Chronic Pain Today

Interstitial cystitis (IC) is a chronic and debilitating disease of the urinary tract and bladder that affects approximately one million people. There is an inflamed and irritated bladder wall that leads to many bladder symptoms. The bladder wall of an IC patient will have stiffening and scarring of the bladder, less bladder capacity as a result of the scarring, small pinpoint bleeding on the bladder (glomerulations) and ulcers in the bladder lining (Hunner’s ulcers).

So much isn’t known about the illness, even though it has been around for a while now. This article deals with the signs and the symptoms of interstitial cystitis. A general guideline for interstitial cystitis is from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and although it has come under fire and scrutiny as it doesn’t incorporate all of the prevailing symptoms and has some things included as an exclusion that some people with IC do indeed have, it is meant as a oversee of the illness and not a conclusive.

NIDDK Research Definition of Interstitial Cystitis

Inclusion Criteria
1. Cystoscopy - glomerulations and/or classic Hunner’s ulcer.
2. Symptoms - bladder pain and/or bladder urgency.

Exclusion Criteria
1. Bladder capacity greater than 350cc on awake cystometry.
2. Absence of an intense urge to void with the bladder filled to 100cc during cystometry using a fill rate of 30-100cc/min.
3. Demonstration of phasic involuntary bladder contractions on cystometry using the fill rate described in number 2.
4. Duration of symptoms less than 9 months.
5. Absence of nocturia.
6. Symptoms relieved by antimicrobials, urinary antiseptics, anticholinergics, or antispasmodics.
7. Frequency of urination while awake of less than eight times a day.
8. Diagnosis of bacterial cystitis or prostatitis within a 3-month period.
9. Bladder or ureteral calculi.
10. Active genital herpes.
11. Uterine, cervical, or urethral cancer.
12. Urethral diverticulum.
13. Cyclophosphamide or any type of chemical cystitis.
14. Tuberculous cystitis.
15. Radiation cystitis.
16. Benign or malignant bladder tumors.
17. Vaginitis.
18. Age less than 18 years.

This is a research definition only (for inclusion of patients in clinical trials) and is not necessarily applicable to diagnoses made in clinical practice. The major difference in the less stringent Interstitial Cystitis Database (ICDB) inclusion criteria for the diagnosis of IC is that cystoscopy (and its related diagnostic criteria) is an optional criterion for entry into the ICDB study. The rigid urodynamic exclusion criteria in the NIDDK definition do not exclude patients from an ICDB IC diagnosis.

Wondering what medical specialist is right for your specific chronic pain condition? There are several choices, and one is right for you.  Here is a continuation of the yesterday post with five other specialists:

Neurologist
These doctors have specialized in the fields of brain, spinal cord, and nervous system diseases, and are good for chronic pain issues such as headaches and nerve pain. It is here that diagnostic procedures such as X-rays and MRIs are ordered and read. They are able to interpret these to see what course of treatment is best for you.

Obstetrician and gynecologist (OBGYN)
These are doctors who specialize in the care of women. They can do a variety of conditions, such as pregnancy and reproductive issues. This is a great start to your chronic pain wellbeing if you have pelvic pain and are a woman.

Psychiatrist or psychologist
Psychiatrists are medical doctors that specialize in the care and treatment of mental health issues. Many chronic pain sufferers are prone to developing depression, and psychiatrists are able to write prescriptions to treat these mental conditions.

Psychologists are health professionals that specialize in the care and treatment of mental health issues; however they aren’t medical doctors and use therapy and counseling to benefit the patient.

Orthopedic surgeon
These medical surgeons are ones that treat bone, muscle, and joint injuries via surgical solutions. This is where some chronic pain sufferers go to undergo surgical treatments for their pain. They can also do corrective surgery like joint and hip replacement.

Rheumatologist
These medical doctors are those that specialize in joint conditions such as arthritis and lupus. They are able to write prescriptions for medications that you may need in the course of your treatment. It is the specialist for all chronic joint pain sufferers.

A gallbladder scan is ordered when you have right side pain and other indications of a dysfunctioning gallbladder. The test takes about two hours and is given while you are lying down underneath a scanner much like an MRI. The first injection is of a tracer to trace the path of the chemical through the liver and bile ducts, and in and out of the gallbladder. Then a chemical known as cholecystokinin, or CCK, is given. This stimulates the gallbladder and can cause nausea and pain if the patient does have a dysfunctioning gallbladder. A series of pictures are taken after every injection, to test for function and structure abnormalities.

Generally it is a very safe test, one that is given on a regular basis to test for gallbladder trouble. Risks and factors in this procedure are very rare. There can be some soreness where the tracer and CCK are injected. This is generally caused by the needle staying in the arm with any movement with the patient and not from the chemicals themselves. If this is the case, warm compresses and an OTC pain remedy can fix this.

Allergies to the tracer can happen, although they are rare. The radioactive tracer used to test the structure of the gallbladder will be excreted through your system in a day. So for the first 24-48 hours after every bathroom visit, you will need to wash your hands with soap and water because the tracer is radioactive. It is a small amount of radiation, but radiation nonetheless. The radiation from the xrays, of course, will not be affected this way.

Cell damage or tissue damage can occur. There is a slight risk of this with the radiation. Even with the low level of radiation from the radioactive tracer, some cases of cell and tissue damage have been reported. This is always a concern, even if not very likely.

There are factors that can affect this test. If you are pregnant, the test will not be administered because the radiation from the tracer and the xrays can damage the fetus. If you have taken barium and/or bismuth recently, the test will be postponed. Usually a gallbladder scan will be scheduled before tests such as barium enemas because of this. And if you can’t stay still for the two hours for any reason, your doctor may schedule an ultrasound first. Patients must stay still for this test.

Wondering what medical specialist is right for your specific chronic pain condition? There are several choices, and one is right for you.

Family medicine doctor /General practitioner
These doctors specialize in the total health of the person and of family. They are able to diagnose and treat a wide variety of illnesses and conditions, or can refer you to a specialist should you need it. This is generally where most chronic pain sufferers begin their journey of healing and treatment.

Doctor of osteopathy (DO)
These doctors deal with the whole body and the interaction between the body’s systems. They are a primary care provider just like the family medicine doctor, and they are able to refer you to specialist should you need it. This is another choice for chronic pain sufferers to begin with in their treatment.

Chiropractor
These health professionals deal with the alignment of muscle and bone in the body. They are able to readjust and correct some forms of abnormality in the bone structure. They are also able to give patients massages, biofeedback, and other techniques for the session. This is a good start if your chronic pain is due to back injuries or other bone conditions.

Pain management specialist
These are doctors who have specialized their practice to those experiencing chronic pain issues. These can be other specialists, such as orthopedics or neurology, which have further honed their niche to include chronic pain.

Physical therapist
Health professionals that have used exercise, heat, electricity, and other methods to ease their patients pain issues. They can be working on extending range of motion, or the quality of life. They provide treatment to help in muscle and joint chronic pain issues.

A gallbladder scan is usually requested when the patient is showing signs and symptoms of having gallbladder dysfunction. It can be used to tell the cause of any jaundice the patient is exhibiting, to determine if there is a problem with the function of the gallbladder and the source of any right side pain, or to detect any blockage of the tubes.

During the test a radioactive tracer fluid will be injected into a vein, usually in the arm. This is so that the scanning pictures can show the path of the tracer going to the liver, the gallbladder, bile ducts, and the duodenum. This can show the radiologist if there is any dysfunction to the gallbladder itself in function or structure, and if there is a blockage in any of the bile duct tubes that lead from the liver to the gallbladder.

After the tracer has ran its course then the cholecystokinin (the substance that will make the gallbladder be stimulated, some say like after a particularly fatty meal) will be injected. Pictures will be taken to see how well the gallbladder is functioning. The results are generally given in a percentage, as in the percentage of solution that is released in the time given. Most doctors feel that anything below 35%-40% is a sign of gallbladder dysfunction, with 70%-75% being normal. If your scan comes back with these numbers, your doctor may be opting for a surgical removal of the gallbladder. They may take additional pictures later, or they may just go with the first set of data they collect. This is usually up to the doctor.

The test is a little time consuming, taking about two hours. And it’s restrictive. You will be lying on a table the entire time, and told not to move much during it. Much like a two hour MRI of sorts.

The test is generally pain free, although a bit uncomfortable. You may request a pillow or blanket if it will make you more comfortable. When the cholecystokinin (or CCK as it is known) is administered you may feel pain. Usually having pain with the CCK injection is a sign of gallbladder dysfunction and if you do hurt during this it is important to tell your radiologist.

If you are experiencing right side pain with nausea and diarrhea after fatty meals, your doctor may tell you to take this test. It is very useful in determining gallbladder function and shouldn’t be put off if you are experiencing any gastrointestinal issues. You can also see about a gallbladder ultrasound, if you would like to get a “second opinion” on whether you need the actual gallbladder scan or not.