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Prospective comparative study of the effects of lidocaine on urodynamic and sensory parameters in bladder pain syndrome.

ABSTRACT: INTRODUCTION AND HYPOTHESIS:Intravesically administered lidocaine is used in patients with bladder pain syndrome (BPS) to test the hypothesis that symptoms have a peripheral versus central mechanism. METHODS:A cross-sectional study of 24 female patients with BPS was performed. The Central Sensitisation Inventory (CSI) and Kings Health Questionnaire (KHQ) were completed. Urodynamic assessment was undertaken. Women were asked to report their pain using a numeric rating scale at cystometric capacity and post void. Participants then received an intravesical instillation of either 20 ml of 2% alkalinised lidocaine (n?=?16) or 20 ml of normal saline (n?=?8). These solutions were allowed to remain in situ for 20 min and pain score repeated. Urodynamics was repeated. RESULTS:There was a statistically significant volume increase following lidocaine treatment: maximal cystometric capacity (MCC) 192-261 ml post lidocaine (p?=?0.005.) In contrast, there was no significant difference in the saline controls: MCC 190-183 ml (p?=?0.879.) Individual analysis revealed five of 16 lidocaine participants did not respond to lidocaine. These five reported a significantly worse quality of life (QoL) than lidocaine responders and had a tendency towards central sensitivity syndromes. CONCLUSION:Lidocaine significantly improved MCC in 11/16 participants in this study. These patients appear to have peripherally mediated disease. However, the failure of response to treatment in five participants, as well as their tendency towards central sensitivity syndromes, implies that in this subgroup, a peripheral drive from the bladder is not critical to their pain, suggesting central nervous system (CNS) pathology. This simple and safe test could be used to stratify patients for research or therapeutic trials.

SUBMITTER: Offiah I

PROVIDER: S-EPMC6647211 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Prospective comparative study of the effects of lidocaine on urodynamic and sensory parameters in bladder pain syndrome.

Offiah Ifeoma I Dilloughery Elaine E McMahon Stephen B SB O'Reilly Barry A BA

International urogynecology journal 20190314 8

<h4>Introduction and hypothesis</h4>Intravesically administered lidocaine is used in patients with bladder pain syndrome (BPS) to test the hypothesis that symptoms have a peripheral versus central mechanism.<h4>Methods</h4>A cross-sectional study of 24 female patients with BPS was performed. The Central Sensitisation Inventory (CSI) and Kings Health Questionnaire (KHQ) were completed. Urodynamic assessment was undertaken. Women were asked to report their pain using a numeric rating scale at cyst ...[more]

PMID: 30874834

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Project description:ObjectiveTo compare bladder sensitivity between patients with pelvic pain and patients who were pain free, undergoing noninvasive, controlled bladder distension via diuresis. We also sought to measure potential mechanisms underlying bladder sensitivity.DesignProspective observational study.SettingCommunity teaching hospital.PopulationReproductive-age women with non-bladder chronic pelvic pain (CPP, n = 23), painful bladder syndrome (PBS, n = 23), and pelvic pain-free controls (n = 42) METHODS: Participants were compared on cystometric capacity, pelvic floor pressure-pain thresholds (PPTs), pelvic muscle function, O'Leary-Sant bladder questionnaire, and psychosocial instruments using Wilcoxon rank-sum tests. Multivariate regression was used to identify factors underlying bladder pain phenotypes.Main outcome measuresPelvic floor pain thresholds; self-reported bladder distension pain.ResultsParticipants with PBS exhibited higher bladder distension pain than those with CPP, with both groups reporting higher pain levels than controls (P < 0.05). No significant associations were found between bladder distension pain and pelvic muscle structure or pain sensitivity measures; however, bladder distension pain positively correlates with both vaginal PPTs adjacent to the bladder (r = 0.46) and pain with transvaginal bladder palpation (r = 0.56). Pain at maximal distension was less influenced by somatic sensitivity than bladder symptoms (r = 0.35 versus r = 0.59; P < 0.05). Multivariate regression identified three independent components of bladder symptoms in PBS: bladder distension pain, bladder sensation, and somatic symptoms.ConclusionsDiuresis-induced bladder pain differentiates CPP from PBS. Experimental bladder pain is not predicted by pelvic floor sensitivity. Compared with patient-reported outcomes it appears less influenced by psychological factors. Further study is needed to determine whether screening for experimental bladder pain sensitivity could predict future risk of PBS.Tweetable abstractControlled, water ingestion-provoked bladder pain can objectively identify visceral pain sensitivity.

Dataset Information

Prospective comparative study of the effects of lidocaine on urodynamic and sensory parameters in bladder pain syndrome.

Publications

Prospective comparative study of the effects of lidocaine on urodynamic and sensory parameters in bladder pain syndrome.

Similar Datasets

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