Bladder pain syndrome/interstitial cystitis response to nerve blocks and trigger point injections

Abstract

Objectives: Bladder pain syndrome (BPS)/interstitial cystitis (IC) is a debilitating condition characterised by bladder/pelvic pain and pressure as well as persistent or recurrent urinary symptoms in the absence of an identifiable cause. It is hypothesised that in addition to organ specific visceral hypersensitivity, contributions of the hypertonic pelvic floor, peripheral sensitisation, and central sensitisation exacerbate this condition. The aim of this paper is to investigate outcomes of treating underlying neuromuscular dysfunction and neuro-plastic mechanisms in BPS/IC patients.Methods: A retrospective chart review of 84 patients referred to an outpatient pelvic rehabilitation centre with a diagnosis of BPS/IC given to them by a urologist. All 84 patients failed to progress after completing 6 weeks of pelvic floor physical therapy and underwent an institutional review board approved protocol (IRB# 17-0761) consisting of external ultrasound-guided trigger point injections to the pelvic floor musculature, peripheral nerve blocks of the pudendal and posterior femoral cutaneous nerves and continued pelvic floor physical therapy once weekly for 6 weeks. Pelvic pain intensity and functionality were measured pretreatment and 3 months posttreatment using Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS).Results: Pretreatment, mean VAS was 6.23 AE 2.68 (95% CI 5.65 to 6.80). Posttreatment mean VAS was 3.90 AE 2.63 (95% CI 3.07-4.74). Mean FPPS before treatment was 11.98 AE 6.28 (95% CI 10.63 to 13.32). Posttreatment mean FPPS was 7. . Analysis of subcategories within FPPS indicated highest statistically significant improvement in the categories of bladder, intercourse and working.Conclusions: Analysis suggests the treatment was effective at ameliorating bladder pain and function including urinary urgency, frequency, and burning in BPS/IC patients.

Efficacy of Pudendal Nerve Blocks and Ultrasound-Guided Superior Hypogastric Plexus Blocks for the Management of Refractory Interstitial Cystitis: A Case Series

“…In this context, peripheral nerve blocks of the pudendal nerves may be an ideal target to reduce pelvic pain [ 6 , 18 ]. A retrospective study of 84 patients with IC/BPS demonstrated significant improvements in pain and function after six weeks of weekly pudendal and posterior femoral cutaneous nerve blocks, in combination with pelvic floor trigger point injections and physical therapy [ 19 ]. However, analysis of pain and function was only conducted at the three-month consult; the efficacy of the treatment protocol was not assessed past this time point.…”