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You are here: IC Network > Patient Handbook > Pain Management - Pain Treatments
Pain Management and IC
"When there is no good treatment for a patient's interstitial cystitis, there will almost always be an effective treatment for pain. To leave a patient to suffer with treatable pain is a show of disrespect for that patient and a breach of our ethics as caregivers. When confronted with a patient with severe pain of IC, physicians often ask themselves whether the patient should receive treatment for pain. Perhaps the question should be 'Why should this person be left in pain?'" (2,3,4)
Pain Treatments
There are a wide variety of pain management strategies available for an IC patient to consider. Some doctors, however, may feel uncomfortable treating pain aggressively. For chronic pain patients, it can be helpful to consult with a pain management specialist or clinic rather than a general physician. They are often more informed about the latest pain management breakthroughs as well as the development of comprehensive pain management plans for their patients. Best of all, they clearly see that pain patients need compassionate treatment.Opioids
"As a general principal, narcotics are dispensed on a chronic basis when other medical therapies cannot adequately relive the patients discomfort."(1)
Opioids are the mainstream of treatment for moderate to severe pain. Opioids are grouped into categories based on their duration of action (short half-life drugs or long-acting sustained-release agents). Opioids are available as oral medications, rectal suppositories, transdermal patches, subcutaneous injections, intravenous injections, by epidural, subdermal and intramuscular injections.
The side effects of opioids may include nausea, vomiting, itching, respiratory depression, edema and constipation. For IC patients, constipation can antagonize our already sensitive bladders. Therefore, patients who are using these medications may require the use of a stool softener very early in the medication process.
For more information please visit Myths and Issues of Narcotic Pain Management
Tri-cyclic Antidepressants (ELAVIL, etc.)
Physicians may offer an antidepressant to patients very early into the diagnostic process to help with sleep and general IC symptoms. Sadly, without additional explanation as to why antidepressants are helpful as a long term pain management strategy, many patients are offended that a doctor would recommend a "psychiatric" medication which could imply that they don't believe the pain is real. Happily, this is not the case. Antidepressants have long been useful in the treatment of chronic pain (6) including: amitriptyline, imiprimine, doxepin, desipramine, and nortriptyline.
Side effects may include drowsiness, dry mouth, weight gain and constipation. For some patients, they may cause cardiac arrhythmia and/or tachycardia, which may preclude their use. If you experience an irregular or rapid heart beat, notify your physician immediately. Your dosage may be reduced or you may need to stop the medication.
Anticonvulsants & Antiarrhythmics (MEXILITINE, etc.)
Mexilitine, carbemazepine & gabapentin are lesser known options in a pain management arsenal. Brookoff (1) reports that Mexilitine has been used for a variety of neurogenic pain syndromes and works via stabilizing nerve cell membranes. Its side effects, however, can be intolerable. Carbamazepine has been used for neurogenic pain syndromes, yet also has concerns with potential side effects. Gabapentin is used for seizure disorders and may be worth further research by physicians looking for pain management alternatives.
Local Anesthetic Procedures
Local anesthetics can be used to reduce bladder pain. Intravesical lidocaine and/or marcaine has been instilled directly into the bladder (7). Oral pyridium (phenazopyridine) also serves as a local anesthetic in the bladder. A variety of procedures can also direct anesthetic directly onto the relevant nerves near, or into, the spine.
Transcutaneous Electrical Nerve Stimulation (TENS)
A TENS unit (also discussed in Chapter Six) disrupts pain signals from the bladder to the brain. An essential part of an IC Tool Kit, this non medication based strategy is portable, easy to apply and pain free. TENS is an exceptional short and long term pain management strategy. They are available for purchase via the ICN Marketplace. US residents require a prescription for purchase.
Relaxation, Mindfulness & Support Groups
The support, companionship and information found in patient education groups can become one of the most important alternatives for pain patients and family members to explore. Some programs will help you decrease your perception of pain while helping you to increase your personal coping skills.
Relaxation skills are integral to the ability of an IC patient to cope with the flares of IC and, when learned well, can serve that patient whenever any stressful event occurs. Indeed, it is an essential long term life skill and can be useful in a wide variety of occasions, such as ER visits, injuries, accidents, weddings & more! ;)
Approaches such as Mindfulness, based upon the book "Full Catastrophe Living" (Written by Jon Kabat-Zinn), help patients reduce the tension and emotional cycle that many pain patients experience when pain resumes.
Support groups offer the opportunity to learn from the successes from veteran IC patients and breaks the isolation that so many IC patients face.
Related ICN Resources
Chapter 23: The Causes and Treatment of Pain: Dr. Brookoff Interstitial Cystitis - Grannum R. Sant - ICN Book Review
References:
(1) Moldwin, R. The Interstitial Cystitis Survivial Guide. New Harber Publishers, 2000; 100
(2) Somerville MA. Death of pain: pain, suffering and ethics. In: Gebhart GF, Hammon DL, Jensen TS, eds. Progress in Pain Research and Management. Seattle:IASP Press, 1994:41-58
(3) Caudill MA. Managing Pain Before it Manages You. New York: Guilford Press, 1995.
(4) Cain JM, Hammes BJ. Ethics and pain management: respecting patient wishes. J Pain Symptom Manage 1994;9:160-165