Intravesical Lidocaine Can Aid Diagnosis and Relieve Symptoms of Painful Bladder Syndrome
Over the course of an entire year, doctors at a women’s health clinic worked with Darlene, a 70-year-old retired teacher who already had a diagnosis of endometriosis, to try to figure out what was causing the intensely painful suprapubic discomfort in her bladder and lower urinary tract issues. Through a period of trial and error, during which Darlene reported increasing pain, they finally arrived at a diagnosis of interstitial cystitis and painful bladder syndrome.
Interstitial cystitis/painful bladder syndrome (IC/PBS) is one of those chronic conditions in which the clinical picture is clear, but the etiology and pathogenesis are so poorly understood that coming up with effective treatments that work well across large patient populations has been nearly impossible for pharmacists.
Like Darlene, somewhere between three and six percent of all women in the U.S. could have painful bladder syndrome, defined as suprapubic pressure or discomfort in the bladder along with lower urinary tract symptoms. That’s as many as 8 million women and possibly up to 4 million men, who often have IC/PBS misdiagnosed as prostatitis or pelvic pain syndrome. Despite being a condition affecting up to 12 million Americans, effective painful bladder syndrome treatments remain rare and elusive.1
Intravesical Lidocaine Can Help Identify Causes of Suprapubic Pain
Recent research posits that IC/PBS may be more neuropathic than previously thought. Studies have found that compounding pharmacists can work with intravesical local anesthetics to help identify the source of BPS symptoms and potentially treat some of the effects.
Comprehensive diagnostic strategies and therapies often elude researchers because the causes of IC/PBS can be so varied and inconsistent. In a study published in the International Urogynecological Journal, intravesical instillations into the bladder of a 20 ml of a compounded 2% lignocaine/lidocaine formula were used to rule out IC/PBS for women with pelvic pain—a common issue for physicians trying to figure out the right diagnosis.
Seventy percent of the study’s patients responded to the lidocaine treatment and recorded a significant decrease in pain, helping doctors diagnose 86% those women with IC/PBS. The other women were then diagnosed with endometriosis, pelvic inflammatory disease or diverticulitis after the initial screening with the intravesical lidocaine.2
Compounding pharmacists may be called upon to provide the lidocaine dosages for the intravesical instillations during this process, and also may be part of the treatment and pain relief strategy once the patient has a diagnosis. This screening process is crucial to helping doctors and pharmacists alike provide patients with the most effective treatments for pain relief from chronic pain in the abdominal area. As the story of Darlene shows, patients can suffer for months while undergoing treatments for the wrong condition, with potential adverse effects.3
Lidocaine’s Anti-Inflammatory Properties for Treating Painful Bladder Syndrome Symptoms
Beyond diagnosis, compounding pharmacists can assist with delivering intravesical alkalinized lidocaine for sustained symptom relief for patients with chronic IC/PBS.
Specifically, a solution of 200 mg lidocaine and 8.4% sodium bicarbonate solution with a total volume of 10 mL provided sustained and effective improvement for patients in a clinical study. Not only did patients report significant improvement in symptoms, but the intravesical delivery carried no systemic side-effects when compared with oral treatments.4
A well-received theory for developing IC/PBS revolves around visceral allodynia and the resulting overly sensitized afferent nerves in the bladder, which would explain lidocaine’s effectiveness. Its anti-inflammatory properties control the nerve-related pain and help to restore the bladder to neuropathic normalcy over time. The challenges with utilizing lidocaine have been finding ways to create effective formulations that are not negated by the acidity of urine in the bladder while still having the solution convert to soluble form after tissue penetration.5
Compounding pharmacists, with significant experience adjusting formulations for maximum effectiveness for every patient, could be valuable partners for patients’ health care teams in the treatment of IC/PBS with lidocaine.
Additional Treatment Information for Painful Bladder Syndrome for Compound Pharmacists
As we discussed, treating IC/PBS can be a prolonged trial-and-error process. As a compounding pharmacist, you have the ability to work with patients on various off-label treatments with high potential for relieving symptoms of painful bladder syndrome. If intravesical local anesthetics like lidocaine do not identify pain sources or relieve pain, try working through other possible sources and treatment options.
Compounding pharmacists can also recommend tricyclic antidepressants and potentially hormonal manipulation or anticonvulsants, though the latter are relatively untested. Among antidepressants, amitriptyline in lower dosages than required for depression can reduce urinary frequency and improve sleep for patients with IC/PBS. For women whose IC/PBS symptoms could be related to perimenstrual flares, compounding for cyclic suppression and hormonal manipulation could also be a potential treatment avenue.
Be open to combination therapies and delivery systems as well. Help your patient explore dietary modifications and physical therapy with other specialists to help keep symptoms manageable.6
Compounding pharmacists often treat symptoms of chronic pain. In cases where the causes and modalities of that pain are hard to discern, such as with IC/PBS, it’s crucial that pharmacists are involved in conversations with the patient’s health care team on narrowing to a diagnosis and exploring different ways to best treat painful symptoms. With experience evaluating off-label and customized treatment options, compounding pharmacists can add a unique dimension to these conversations that will ultimately benefit the patient.
Pharmaceutica North America is a premier provider of active pharmaceutical ingredients to compounding pharmacies. Contact us to learn more about how our high-quality APIs, including lidocaine, can help you provide the highest level of custom patient care.
- “4 to 12 Million May Have IC,” Feb. 18, 2015, http://www.ichelp.org/about-ic/what-is-interstitial-cystitis/4-to-12-million-may-have-ic/ ↩
- “Beyond a Simple Anesthetic Effect: Lidocaine in the Diagnosis and Treatment of INterstitial Cystitis/bladder Pain Syndrome,” January 2015, https://www.researchgate.net/publication/275528266_Beyond_a_Simple_Anesthetic_Effect_Lidocaine_in_the_Diagnosis_and_Treatment_of_Interstitial_Cystitisbladder_Pain_Syndrome ↩
- “Dyspareunia Response in Patients with Interstitial Cystitis Treated with Intravesical Lidocaine, Bicarbonate, and Heparin,” Sept. 2007, http://www.goldjournal.net/article/S0090-4295(07)02202-9/abstract ↩
- “Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome,” April 2009, http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2008.08162.x/full ↩
- “Continuous Intravesical Lidocaine Treatment for Interstitial Cystitis/Bladder Pain Syndrome: Safety and Efficacy of a New Drug Delivery Service,” July 18, 2012, http://stm.sciencemag.org/content/4/143/143ra100.full; “Intravesical alkalinized lidocaine,” Ibid. ↩
- “When treating interstitial cystitis, address all sources of pain,” July 2010, http://www.obgmanagement.com/the-latest/past-issues-single-view/when-treating-interstitial-cystitis-address-all-sources-of-pain/d25dca31e3993e9a3e099d44d1174ffc.html ↩