Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis

Area of Science:

• Urology
• Pain Management
• Neuromodulation

Background:

• Interstitial cystitis (IC) is a chronic condition causing pelvic pain, urgency, and frequency.
• Standard therapies often fail for refractory IC, leading to significant pain and reliance on narcotics.
• Sacral neuromodulation (InterStim) is a potential treatment for refractory conditions.

Purpose of the Study:

• To evaluate the long-term effectiveness of sacral neuromodulation (InterStim) for chronic pelvic pain in interstitial cystitis patients.
• To assess changes in narcotic requirements and pain levels after InterStim implantation.

Main Methods:

• Retrospective review of 21 patients (17 female, 4 male) with refractory IC and chronic pelvic pain.
• All patients had failed a mean of six previous IC treatments.
• Permanent InterStim devices were implanted after positive temporary tests; data collected via chart reviews and questionnaires.

Main Results:

• Mean follow-up was 15.4 months. 20 out of 21 patients reported moderate to marked pain improvement.
• Mean daily opioid dose equivalent (MDE) decreased by 36% (from 81.6 to 52.0 mg/day, P=0.015).
• Four of 18 patients on chronic narcotics stopped them entirely after InterStim implantation.

Conclusions:

• Sacral neuromodulation effectively decreases narcotic dependence and subjective pelvic pain in patients with refractory interstitial cystitis.
• Continued dose reductions in narcotics are expected in improved patients.
• InterStim therapy represents a viable treatment option for refractory IC patients experiencing chronic pelvic pain.