New approaches to understanding and treating pelvic pain

Chronic pelvic pain is a broad and highly variable condition that encompasses both organ-centric and systemic disease.

Aaron D. Mickle, PhD
Aaron D. Mickle, PhD

The AUA’s first basic science symposium devoted entirely to chronic pelvic pain focused on the peripheral nervous system, the central nervous system and neuroinflammation pathways and biomarkers.

One of the key gaps in knowledge is the role urothelial cells play in bladder pain.

“There are differences in urothelial receptors, gene expression, cell differentiation and cell signaling in individuals with and without chronic pain,” said Aaron D. Mickle, PhD, assistant professor of neuroscience at the University of Florida.

The P2X receptor pathway plays a role in pain perception, but it is not yet clear what types of neurons are involved, how the brain interprets these signals or how bladder disease or dysfunction might affect signaling.

Pain signals from the bladder are transmitted via the rostral ventromedial medulla to the spinal cord, continued Vijay K. Samineni, PhD, assistant professor of anesthesiology in the department of biology and biomedical sciences at Washington University in St. Louis.

Endogenous analgesic pathways in rats and in humans suggest the possibility of chronic pelvic pain analgesic pathways.

Neurostimulation of the dorsal root ganglia is one potential approach to pain management.

“If the signal does not reach the brain, the patient will not feel the pain,” said Bin Feng, PhD, assistant professor of bioengineering at the University of Connecticut.

Dorsal root ganglia neurostimulation in the 50- to 100-hertz range blocks afferent neural transmission, he said, and is completely reversible.

Manipulating peripheral glia signaling is another approach. Glial fibrillary acidic protein positive glia can reduce pressure and pain sensations, said Xiaoqiao Xie, PhD, assistant professor of surgery-urology at the University of Colorado School of Medicine.

Chronic pelvic pain is a broad and highly variable condition that encompasses both organ-centric and systemic disease.

“A nonlinear system is not the sum of its parts,” said Jennifer DeBarry, PhD, assistant professor of anesthesiology and perioperative medicine at the University of Alabama at Birmingham. “What is happening in the pain-free state is not the same as in the chronically painful state. We need a truly complete picture built from many different angles.”

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