This is the explanation used to understand why patients can have their bladders removed and still suffer chronic pain symptoms in some cases.

Michael Jarvis from Abbott Laboratories comments in an interesting forward on the topic of neuropathic pain for a recent special journal issue devoted to the topic of drug development for neuropathic pain that many clinicians and PBS/IC researchers will find enlightening.

Neuropathic pain has been defined by the International Association for the Study of Pain as "pain initiated or caused by a primary lesion or dysfunction in the nervous system". Following nerve injury, neurophysiological changes occur in the CNS (sensitization) that can persist indefinitely. Under these conditions, pain can occur without a specific stimulus or can be disproportionate to the stimulus intensity. Neuropathic pain may be constant or intermittent. It can be manifest by allodynia or hyperalgesia associated with mechanical or thermal stimuli, and also spontaneous sensations such as burning, tingling, prickling, shooting, deep aching, and spasm.

The most effective treatments have been anti-convulsants like carbamazepine and Gabapentin, or antidepressants like amitriptyline and duloxetine. During the last decade a number of analgesic targets have emerged that are known to alter neuronal excitability both at the level of the primary sensory afferent neuron and in the central nervous system. Nictotinic receptor agonists, endocannabiniods and endovanilliods are involved in modulating neuropathic pain.

A great deal of scientific progress has been achieved in understanding both the physiological and pathophysiological responses to noxious stimuli. This progress has yet to translate into the development of truly new clinically effective analgesics beyond the currently approved incremental advances in traditional opioid, non-steroidal anti-inflammatory and analgesic adjuvant medicines. This collection of articles is important reading for those interested in neuropathic pain, and may provide clues to future treatments for PBS/IC.

Michael F. Jarvis

Drug Development Research 67(4):287 - 288

Written by Philip M. Hanno, MD, a Contributing Editor with UroToday.

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