Bladder pain is complex

The numbers tell the tale, an old expression. But in the case of pain relief, things are not that easy.

"Many patients experience placebo effects’’, says MD and PhD Jos Houbiers, Executive Director of the Department of Medical Science - Urology / Nephrology Development at Astellas. This pharmaceutical company is host for the Leiden Pharma Science Symposium on May 25th.

"Pain is a signal that there is something wrong in the human body," Jos starts his explanation of the complexity of pain management. "There is sharp, acute pain, which lasts generally for just a short while. Another type of pain is caused by damage to the nerves. The recovery from this neuropathic pain is longer, and frequently the pain becomes chronic. Chronic pain can also be associated with inflammation, for instance in the case of rheumatoid arthritis. Furthermore, we distinguish a chronic pain where the pain persists while the original damage or pathology has disappeared. Apparently the interpretation or processing of sensory signals in the brain is not in order."

No abnormality found

Jos talks about the chronic pain of the bladder, topic of his presentation at the upcoming  symposium. "The difficult part of disease ‘’Bladder Pain Syndrome’’ (BPS) is that no abnormality can be found in the body. It appears that the brain of patients with BPS has been wrongly programmed (learned) to interpret signals of the filling with urine of the bladder as pain signals. In the past these patients may have had a bladder issue, for example a urinary tract infection. Because visible pathology is missing, the diagnosis of BPS is sometimes missed, even though this disease can be severe and disrupt social lives’’ There is another variant of chronic pain of the bladder that has clear signs of inflammation of the bladder wall: interstitial cystitis.

Promising drug candidates

Thanks to research at universities and pharmaceutical companies, including Astellas, there is hope for better drugs for the worldwide estimated 30 million patients - mostly women - who suffer from BPS/IC” says Jos. "Now that we distinguish between different variants, research into new medicines can be more targeted. Astellas´ pipeline shows a number of promising drug candidates that are already being tested in people."

Not black and white

These tests are not as simple as they seem. It is not black and white, whether something is working or not. "Pain is hard to measure," says Jos. "You're dealing with differences between patients and even within patients, as patients can experience pain very differently throughout time. Here, the placebo effect plays an important role. The sole fact that a patient is receiving medication and is being tended to, may already alleviate pain while in fact it is not."

Curious by nature

Jos finds the complexity of pain intriguing. "I call myself not a scientist, but rather a researcher. I'm curious by nature. During my medical studies, I halted my studies for a year to do research. I like to design trials, a good clinical study is like a piece of art. The fun part of the pharmaceutical industry is to do targeted research for solutions with a team of specialists. The common goal is to develop a product from which both the patient and the company benefit. It's about people and it's tangible. That fascinates me."

Join the Leiden Pharma Science Symposium on Pain

Please find more information on the Leiden Pharma Science Symposium dedicated to Pain at May 25th, the program (with also presentations from research by CHDR and Grünenthal) and registration here.

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Article by Richard Post