Study Reveals IC Patients Are More Sensitive to Pain
January 28, 2010 by Sandy Robinson
Filed under Interstitial Cystitis, Pain
Italian researchers have reported through a new study that they have “direct evidence” for central sensitization in Interstitial Cystitis patients.
Central sensitization—essentially amplification of pain signals in the central nervous system—is thought to contribute to perpetuation of pain—and possibly its initiation—in the condition.
This theory, if true, may help explain why IC Disease patients also suffer from other pain-related conditions such as Fibromyalgia and IBS. There was also recently another study that found that Interstitial Cystitis patients are also more likely to suffer from Vulvodynia – another pain-related condtiion.
This news on IC was recently presented at the International Continence Society annual meeting by Dr. Silvia Malaguti & Dr. Mauro Cervigni, both from Rome.
According to the study, these doctors…
…investigated spinal transmission of pain signals and diffuse noxious inhibitory controls in 14 IC/PBS patients—12 women and two men—and in 10 age- and sex-matched healthy controls. Diffuse noxious inhibitory control is the phenomenon of inhibition of perception of a painful stimulus by a second painful stimulus administered distally. In subjects who do not have chronic pain disorders, pain from the test stimulus is decreased or inhibited when a conditioning stimulus is applied at a distal site.
The investigators did this using the nociceptive flexion reflex (NFR) RIII and the cold pressor test (CPT), both of which are standard tests in pain research.
The NFR is administered by electrically stimulating the sural nerve. The test’s RIII, or long-latency, component is evoked by stimulation intense enough to activate the A-delta and C fibers responsible for transmission of pain signals. Thresholds for the reflex correlate strongly with subjective pain thresholds, and increases in NFR amplitude correlate with increases in subjective pain intensity.
In the CPT, the patient places a hand in ice water. The patient lets the researcher know when he/she first feel pain and then withdraws the hand when the pain becomes unbearable. This measures a threshold for and tolerance of this type of pain. In this study, the CPT was used as the noxious conditioning stimulus. The investigators measured the NFR RIII at baseline and then during the CPT.
What the research showed was that Interstitial Cystitis patients had significantly lower pain thresholds than that of the non-IC subjects in the study. The RIII reflex thresholds were also significantly lower than that of the non-IC subjects. But when the non-IC subjects did the test with placing their hands in ice water, their NFR RIII reflex was significantly inhibited (down 39%). In the IC patients, their NFR RIII reflex was stronger during this test and went up 35%.
Apparently, patients with IC/PBS do modulate pain differently from those without the condition.
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Central sensitization research is popping up all over the place. Since there are medicines on the horizon that appear promising we will likely continue to see more research results.
I am however concerned about the big switch from the thinking that fibromyalgia is an auto immune disease to thinking it a Central sernsitization issue.
When I was diagnosed in 2002 with fibromyalgia, the condition had an official disease number and was considered one of the “fibro” five. Lupus was one of the other maladies in the group.
I have done extensive research on the issue. Some of the better research, I have seen was done on dna . Auto immune disease was shown to have its own marker, including such maladies as diabetes 1 and psoriatic arthritis.
I would welcome help for this stupid malady. It’s embarassing when you are asked, what is it you have. Then you get this glazed over look and professionals tell you, well you are a very sensitive person. Even in the Ciba-Geigy medical manual, it is concluded that fibromyalgia patients, all seem to have a specific type of sensitive personality . Much ado is given to the depression that patients suffer. What is it going to take in order for the medical community to understand. This is an incredibly obnoxious tyrant we have on our hands. Tailoring what medicines can do, then arranging and reorganizing symptoms to fit, is not the kind of help I am looking for. It will make anyone connected with the “new miracle ” drug better off. I am concerned, because we are not getting to the core of what causes these maladies.
Medicine needs to re-think the current direction. We need real help.
I totally disagree with you. I have had IC and Pelvic floor dysfunction since I had a hysterectomy and a burch procedure. My muscles used to urinate do not work in the normal fashion as you relax and you urinate. I have to use my muscles to urinate and thus a viscous cycle started. I then had a very bad UTI that took two rounds of antibiotics to treat it and it still didn’t go away and that is when I was diagnosed with IC. I never had pain or took pain meds. In 1999 they didn’t give you pain meds they gave you DMSO treatments once a week. That in no way touched the pain. The pain is real and to say the IC patients are sensitive to pain is ridiculous it obviously comes from someone who has never suffered from the terrible pain of IC. I see a pelvic floor physical therapist and she says I am the worst patient she has ever seen, all my muscles are spasming. I cannot invent that pain in my head. I have rectal and vaginal spasms. The burning in the urethrae is the worst thing I have ever dealt with. It is like you are on fire after you pee. The only relief you get is uristat and prelief and morphine and ice paks and taking muscle relaxants to break the spasms. I also had a interstim implanted to help with the frequency and urgency, which it does as long as you don’t have a UTI. For anyone to say that IC patients are more sensitive to pain yeah they are sensitive to pain because they are in so much pain and no one understands not even the medical establishment. I am a RN and they don’t understand that when they put you NPO they are sentencing you to a pain you can’t get away from until they put you to sleep or do the test and you can get to your meds. I self cath and use sodium bicarb/lidocaine/heparin and put it in my bladder and pray I can hold it and the spasms won’t make me lose it. I use suppositories from a compounding pharmacy in North Carolina and doing all this I still have pain on a scale of 1-10 I am a 8 or 9 until my meds kick in. IC is acid in your bladder leaking thru the walls of the bladder, IC is what causes you to be sensitive to pain the disease not something wrong with the person in their mind or if your trying to say they are an addict you are so off. I wish you could spend one day in my shoes. I can only drink water, can’t eat hardly anything I like if it has acid in it, no nutrisweet or artificial sweetners, no colas, no coffee, nothing with caffiene, no alcohol, certain medications for colds and flu the list goes on. Have you ever studied pain? I go to a pain management Dr and he has done blocks on me, I have had botox put into all the muscles to keep them from spasms. I feel like I can’t go anywhere or I can’t cath if I need to and I need that medicine to deaden the area. It really hurts when studies come out and make bold statements blaming the IC sufferer to being more sensitive to pain than the regular person. I never took pain medicine or was overly sensitive to pain until I have suffered so much pain and the DR looks at you and says there is nothing more we can do for you. I was just at the Cleveland Clinic in Ohio last week and that is exactly what happened. He rammed his hand up inside of me and felt the muscles and said there is nothing more we can do for you. Well you knew that before you rammed your hand up me. We are human beings, that feel, love, hurt, and want to be treated like a person and not some disease. If it weren’t for my pelvic floor physical therapist no one would care. She is the only one that tries to help and really knows what is going on with the patients because she feels their insides everyday and knows. But I bet nobody has thought to interview people like her. It is a disease that causes terrible pain and they don’t know why. It is not people with IC are sensitive to pain. There is a huge difference. I know I live it everyday.