IC can be severely painful and incapacitating. And may require aggressive pain management medicines such as opiate therapy when more conservative approaches fail. People with IC can experience both acute and chronic pain:
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Comments due June 30, 2009
Let your voice be heard! The Risk Evaluation and Mitigation Strategies (REMS) that the Food and Drug Administration (FDA) is proposing on pain medicines could severely limit your access to pain meds. You have an opportunity to have your voice heard by sharing your comments about the needs of people with pain to improve quality of life and to reduce their sense of suffering.
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- Acute pain has a sudden beginning and a short duration.
- Chronic pain recurs frequently or is of long duration
By investigating the differences in how men and women experience pain, researchers hope to better understand why more women than men experience chronic painful conditions such as IC.
Over-the-counter medicines are available without a prescription at drug stores and many supermarkets. Ask your doctor if any of the following medicines might be helpful for your pain:
- Aspirin (Bufferin, Ecotrin)
- Acetaminophen (Tylenol, Datril)
- Non-steroidal anti-inflammatory drugs (NSAIDs)
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Local anesthetics, anticonvulsants/antiarrhythmics such as mexiletine (Mexitil) and gabapentin (Neurontin). These medications have been shown to help various neurological pain syndromes. Common side effects: mexiletine - hypotension (low blood pressure), nausea; gabapentin - fatigue, drowsiness, loss of coordination.
Benzodiazepines such as alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin - also considered an anticonvulsant), and lorazepam (Ativan). Traditionally used as muscle relaxants or to treat anxiety, benzodiazepines are now considered as a possible treatment for chronic pain. Tolerance and physical dependency may occur. Common side effects: drowsiness, impaired coordination, dizziness, and headache.
Tramadol (Ultram) combines the effects of a weak opioid with the pain reducing actions of tricyclic antidepressants. Common side effects: similar to those of opioid medications and tricyclic antidepressants. Seizures have been reported.
Opioid analgesics used for moderate IC pain:
- Codeine: Sometimes combined with aspirin or acetaminophen
- Hydrocodone: Lortab and Vicodin (combined with acetaminophen), Lorcet Zydone (combined with acetaminophen)
- Oxycodone: Percodan (combined with aspirin), Percocet, Tylox(combined with acetaminophen)
Opioid analgesics used for severe IC pain:
- Morphine
- Hydromorphone: Dilaudid
- Levorphanol: Levo-Dromoran
- Methadone: Dolophine
- Oxycodone: (see above)
Long-acting opioids are generally used for IC patients who experience unremitting or frequently recurring pain. These long-acting medications are not combined with other medications such as acetaminophen or aspirin, thus reducing potential problems or side effects. They are controlled-release, meaning that they require less of a maintenance schedule, as the dosage is gradually released into the patient’s system. IC patients receiving long-acting opioids should be supplied with a fast-acting opioid "rescue drug" (e.g. Vicodin, Lorcet. etc.) for breakthrough pain, which occurs unpredictably, or when the long-acting opioid starts to wear off, prior to the time of the next scheduled dose. Examples of controlled release opioid preparations:
- Long-acting morphine: MS Contin, Oramorph
- Long-acting oxycodone: OxyContin
- Levorphanol: Levo-Dromoran
- Methadone: Dolophine
- Fentanyl: Duragesic patch Possible side effects: constipation, nausea, itching, edema, sedation, muscle spasms and possible respiratory depression. Ask your healthcare provider for advice on reducing side effects. Tolerance and physical dependency may occur.
These include diet modification, physical therapy (pelvic floor relaxation exercises), acupuncture/acupressure, electric nerve stimulation, biofeedback training, hypnosis and cognitive therapy.
Revised December 3, 2008