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Revision: April 5, 2004
Created: June 1999
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Jill Osborne
Jill Osborne
There are three types of pain carried by different
parts of our nervous system. People feel different sensations and symptoms
with each. Somatic pain starts in the skin, muscles and bone and is usually
localized. Everyone has had somatic pain. When you cut yourself, it hurts
intensely and then a few minutes later, it doesn't hurt as much. We don't
suffer for days and days with this pain. We don't lose our emotional composure.
This type of pain resolves quickly.
Visceral pain is the most common pain found in IC patients. The
pain is caused by inflammation, distention and/or increased amounts of
pressure. It is not localized and produces stronger autonomic and affective
responses.
Visceral pain has a more agonizing quality. It is carried to
a different part of the brain than the somatic, the part of the brain
that deals with emotions. So people with visceral pain have emotional
content.. they get more upset and may cry often. Why? Emotions are a physical
quality of the pain. It doesn't mean that the patient is emotionally weak
or having a breakdown. It just means that a different part of the brain
is being stimulated.
Neuropathic pain is usually caused by a degeneration of the nervous
system, i.e. that the nerves have damaged in some way. It often feels
like burning or shooting pain. Some patients describe it as electrical
shocks. It can be a harder pain to treat.
Pain Management and IC
Understanding IC Pain
The Pain of IC
In IC, the bladder is inflamed and, at times, severely irritated. Why? We're not sure. It appears that the nerves within the bladder have become hypersensitized, perhaps by infection, urinary toxins, histamine or other substances which can irritate the bladder. Hyperalgia subsequently develops, in which the bladder becomes more sensitized and responds with high levels of pain, even if the source of the pain is mild.
If the patient receives no treatment for pain, the repeated pain signals sent from the bladder to the spine may cause changes in the dorsal horn of the spinal cord, which can then perpetuate the pain signals to the brain independently of the bladder. This is called central sensitization and could explain why some IC patients may still experience what feels like bladder pain even after their bladder is removed. It is also believed that persistent irritation and stimulation may cause the normally silent nerves of the bladder, the hypogastric and lumbar splanchnic nerves, to become activated (1).
When IC patients speak of their pain, they often describe it in many different ways, including: pressure, heat, electrical currents, razor blades or ground glass. Many IC patients also describe their pain as being referred to their back, vagina, rectum, perineum or lower extremities.
Recommended Reading
The Interstitial Cystitis Survival Guide, by Robert Moldwin, MD.Special Report on Pain by the San Francisco Chronicle