Background & Aims

Interstitial cystitis/ Bladder Pain Syndrome is a painful condition associated with pain and
troublesome urinary symptoms. This may result in disruption of sleep, anxiety, depression, loss of job which
affects physical, psychological health and quality of life. Neuromodulation may be offered in such cases although
the evidence is limited.

Methods

A 42-year-old female, bus driver, with intractable suprapubic and perineal neuropathic pain (NRS
9/10), urgency and frequency (10-12/ night) underwent spinal cord stimulation with dual infinion lead covering
T9-12 with on table testing. After 2-week positive trial (NRS>80%) Alpha wave-writer IPG (BSCR) was implanted.
Pre-implant urodynamic studies demonstrated detrusor overactivity during feeling of urgency and voiding. [1,2]
Patient demonstrated
improvement at 1, 3 and 6 and 9 months with persistent improvement in pain scores and improved urinary frequency (3-4/night) and minimal urgency at 6 months. Urodynamic study at 8 months demonstrated no detrusor overactivity during urgency while only some
overactivity just prior to voiding. She had
no more painful bladder spasms and
was able to resume her 12 hour shift
pattern job. Unfortunately she had lead displacement at 24 month follow up leading to loss of therapy necessitating revision surgery and had full effect thereafter

Results

Sensory afferents from the bladder innervate via the pelvic, hypogastric/splanchnic nerves and
synapse within the dorsal horn of the lumbosacral (L5-S1) and thoracolumbar (T10-L2) spinal cord [1]. The
sympathetic preganglionic input to pelvic ganglia is also carried out through hypogastric nerves [1,2]. Use of
SCS in experimental rat model was found be effective in decreasing detrussor overactivity and reduce bladder
hyperalgesia.[3] A case report mentioned relief in bladder pain as byproduct where SCS implant was done for
back and leg pain.[4] We report a clinical scenario where meaningful benefit was demonstrated using SCS for intractable bladder pain

Conclusions

We report objective improvement in pain and bladder functions following SCS with validated
outcome measures and urodynamic studies. This suggests possible role of SCS in managing such neuropathic pain conditions

References

L. Grundy, A. Caldwell, S.M. Brierley. Mechanisms underlying overactive bladder and interstitial cystitis/painful bladder syndrome.Front. Neurosci., 12 (2018), p. 931,
10.3389/fnins.2018.00931.

Daniel Brookoff, MD, PhD, Daniel S. Bennett, MD, DABPM, Neuromodulation in Intractable Interstitial Cystitis and Related Pelvic Pain Syndromes, Pain Medicine,
Volume 7, Issue suppl_1, May 2006, Pages S166–S184.

H.H. Chang, J.C. Yeh, J. Mao, D.A. Ginsberg, G. Ghoniem, L.V. Rodriguez. Spinal cord stimulation ameliorates detrusor over-activity and visceromotor pain responses
in rats with cystitis.Neurourol. Urodyn., 38 (1) (2019), pp. 116-122, 10.1002/nau.23827.

Nazih Moufarrij, Miranda Huebner,Relief of interstitial cystitis/bladder pain syndrome by spinal cord stimulation,Interdisciplinary Neurosurgery,Volume 28,2022

Presenting Author

Mohammed Yunus Khilji

Poster Authors

mohammed yunus khilji

MD, FFPMRCA

Sardar Patel Medical College Bikaner

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Urogenital Pain