The IC Underground

What’s the worst that could happen after eating a slice of pepperoni pizza? A little heartburn, for most people.

But for up to a million women in the U.S., enjoying that piece of pizza has painful consequences. They have a chronic bladder condition that causes pelvic pain. Spicy food — as well as citrus, caffeine, tomatoes and alcohol — can cause a flare in their symptoms and intensify the pain. Researchers had long believed the spike in their symptoms was triggered when digesting the foods produced chemicals in the urine that irritated the bladder.

A surprising new discovery from Northwestern University’s Feinberg School of Medicine reveals the symptoms — pain and an urgent need to frequently urinate — are actually being provoked by a surprise perpetrator. It’s the colon, irritated by the spicy food, that’s responsible. The finding provides an explanation for how the body actually “hears” pelvic pain.

The discovery also opens up new treatment possibilities for “painful bladder syndrome,” or interstitial cystitis, a condition that primarily affects women (only 10 percent of sufferers are men.) During a flare up, the pelvic pain is so intense some women inject anesthetic lidocaine directly into their bladders to get relief. Patients typically also feel an urgent need to urinate up to 50 times a day and are afraid to leave their homes in case they can’t find a bathroom.

“This disease has a devastating effect on people’s lives,” said David Klumpp, principal investigator and assistant professor of urology at the Feinberg School. “It affects people’s relationships with family and friends.” Klumpp said some women who suffer from this become so depressed, they attempt suicide.

Klumpp conducted the study with postdoctoral fellow Charles Rudick. The paper is published in the September issue of Nature Clinical Practice Urology.

The Northwestern researchers discovered the colon’s central role in the pain is caused by the wiring of pelvic organ nerves. Nerves from this region — the bladder, colon and prostate — are bunched together like telephone wires and plug into the same region of the spinal cord near the tailbone.

People with interstitial cystitis have bladder nerves that are constantly transmitting pain signals to the spinal cord: a steady beep, beep, beep.

But when the colon is irritated by pepperoni pizza or another type of food, colon nerves also send a pain signal to the same area on the spinal chord. This new signal is the tipping point. It ratchets up the pain message to a chorus of BEEPEEPBEEPBEEP!

“It was known that there was cross talk between organs, but until now no one had applied the idea to how pain signals affect this real world disease, how the convergence of these two information streams could make these bladder symptoms worse,” said Klumpp, who also is an assistant professor of microbiology-immunology at the Feinberg School.

The findings suggest the bladder pain can be treated rectally with an anesthetic in a suppository or gel. Another possibility is an anesthetic patch applied to pelvic skin. Studies in back pain show anesthetic patches applied to the skin can reduce back pain, Klumpp said.

“We imagine a similar kind of patch might be used to relieve pelvic pain, which might be the best solution of all,” he noted.

HOW THEY “CAUGHT” THE COLON

For the study, Klumpp and Rudnick created a model of a mouse that mimicked an inflamed bladder with pelvic pain. Then they injected lidocaine into the bladder. The pain vanished. Next they injected lidocaine into the uterus. There was no diminishment of the pain. Lastly, they tried lidocaine in the colon.

“In the colon it knocked down pain just as effectively as if we put it in the bladder. We thought if the colon can suppress bladder-associated pain, maybe it can make it worse in the way that foods irritate bladder symptoms,” Klumpp explained.

So, Klumpp injected a small dose of red pepper into the colon of a normal mouse. The injection didn’t provoke any pain. But then he injected a small dose into a mouse with pelvic pain. The pelvic pain worsened.

“We likened it to what happens to humans,” Klumpp said. “Pepperoni pizza does nothing to most people other than heartburn, but when you give it to a person with an inflamed bladder, that will cause their symptoms to flare because the nerves from the bladder and bowel are converging on the same part of the spinal cord.”

MEASURING PELVIC PAIN IN A MOUSE

When pain emanates from a visceral organ, the pain message is delivered to the spinal cord and bounces out to the corresponding skin surface, called the dermatome. To measure pelvic pain in the mice, Kumpp prodded their pelvic skin with nylon filaments of varying thickness and stiffness, beginning with one that was as thin as a human hair. The more pelvic pain the mouse was experiencing, the more sensitive its pelvic skin to even the finest filament.

Source: Marla Paul

Northwestern University

This is yet another reason, if not proof, that Chinese manufacturers appear to place $$ higher than public health and safety. That ANYONE would be foolish enough to put melamine into a human consumable.. this AFTER how many hundreds of pets were killed last year by the same contaminant… is just shocking. I remain appalled and completely unwilling to trust any consumable product from China. Eat them at your own peril!

The real question, though, is how will China punish these individuals now that Chinese citizens have died. Then, based upon that, how should they treat those who added fake heparin to create the massive recall earlier this year that resulted in many more human fatalities. - Jill

FDA issued a Health Information Advisory to consumers and healthcare professionals regarding milk-based infant formula manufactured in China. The Chinese manufactured infant formula may be contaminated with melamine. Melamine artificially increases the protein profile of milk and can cause kidney diseases. Currently, no Chinese manufacturers of infant formula have fulfilled the requirements to sell this product in the United States. FDA officials are investigating whether or not infant formula manufactured in China is being sold in specialty markets which serve the Asian community. Caregivers should not feed infant formula manufactured in China to infants and should replace any product from China with an appropriate infant formula manufactured in the United States. Individuals should contact their health care professional if they have questions regarding their infant’s health or if they note changes in their infant’s health status.

Read the entire 2008 MedWatch Safety Summary, including a link to the FDA Health Information Advisory regarding the above issue:

http://www.fda.gov/medwatch/safety/2008/safety08.htm#formulaChina

NIH Launches Effort to Advance Study of Urologic Chronic Pelvic Pain DisordersThe National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH), announces awards to eight academic research centers to conduct collaborative studies of urologic chronic pelvic pain disorders by looking for clues outside the bladder and prostate. The total research investment for the five-year project is estimated to be up to $37.5 million.

“The launch of this novel research effort is an excellent example of NIH’s commitment to encouraging translational research,” said NIH Director Elias A. Zerhouni, M.D. “It also illustrates NIH’s leadership in furthering innovative approaches to discovering effective new therapies to help our patients.”

The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network includes six Discovery Sites that will conduct the studies and two Core Sites that will coordinate data collection, analyze tissue samples, and provide technical support. The Discovery Sites are at: Northwestern University, Chicago; the University of California, Los Angeles; the University of Iowa, Iowa City; the University of Michigan, Ann Arbor; the University of Washington, Seattle; and Washington University, St. Louis. Core Sites are at the University of Colorado, Denver and the University of Pennsylvania, Philadelphia.

The MAPP initiative is unusual in requiring investigators to conduct highly collaborative research of the most common urologic chronic pelvic pain syndromes from a broadened systemic perspective. This is a major shift from earlier organ-specific research on the two most prominent urologic chronic pelvic pain disorders, interstitial cystitis/painful bladder syndrome, and chronic prostatitis/chronic pelvic pain syndrome.

“The MAPP Network’s expanded scientific approach will address many persistent questions about urologic chronic pelvic pain,” said NIDDK Director Griffin P. Rodgers, M.D. “Knowing whether there are risk factors common to all the disorders and whether clinical profiles can be identified for each will provide invaluable, fundamental information for developing treatment strategies.”

The innovative shift in research focus represented by the MAPP initiative is supported by recent epidemiological studies showing that interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome are frequently associated with other chronic pain disorders such as fibromyalgia (chronic pain of unknown origin), chronic fatigue syndrome, and irritable bowel syndrome. These latest findings suggest the possibility of common underlying disease processes in these chronic disorders.

“The bladder was assumed to be the origin of the interstitial cystitis/painful bladder syndrome symptoms and the prostate was assumed to be the source of chronic prostatitis/chronic pelvic pain syndrome symptoms,” explained Leroy M. Nyberg Jr., M.D., Ph.D., the NIDDK urologist heading the program. “However, in spite of intense study funded by NIDDK, no organ-specific cause has been identified for either disorder.”

The MAPP research effort is expected to lead to critical new insights into the underlying causes of urologic chronic pelvic pain. Widening the scope of research will be bolstered by the perspectives of project leaders not normally involved in urologic pelvic pain studies, but who have expertise in relevant scientific disciplines. This will expand the context in which research into interstitial cystitis/painful bladder syndrome and chronic prostatitis/chronic pelvic pain syndrome occurs and will encourage a more comprehensive approach to understanding chronic pelvic pain.

Scientists at Discovery Sites will conduct individual and collaborative multi-site research projects, supported by each Core Site. An important first step in these studies will be the careful and extensive phenotyping (clinical characterization) of the men and women participating in the studies.

The Data Coordination Core (University of Pennsylvania) will provide overall administration and coordination of multi-site research studies and perform data analyses.

The Tissue Analysis and Technology Core (University of Colorado) will bank, analyze, and distribute biopsy, serum and urine samples. Tissue analyses will help in the search for biomarkers, important in screening for diseases and for monitoring treatment outcomes. The Colorado Core Site also will perform genomic and proteomic tissue expression analyses which may lead to new treatment approaches and help predict which patients may respond to these treatments.

In addition to initial collaborative projects by the Network, MAPP investigators will be invited to propose ancillary research projects to further the goals of the collaborative study group. Proposals will be reviewed for scientific merit and feasibility by an external Scientific Advisory Committee.

For more information on the MAPP Research Network, visit http://www2.niddk.nih.gov/Research/ScientificAreas/Urology/MAPP.

NIDDK conducts and supports research in diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans. For more information about NIDDK and its programs, see www.niddk.nih.gov.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.