Pain Management for IC/BPS
The 2022 American Urology Association Guidelines for IC/BPS states that “pain management should be an integral part of the treatment approach and should be assessed at each clinical encounter for effectiveness.” (1,2) Why? The bladder, like any other part of the body, can generate pain so severe that patients require immediate medical care and treatment. Unfortunately, IC/BPS patients struggle to overcome the perception their bladder pain “isn’t that bad” or is very mild in nature. Of course, pelvic pain can also originate from the pelvic floor muscles, the pudendal nerve, fibroid tumors, endometriosis, and several other structures.
The AUA suggests the use of a multimodal strategy to treat pain including the use of:
- urinary analgesics
- narcotic medications
- nonnarcotic medications
- physical therapy
On Narcotic Medication
The AUA specifically does NOT discourage the use of narcotic pain medication which may be required during periods of intense flares and discomfort. They state “It is clear that many patients benefit from narcotic analgesia as part of a comprehensive program to manage pain.” The use of pain medication, however, should NOT be considered or used as the only treatment. Other therapies that treat and, ideally remove, the cause of pain, should be explored, such as the treatment of painful trigger points or Hunner’s ulcers.
Pain care can be provided by the urologist, primary care provider or pain specialists. The challenge, of course, is that some care providers are simply uncomfortable providing prescriptions for opiate medication. If you, the patient, are not receiving adequate care for your pain, you can request a referral to a pain specialist.
On the Opiate Crisis & Physicians Refusing To Provide Medication
In 2016, the Centers for Disease Control issued new opiate prescribing guidelines that has resulted in many chronic pain patients being refused or discontinued from necessary pain medication. It is the tragedy of our generation due, sadly, the abuse of opiate medication and influence of drug cartels. If you are facing the loss of your pain medication, please consider these options:
Focus first on reducing the source of the pain so that you won’t need as much pain medication.
- If your pain is coming from your bladder wall, then focus on healing your bladder.
- Ask that Hunner’s lesions be treated if you have them.
- Follow the IC diet to avoid unnecessarily irritating your bladder and causing flares.
- Tight pelvic floor muscles need to be treated. Do your physical therapy. Relax those muscles daily. Follow up on your physical therapy, if necessary. Muscle relaxants can help.
- Keep stress at a minimum.
- Avoid your well known flare triggers (i.e. long car rides, etc.)
- Consider other therapies, such as acupuncture.
Try OTC products
There are many OTC products that have the potential to help.
- AZO Bladder Pain Relief Tablets can help numb the bladder
- Pro-Sirona, Neuroquell and Tiger Balm are essential oil products that you can rub on your skin (not internally of course)
- Use heat or ice packs. Bodiheat heating pads can deliver heat for over 8 hours and work well for long car rides, work and/or traveling.
- Get massages to help keep your muscles relaxed
Work with, not against, your doctor
- Don’t ask for pain medication first. You’ll look like a drug seeker. Tell them what your functional level is. Can you walk easily? Can you drive? Can you work? Can you shop or go to church? Show them how limited your life is and then ask “What can we do to improve my functionality?”
- Bring the complete AUA Guidelines with you to appointments to show that the AUA supports pain care. It’s Guideline Statement 13!
- Be willing to do a pain diary and track your symptoms.
- Be willing to sign a contract about your medication use.
- Always store your medication in a lock box so that it cannot be stolen.
Consider Medical Marijuana
If medical marijuana is legal in your state or country, then it is worth considering. Research studies have found medical marijuana to help reduce pain and/or relax muscles. It’s also been found to improve the ability of pain medications to work. Learn more in the articles here:
- It’s time to consider medical marijuana for bladder and pelvic pain.
- Illinois MMJ law covers interstitial cystitis
- Clemens JQ et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 2022. Jul;208(1):34-42
- Osborne J. New IC/BPS Guidelines Released in May 2022. ICN. May 23, 2022
Author: Jill H. Osborne MA
Revised: July 6, 2022 – JHO