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You are here:Home Patient Information Treatment OptionsFact SheetsIC and Pain
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 * Medications marked with this asterisk are available by prescription only.
Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder wall that can be severely painful and incapacitating. Fortunately, there have been many recent advances in pain research and therapies. Leading pain specialists in the United States believe that nonmalignant pain (pain not caused by cancer), such as the pain of IC, is as serious and debilitating as malignant pain, and should be treated just as aggressively. This includes opiate therapy when more conservative approaches fail.
IC patients can experience both acute and chronic pain. Acute pain is pain that may have a sudden beginning and a short duration. Chronic pain is pain that frequently recurs or is of long duration.Pain medications can generally be placed into two categories: Non-Opioid & Opioid
aspirin: (Bufferin®, Ecotrin®)
acetaminophen: Tylenol®, Datril®
non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen (Advil®, Motrin® and Nuprin®), ketoprofen (Orudis®) and naproxen sodium (Aleve®, Anaprox®).
These medications, in low dosages, are available without prescription. They are used for mild to moderate pain.
Side Effects: Aspirin and other NSAIDs may cause stomach irritation or ulcers, asthmatic and/or allergic reactions, and/or damage to the kidneys. Do not take NSAIDs if you have stomach ulcers, asthma or are allergic to aspirin. Acetaminophen is metabolized in the liver. If taken in excess of recommended dosage, acetaminophen can cause liver damage. Do not take acetaminophen with alcohol or if you suffer from liver disease.
(All of these medications have been shown to be effective in relieving pain in some IC patients, although none of them are considered "pain medications."):
*Tricyclic antidepressants (Sinequan), and desipramine (Norpramin). Tricyclic antidepressants are considered more effective for IC pain than the newer selective serotonin reuptake inhibitors (SSRls), selective norepinephrine re-uptake inhibitors (SNRIs), or other novel therapies, although some IC patients have reported symptom improvement with each of these. Tricyclics are often used in combination with opioid medications because they appear to increase the opioid's painkilling or analgesic effects. Tricyclic antidepressants have been shown to help with the pain and frequency of IC. Dosages used for pain control are usually lower than dosages used for depression. Most Common Side Effects: drowsiness, dry mouth, weight gain, constipation, blurred vision, difficulty urinating, increased sensitivity to sunlight, increased heart rate, drops in blood pressure accompanied by dizziness.
*Pentosan polysulfate sodium (Elmiron), which was FDAapproved in 1996. It is the only oral medication approved specifically for use in IC. Thought to work by restoring a damaged, thin, or "leaky" bladder surface. Eases the pain and discomfort of IC. Most Common Side Effects: minor gastrointestinal disturbances, slight hair loss that is reversible upon discontinuation of the medication. Liver function tests (blood tests) should be obtained every six months while on the medication.
*Local anesthetics, anticonvulsants/antiarrhythmics such as mexiletine (Mexitil®) and gabapentin (Neurontin®). These medications have been shown to help various neurological pain syndromes. No clinical trials have yet been conducted using these types of medications for treatment of IC. Most 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. Most Common Side Effects: drowsiness, impaired coordination, dizziness, and headache.
*Antihistamines such as hydroxyzine pamoate (Vistaril), and hydroxyzine hydrochloride (Atarax). Vistaril has a slightly higher absorption rate. Atarax is available in liquid form for patients allergic to fillers or dyes used in capsules or pills. Hydroxyzine may help to alleviate IC symptoms in some patients, especially those with a history of allergies. As well as having anti-pain properties of its own, when used in conjunction with opioids, hydroxyzine helps to increase the pain-reducing actions of the opioids. Most Common Side Effects: sedation, dry mouth, increased depression in patients with concurrent depression.
Other medications used to treat IC include:
H2 Blockers such as cimetidine (Tagamet®) and ranitidine (Zantac®). H2 blockers are used in IC for their histamine blocking effects.
Most Common Side Effects: constipation, abdominal discomfort, headache, rare reports of heart arrhythmias.
The mast cell inhibitor, cromolyn sodium (Gastrocrom®), stabilizes mast cells, which may play a role in some cases of IC.
Most Common Side Effects: headache, diarrhea.
*Tramadol: Ultram®. This is a relatively new analgesic. It combines the effects of a weak opioid with the pain reducing actions of tricyclic antidepressants. Side effects are similar to those of opioid medications and tricyclic antidepressants. Seizures have been reported with the use of Ultram®.
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)
Examples of Long-Acting (controlled release) Opioid Preparations:
- *long-acting morphine: MS Contin® , Oramorph®
- *long-acting oxycodone: OxyContin®
- *levorphanol: (see above)
- *methadone: (see above)
- *fentanyl: Duragesic® patch
Long-acting opioids are generally used for IC patients who experience unremitting or frequently recurring pain. 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.
Possible Side Effects of Opioid Medications: constipation, nausea, itching, edema, sedation, muscle spasms and possible respiratory depression. All of these side effects can be managed. Ask your physician for advice on reducing side effects. Note that some of these medications also contain non-opioid medications, such as aspirin or acetaminophen, as well. These medications are available by prescription only. Tolerance and physical dependency may occur.
Many IC patients severely debilitated from pain have benefited from OxyContin® (controlled release oxycodone), MS Contin® (controlled-release morphine), or Duragesic® (fentanyl patch). 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.
These include diet modification, physical therapy (pelvic floor relaxation exercises), acupuncture/acupressure, transcutaneous electric nerve stimulation unit (TENS), biofeedback training, hypnosis and cognitive therapy. Complementary techniques such as these can play a valuable role in the treatment of IC pain.
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