title: Botulinum toxin a has antinociceptive effects in treating interstitial cystitis.
abstract: OBJECTIVE
  To present clinical evidence with botulinum toxin A (BTX-A) suggesting an antinociceptive role in patients with interstitial cystitis (IC). Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic (inflammatory) pain.
  
  
  METHODS
  Thirteen female patients (6 in the United States and 7 in Poland) with IC according to the criteria of the National Institute of Diabetes, Digestive and Kidney Disease were included. Under short general anesthesia or sedation, 100 to 200 U of Dysport (Polish patients) or Botox (U.S. patients) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder. Patients were evaluated with the O'Leary-Sant validated IC questionnaire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals. The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations.
  
  
  RESULTS
  Overall, 9 (69%) of 13 patients noted subjective improvement after BTX-A treatment. The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71% and 69%, respectively (P <0.05). Daytime frequency, nocturia, and pain by visual analog scale decreased by 44%, 45%, and 79%, respectively (P <0.01). The first desire to void and maximal cystometric capacity increased by 58% and 57%, respectively (P <0.01).
  
  
  CONCLUSIONS
  Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC, producing both symptomatic and functional (ie, urodynamic) improvements.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Smith
authors.forename: Piotr
authors.initials: P
authors.lastname: Radziszewski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Borkowski
authors.forename: George T
authors.initials: GT
authors.lastname: Somogyi
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Boone
authors.forename: Michael B
authors.initials: MB
authors.lastname: Chancellor
mesh_terms: D000283:Administration, Intravesical; D000700:Analgesics / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D018856:Cystitis, Interstitial / Q000503:physiopathology / Q000628:therapy* / Q000652:urine; D005260:Female; D006801:Humans; D008875:Middle Aged; D059408:Pain Management; D011795:Surveys and Questionnaires; D013997:Time Factors; D001743:Urinary Bladder / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D014554:Urination; D014555:Urination Disorders / Q000628:therapy; D014563:Urodynamics; D017833:Visceral Afferents / Q000187:drug effects
chemical_list: D000700:Analgesics; D019274:Botulinum Toxins, Type A