Cannabis for the treatment of the painful bladder

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Intestine inflammation of the bladder (IC) or painful bladder syndrome (PBS) is manifested in pelvic pain, urgency and frequency of urination, and significantly harms the quality of the patients’ lives. The prevalence of the syndrome is 0.5% of the population and 9 times higher in women. The average age of symptoms is 42 years. Most patients are diagnosed after seven years of suffering. [1] The disease is probably caused by a combination of factors that impair the integrity of the glycosaminoglycan layer, . The sands rarely leave the house and are dependent on comfort, and nocturnal frequency harms the quality of sleep, resulting in fatigue and depression. The incidence of symptoms in descending order is: frequent urination (92%), urgency (92%), pelvic pain (80%), and pain during intercourse (50%). Half of the patients experience pain exacerbation following eating spicy foods, drinking alcohol, coffee, and carbonated or acidic beverages. Studies have shown that the prevalence of inflammatory bowel disease (IBD), systemic lupus erythematosus (SLE), and fibromyalgia are higher in patients with PBS / IC than in the general population [3].

Treatment of the syndrome is very challenging. Psycho-cognitive therapy, pelvic floor physiotherapy, and drug therapy. Among the medical treatments are the leakage of substances to the bladder, in order to relieve pain, prevent inflammation and suppress mast cells. Capsaicin, a drug that binds to the Vanilloid receptor at the nerve endings of the bladder, has also been stimulated by the pain nerves. Studies have shown inconsistent results and therefore the use of this drug is not common. In cases of lack of success in a number of treatments there is also a surgical option but also here without any brilliant results. The main goals of treatment are breaking the cycle of pain and providing quality of life. The many drugs, anti-inflammatory NSAIDS, tricyclic antidepressants, antihistamines and more … that patients are taking side effects and therefore can be treated with cannabis. There is still not enough research information on cannabis treatment for painful bladder syndrome and the findings are more likely than studies in mice. A preclinical study published in 2014 [4] found that CB2a, a CB2 receptor agonist, was easier for mice with painful bladder syndrome. The study demonstrated that CB2 receptors were an effective target site for treating this syndrome. Given that the phytoplanknabinoids from the cannabis plant are also active on receptors CB1 and CB2, it seems that cannabis may be an effective treatment for the syndrome. Studies [5], [6] Multiple sclerosis patients found a strong correlation between urination and activation of TRPV1 and found that cannabis positively affects events associated with urgency and frequency of urination. It was found that the bladder and detrusor have many CB1 and CB2 receptors. It was also found that it is important to use the plant itself and not individual synthetic cannabinoids [7], probably due to the known entourage effect of cannabis. Activation of TRPV1 reduces pain sensitivity [8]. In ophthalmic (the epithelium that covers the bladder), there are more CB2 receptors. New drugs based on cannabinoids can be divided into direct agonists that selectively activate CB1 and CB2 receptors and agonists that stimulate CB2 receptors without the causal effects of CB1 receptor stimulation [9]. Indirect agonists affect by reducing endocannabinoid activity by blocking the breakdown or breakdown of enzymes. These compounds can affect tissues with fewer side effects from direct agonists. Another advantage of indirect agonists is that they can act on other receptors, CB1, CB2, and TRPV1. Another study [10] in mice found that there was room for cannabinoids to treat bladder dysfunction due to the presence of CB1 and CB2 receptors in the bladder and urethra. Another study found that treatment with CB2 receptor agonist was effective in treating bladder disease and pain. Many patients with bladder pain need medical cannabis and some consume it without a license from the Ministry of Health, because they find it difficult to obtain a recommendation from a doctor because procedure 106 does not indicate symptoms of bladder syndrome. Patients report significant relief of symptoms and pain in the treatment of medical cannabis. Following the reading of the articles mentioned above and many others, consideration should be given to adding the indication to procedure 106.

Link to the bladder association Click here

[1] Forrest JB & Mishell DR, Breaking the cycle of pain in interstitial cystitis/ painful bladder syndrome: toward standardization of early diagnosis and treatment: consensus panel recommendations. J Reprod Med, 2009; 54: 3-14.

[2] Koziol JA, Epidemiology of interstitial cystitis. Urol Clin North Am, 1994; 21: 7-20

[3] Clauw DJ, Schmidt M, Radulovic D & al, The relationship between fibromyalgia and interstitial cystitis. J Psychiatr Res, 1997; 31: 125-31

[4] Wang, Z.-Y., Wang, P., & Bjorling, D. E. (2014). Treatment with a Cannabinoid Receptor 2 Agonist Decreases Severity of Established Cystitis. The Journal of Urology, 191(4), 1153–1158. http://doi.org/10.1016/j.juro.2013.10.102

[5] Kalsi V, Fowler CJ. Therapy Insight: Bladder dysfunction associated with multiple sclerosis. Nat Clin Pract Urol. 2005;2:492–501. [PubMed]

[6] Ahluwalia J, Urban L, Bevan S, Nagy I. Anandamide regulates neuropeptide release from capsaicin-sensitive primary sensory neurons by activating both the cannabinoid 1 receptor and the vanilloid receptor 1 in vitro. Eur J Neurosci. 2003;17:2611–8. [PubMed]

[7] Russo E, Guy GW. A tale oftwo cannabinoids: The therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. Med Hypotheses. 2006;66:234–46. [PubMed]

[8] Hayn MH, Ballesteros I, de Miguel F, Coyle CH, Tyagi S, Yoshimura N, et al. Functional and immunohistochemical characterization of CB1 and CB2 receptors in rat bladder. Urology. 2008;72:1174–8.[PubMed]

[9] Malan J, Philip T, Ibrahim MM, Lai J, Vanderah TW, Makriyannis A, Porreca F. CB2 cannabinoid receptor agonists: Pain relief without psychoactive effects? Current Opinion in Pharmacology. 2003;3:62–7. [PubMed]

[10] Juszczak K, Maciukiewicz P. The role of the peripheral cannabinoid system in the pathogenesis of detrusor overactivity evoked by increased intravesical osmolarity in rats. Can J Physiol Pharmacol. 2015 Aug;93(8):721-6. doi: 10.1139/cjpp-2015-0091. Epub 2015 Apr 13

[11] Wang ZY, Wang P, Bjorling DE. Treatment with a cannabinoid receptor 2 agonist decreases severity of established cystitis. J Urol. 2014 Apr;191(4):1153-8. doi: 10.1016/j.juro.2013.10.102. Epub 2013 Oct 29.

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