Botulinum toxin a has antinociceptive effects in treating interstitial cystitis
Received 7 April 2004; accepted 15 June 2004.
Abstract
Objectives
To present clinical evidence with botulinum toxin A (BTX-A) suggesting an antinociceptive role in patients with interstitial cystitis (IC). Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic (inflammatory) pain.
Methods
Thirteen female patients (6 in the United States and 7 in Poland) with IC according to the criteria of the National Institute of Diabetes, Digestive and Kidney Disease were included. Under short general anesthesia or sedation, 100 to 200 U of Dysport (Polish patients) or Botox (U.S. patients) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder. Patients were evaluated with the O’Leary-Sant validated IC questionnaire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals. The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations.
Results
Overall, 9 (69%) of 13 patients noted subjective improvement after BTX-A treatment. The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71% and 69%, respectively (P <0.05). Daytime frequency, nocturia, and pain by visual analog scale decreased by 44%, 45%, and 79%, respectively (P <0.01). The first desire to void and maximal cystometric capacity increased by 58% and 57%, respectively (P <0.01).
Conclusions
Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC, producing both symptomatic and functional (ie, urodynamic) improvements.
aScott Department of Urology, Baylor College of Medicine, Houston, Texas
bDepartment of Urology, Warsaw School of Medicine, Warsaw, Poland
cDepartment of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Reprint requests: Michael B. Chancellor, M.D., Departments of Urology and Obstetrics and Gynecology, University of Pittsburgh School of Medicine, 700 LS Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213
This study was supported by the Scott Department of Urology, Neurourology Fund, and the Fishbein Family CURE-IC (the funding sources had no involvement in the study method or data collection, analysis, or interpretation).
1 C. P. Smith, P. Radziszewski, and M. B. Chancellor are paid consultants to Allergan, Inc., the manufacturer of a product mentioned in this article.
ABSTRACT