The American Urology Association (Guidelines 14) states that “pain management should be an integral part of the treatment approach and should be assessed at each clinical encounter for effectiveness.” Why? The bladder, like any other part of the body, can generate pain so severe that patients require immediate medical care and treatment. Unfortunately, IC patients struggle to overcome the perception their bladder pain “isn’t that bad” or is very mild in nature. Of course, the pelvic floor muscles can also be a source of pain. The first published epidemiological study on IC in 1987 found that the pain of IC rated equivalent to that of cancer pain on the McGill Pain Scale. Similarly, the quality of life for some IC patients was rated equivalent to patients in end-stage renal failure.
Given the fact that patients suffering from cancer pain or kidney failure usually receive immediate care and attention, many IC patients also deserve prompt and compassionate pain care. The AUA suggests the use of a multimodal strategy to treat pain including the use of:
- urinary analgesics
- narcotic medications
- nonnarcotic medications
On Narcotic Medication
The AUA specifically does NOT DISCOURAGE the use of narcotic pain medication which may be required during periods of intense flares and discomfort. They state “It is clear that many patients benefit from narcotic analgesia as part of a comprehensive program to manage pain.” The use of pain medication, however, should NOT be considered or used as the only treatment. Other therapies that treat and, ideally remove, the cause of pain, should be explored, such as the treatment of painful trigger points or Hunner’s ulcers.
Pain care can be provided by the urologist, primary care provider or pain specialists. The challenge, of course, is that some care providers are simply uncomfortable providing prescriptions for opiate medication. If you, the patient, are not receiving adequate care for your pain, you can request a referral to a pain specialist.
On the Opiate Crisis & Physicians Refusing To Provide Medication
In 2016, the Centers for Disease Control issued new opiate prescribing guidelines that has resulted in many chronic pain patients being refused or discontinued from necessa