Advances in the treatment of interstitial cystitis

Parsons, C. Lowell

doi:10.1517/14656566.7.4.411

Cited by 12 publications

(11 citation statements)

References 45 publications

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“…Our observations of pelvic pain relief following intravesical lidocaine administration are consistent with clinical findings where patients with severe IC experience temporary relief of pelvic pain by instillation of 2% lidocaine into the bladder (27). In addition, we found that colonic lidocaine relieves pelvic pain associated with neurogenic cystitis, an observation that is reminiscent of irritable bowel patients who experienced relief of both rectal symptoms and abdominal pain from lidocaine administered to the colon (36,37).…”

Section: Discussionsupporting

confidence: 88%

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Organ cross talk modulates pelvic pain

Rudick

Chen

Mongiu

et al. 2007

American Journal of Physiology-Regulatory, Integrative and Comp

101

111

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(IC) is a chronic bladder inflammatory disease of unknown etiology that is often regarded as a neurogenic cystitis. IC is associated with urothelial lesions, voiding dysfunction, and pain in the pelvic/perineal area, and diet can exacerbate IC symptoms. In this study, we used a murine neurogenic cystitis model to investigate the development of pelvic pain behavior. Neurogenic cystitis was induced by the injection of Bartha's strain of pseudorabies virus (PRV) into the abductor caudalis dorsalis tail base muscle of female C57BL/6J mice. Infectious PRV virions were isolated only from the spinal cord, confirming the centrally mediated nature of this neurogenic cystitis model. Pelvic pain was assessed using von Frey filament stimulation to the pelvic region, and mice infected with PRV developed progressive pelvic pain. Pelvic pain was alleviated by 2% lidocaine instillation into either the bladder or the colon but not following lidocaine instillation into the uterus. The bladders of PRV-infected mice showed markers of inflammation and increased vascular permeability compared with controls. In contrast, colon histology was normal and vascular permeability was unchanged, suggesting that development of pelvic pain was due only to bladder inflammation. Bladder-induced pelvic pain was also exacerbated by colonic administration of a subthreshold dose of capsaicin. These data indicate organ cross talk in pelvic pain and modulation of pain responses by visceral inputs distinct from the inflamed site. Furthermore, these data suggest a mechanism by which dietary modification benefits pelvic pain symptoms.bladder; interstitial cystitis; diet INTERSTITIAL CYSTITIS (IC), also known as painful bladder syndrome, is a chronic bladder inflammatory disease with unknown etiology that afflicts as many as 1 million patients in the United States, with females comprising ϳ90% of patients (21). Symptoms of IC include pelvic and/or perineal pain, urinary frequency, urgency, and nocturia (17,20,32,39). IC is often regarded as a neurogenic cystitis due to voiding dysfunction and the partial efficacy of sacral nerve stimulation or neuropharmacological therapies in some patients that suggests a neuronal component. Supporting this idea, cats are susceptible to feline IC, a disease that closely mimics human IC and is associated with increased activity in the sympathetic nervous system (40). Since IC symptoms can flare in response to certain foods (e.g., tomatoes), dietary modification is commonly employed by IC patients, although evidence of altered urine properties as the mechanism for dietary effects is lacking.One model of IC pathogenesis involves a positive feedback loop, whereby substance P-containing peripheral nerves stimulate mast cells, in turn releasing inflammatory mediators that induce urothelial inflammation (15). Furthermore, histamine release by mast cells feeds back onto peripheral nerves to cause sustained release of substance P and mast cell activation. Consistent with this model, patients with IC show elevated mast cell counts ...

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Section: Discussionsupporting

confidence: 88%

“…One clinical treatment that offers temporary relief of chronic pain in patients with IC is instillation of 2% lidocaine directly into the bladder (27). This treatment modality presumably works by quelling C-fiber activity associated with IC bladder pathophysiology.…”

Section: Resultsmentioning

confidence: 99%

Organ cross talk modulates pelvic pain

Rudick

Chen

Mongiu

et al. 2007

American Journal of Physiology-Regulatory, Integrative and Comp

101

111

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“…Visceral pain originating from inflamed bladder can be relieved by use of local anesthetics such as lidocaine 2,3. The present study evaluated the effects of lidocaine on referred mechanical hyperalgesia (as opposed to visceral pain per se), and results indicate that pre-treatment with lidocaine prevents referred hyperalgesia that accompanies cystitis.…”

Section: Discussionmentioning

confidence: 91%

“…Local anesthetics have been used extensively to prevent or minimize pain that accompanies cystitis 1,2. Lidocaine primarily blocks generation and propagation of action potentials through direct binding of neuronal voltage-gated sodium channels thereby producing analgesia by inhibiting excitation of nerve endings or blocking conduction in peripheral nerves 3.…”

Section: Introductionmentioning

confidence: 99%

Lidocaine prevents referred hyperalgesia associated with cystitis

Guérios¹,

Wang²,

Boldon³

et al. 2009

Neurourology and Urodynamics

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Aims-Lidocaine produces analgesia by inhibiting excitation of nerve endings or blocking impulse conduction in peripheral nerves. This study was performed to determine whether intrathecal or intravesical administration of lidocaine prior, or subsequent, to induction of chemical cystitis in rats would block referred mechanical hyperalgesia. Methods-Intrathecal or intravesical lidocaine was administered 15 (intrathecal) or 30(intravesical) minutes before intravesical instillation of saline or 1mM acrolein (400µl) or 4 hours after saline or acrolein instillation in female Wistar rats. Mechanical sensitivity of hind paws was determined at 24 hours prior to any treatment (baseline) and, 4, 24, and 48 hours after intravesical instillation of acrolein or saline. Also, nerve growth factor (NGF) content was measured in bladder and dorsal root ganglia (DRG).Results-Pre-treatment with intrathecal or intravesical lidocaine attenuated acrolein-induced referred mechanical hyperalgesia of the hind paws. Lidocaine administered after acrolein instillation did not alter referred hyperalgesia. Lidocaine treatment prior to or after induction of cystitis reduced NGF content in the bladder.Conclusions-These results indicate that pre-treatment with lidocaine attenuates referred hyperalgesia associated with cystitis. Lidocaine treatment 4 hours after induction of cystitis failed to prevent referred hyperalgesia despite a similar decrease in bladder NGF.

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“…Oral therapy included administration of analgesics, anticholinergics, anticonvulsives, antidepressants, and hypnotics; the intravesical drug was heparin [17] . Urodynamic examination was performed by two physicians according to the International Continence Society (ICS) and ESSIC standards [18,19] .…”

Section: Examinationmentioning

confidence: 99%

Statistical Analysis of Symptoms, Endoscopy and Urothelial Morphology in 58 Female Bladder Pain Syndrome/Interstitial Cystitis Patients

Zámečník¹,

Hanuš²,

Pavlík³

et al. 2009

Urol Int

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Introduction: The goal of the study was to assess the course of painful syndrome in patients with bladder pain syndrome/interstitial cystitis and to assess the changes in endoscopic and histopathological findings in relation to the type of treatment. Patients and Methods: We included a total of 58 patients with histologically diagnosed interstitial cystitis. Out of these, 31 patients were treated with oral pharmacotherapy and 27 patients were treated by intravesical application of heparin. The patients were followed from time of diagnosis for 6.9 ± 2.5 and 6.6 ± 2.7 years, respectively. Results: Treatment – irrespective of its type – had a clear demonstrable effect on the monitored parameters; intravesical treatment was more effective than oral. Statistically significant (p < 0.05) changes could be observed in both groups (with two exceptions). When evaluating the relationship between subjective symptoms and objective criteria, and patients’ age and time to diagnosis, it is clear that the higher the age and the longer the time from symptoms to diagnosis, the more severe the symptoms. Conclusions: When evaluating the monitored parameters, we found significant correlations (both positive and negative). However, these relationships cannot be used to simplify the evaluation algorithm (according to ESSIC) and the initial criteria cannot predict the course of the disease.

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Advances in the treatment of interstitial cystitis

Cited by 12 publications

References 45 publications

Organ cross talk modulates pelvic pain

Organ cross talk modulates pelvic pain

Lidocaine prevents referred hyperalgesia associated with cystitis

Statistical Analysis of Symptoms, Endoscopy and Urothelial Morphology in 58 Female Bladder Pain Syndrome/Interstitial Cystitis Patients

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