Smith Blog

The American Urological Association Annual meeting in Chicago (April 25th – April 30th) was a huge success for patients suffering from pelvic pain. Some of the latest news…

1.    Various differences may exist in urinary protein expression between interstitial cystitis (IC) patients and those without IC. This suggests that “urinary proteomics” may provide insight into the cause of IC and/or aid in the development of new “markers” for this condition.
2.    Nerve growth factor was found to be elevated in the urine of IC patients and in patients with overactive bladder and even in patients with varied lower urinary tract symptoms.
3.    Patients with IC appear to have significant biosocial impairment as compared to the population at large. Also, conditions such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome were more frequently seen in the IC population.
4.    The Rand Interstitial Cystitis Epidemiology study evaluated almost 100,000 US households and found the prevalence of IC type symptoms in women to be 3-6%, a significantly higher prevalence than previous studies. This suggests that IC symptoms may exist in over 4 million women in the United States!
5.    Botulinum toxin A (100 units) into the bladder base (trigone) improved the symptoms of all 17 patients in one study. At 9 months follow up, 7 patients requested another injection due to return of symptoms.
6.    In another Botulinum toxin A related study, Botulinum toxin A appeared to enhance the clinical effect of bladder hydrodistention.
7.    Antiproliferative factor (APF) is a chemical found in the urine of most IC patients and may be a cause of symptoms. Two new agents have shown promise as APF inhibitors in the laboratory setting.
8.    Both IC patients and patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) had a high prevalence of food sensitivities, but IC patients still had about twice the prevalence as the CP/CPPS patients.
9.     A clinical phenotyping system termed “UPOINT” (Urinary, Psychosocial, Organ specific, Infection, Neurologic/Systemic, Tenderness of pelvic floor muscles) was developed to better understand the cause of and best therapies for CP/CPPS.
10.    In a randomized, double blinded study, pregabalin (Lyrica®)  was not found to be better than a placebo group in the treatment of CP/CPPS…BUT..when evaluating “secondary endpoints” such as global improvements, significant differences where found, suggesting a role for this medication in the treatment of CP/CPPS.

For this information and more, please visit the Pelvic Pain section of this website.

Robert Moldwin, MD
Associate Professor of Clinical Urology
Hofstra University School of Medicine
Director, Pelvic Pain Center
The Arthur Smith Institute for Urology
Long Island Jewish Medical Center

Dr. Moldwin was an invited panelist for the National Institute’s of Health’s (NIH) Office of Research on Women’s Health (ORWH) held March 4-6th, 2009. The meeting was entitled “Moving into the Future: New Dimensions and Strategies for Women’s Health Research.” It was designed to help the NIH formulate its research priorities for the next 10-20 years. The meeting covered all areas of women’s health. Dr. Moldwin was present to plead for more dollars for research projects that would help interstitial cystitis patients. Also present representing the interests of IC patients was Barbara Gordon, the Executive Director of the ICA.

Some suggestions that came from the “Chronic Pain Syndromes” panel that Dr. Moldwin attended included:

1. Developing research strategies to investigate chronic pain syndromes as a “systemic” problem (that has manifestations in multiple systems in the body). This may help better establish why so many patients with IC also have problems like fibromyalgia, irritable bowel syndrome, migraine headaches, Sjögren’s Syndrome, vulvodynia, chronic fatigue syndrome, etc. This topic received the most attention and discussion.
2. Developing better ways to conduct trials for new therapies.
3. Developing better animal models for chronic pain syndromes. We had a very long discussion about this very complex topic.
4. Exploring issues related to clinician- patient interactions in the chronic pain patient. Differences in how people describe their difficulties which may vary on the basis of previous experiences, social environment, or sex.
5. The effect that factors such as hormones and diet may have on these pain syndromes.
6. The great need for the development of a database system where clinical data from patients can be pooled together from multiple institutions.

Other topics that were discussed included:

1. The need for chronic pain syndromes (including IC) to be included in the curriculum of medical schools. Currently, medical students typically graduate without even hearing of fibromyalgia, IC, vulvodynia, etc… no less being taught to manage such patients. Without a basic understanding of these conditions from their basic training, how do we expect any of these bright people to treat or become researchers in this area? We suggested that the ORWH take a role in mandating discussion of these topics in medical school curricula.
2. Pharmaceutical companies apparently have lots of data on various medications which may show promise as future treatments for patients in pain. We would like to see some of these data voluntarily released, thereby giving researchers some groundwork for the development of future therapies.