To our knowledge, using lumbar sympathetic blocks for the IC treatment has not been established. We report 2 patients with severe symptoms of IC successfully treated with lumbar sympathetic block following lumbar epidural block trial.…”

Visceral pain in humans: Lessons from animals

“…This desensitization may result in in c r e a s e d ce n t r a l a n d p er i ph e r a l sy m p a t h et ic outflow, resulting in increased sympathetic activity in the urinary bladder in IC. In humans with IC, abnormal vasomotor tone [59], increased bladder sympathetic neuron density [13,14], and increased urine norepinephrine excretion [19] have been reported. In fact, one study found tyrosine hydroxylase immunoreactivity in the bladder of patients with IC to be 6 to 8 times normal, whereas SP immunoreactivity was only 2 to 4 times normal [14].…”

Neuromodulation in Intractable Interstitial Cystitis and Related Pelvic Pain Syndromes

“…In 1951, more selective neurectomies were described [112], but they too were unsuccessful. Several investigators have noted increased sympathetic activity in the lower extremities of IC patients compared with controls [113], and this led to the use of lumbar sympathetic blocks, but these rarely conferred pain relief [114].…”