STUDIES OF PAIN IN PATIENTS WITH INTERSTITIAL CYSTITIS

本研究的长期目标是阐明间质性膀胱炎（IC）患者疼痛的病理生理机制，以制定更好的策略来缓解这些患者的慢性疼痛。IC与其他慢性非恶性内脏疼痛综合征有许多共同特征。在临床实践中，重点一直放在寻找这种疾病的特定病因和特定的病理标志物，并确定沉淀IC的特定事件。这种概念化影响了临床治疗方法，但迄今为止尚未取得重大进展。根据三个假设的概念化，建议采取另一种办法：（1）一系列不同的损伤可导致患有IC的患者的慢性内脏疼痛，（2）不同的潜在致病性疼痛机制可能需要针对诊断患有IC的患者的不同疼痛治疗策略，（2）不同的潜在致病性疼痛机制可能需要不同的疼痛治疗策略，（3）多种不同的致病性疼痛机制可能在同一患者中共存，需要几种不同的疼痛治疗策略（可能同时）来成功治疗与IC相关的慢性内脏痛。这种概念化可能导致对IC的神经生理机制的新见解，并为IC患者提供新的治疗途径。作为更好地了解IC患者慢性疼痛的神经生理机制的第一步，我们建议使用定量感觉测试详细描述IC患者的疼痛，利用典型的内脏疼痛区域，这些区域很容易进行定量感觉测试。我们假设，IC患者可以分为3个主要群体的基础上，他们的“感觉配置文件”进行评估，定量感觉测试和治疗IC疼痛将更有效，如果基于认识的基础神经生理机制。这些研究将为IC患者慢性疼痛的中枢和外周机制提供新的见解。这些研究的结果可能会迅速有助于专门针对IC患者慢性疼痛的潜在神经机制的治疗策略的设计。

The long range objective of this research is to elucidate the pathophysiological mechanisms of pain in patients with interstitial cystitis (IC)in order to develop better strategies for alleviating chronic pain in these patients. IC shares many features with other chronic non-malignant visceral pain syndromes. In clinical practice much emphasis has been placed on finding a specific etiology and specific pathological markers for this disease and on identifying specific events that precipitate IC. This conceptualization has influenced clinical treatment approaches but has not resulted in significant progress so far. An additional approach is suggested, based on the conceptualization of three hypotheses: (1) a spectrum of different insults can lead to chronic visceral pain in patients suffering from IC, (2) different underlying pathogenic pain mechanisms may require different pain treatment strategies for patients diagnosed with IC, (2) different underlying pathogenic pain mechanisms may require different pain treatment strategies for patients diagnosed with IC, (3) multiple different pathogenic pain mechanisms may coexist in the same patient, requiring several different pain treatment strategies (perhaps concomitantly) to successfully treat chronic visceral pain associated with IC. This conceptualization is likely to lead to new insights into the neurophysiological mechanisms of IC and to novel treatment avenues for patients suffering from IC. As a first step towards a better understanding of the neurophysiological mechanisms of chronic pain in patients with IC we propose to characterize pain in patients with IC in detail using quantitative sensory testing, taking advantage of the typical areas of referred visceral pain, which are easily accessible to quantitative sensory testing. We hypothesize that patients with IC can be differentiated into 3 main groups based on their "sensory profiles" as assessed with quantitative sensory testing and that treatment of pain in IC will be more effective, if based on recognition of the underlying neurophysiological mechanisms. These studies will give new insights into the central and peripheral mechanisms of chronic pain in patients with IC. The results of these studies may rapidly contribute to the design of treatment strategies specifically targeted at the underlying neural mechanisms of chronic pain in patients with IC.