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First evidence of neosaxitoxin as a long-acting pain blocker in bladder pain syndrome

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Abstract

Introduction and hypothesis

Neosaxitoxin is a phycotoxin whose molecular mechanism of action shows a reversible inhibition of voltage-gated sodium channels at the axonal level, impeding nerve impulse propagation. This study was designed to evaluate the clinical efficacy of neosaxitoxin as a long-acting pain blocker in the treatment of bladder pain syndrome (BPS).

Methods

Five patients with a diagnosis of BPS received a total dose of 80 µg of neosaxitoxin in an isoosmotic solution of 0.9 % NaCl, pH 6.5. Infiltration was performed via cystoscopy under spinal anesthesia. Questionnaires were administered immediately before and 7, 30 and 90 days after the procedure to measure the patients’ reported pain severity and quality of life.

Results

This study, for the first time, showed the effect of blocking the neuronal transmission of pain by local infiltration of neosaxitoxin into the bladder submucosa. All five patients successfully responded to the treatment. Furthermore, the analgesic effect lasted for the entire 90 days of follow-up without the need for a second infiltration, and no adverse reactions to neosaxitoxin were detected.

Conclusions

Neosaxitoxin infiltration was shown to be a safe and effective intervention to control pain related to BPS. It was well tolerated by patients, who experienced extended pain relief and associated beneficial effects over a follow-up of 90 days. These results confirm the effectiveness of neosaxitoxin as a long-acting local pain blocker.

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Conflicts of interest

V. Manriquez and M. Naser received support from J&J to attend IUGA and ICS meetings. D. Castro, R. Guzmán, V. Iglesias, and N. Lagos report no conflicts of interest.

Author information

Authors and Affiliations

  1. Female Pelvic Floor Unit, Gynecologic and Obstetric Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile

    Valentin Manríquez, Daniela Castro Caperan, Rodrigo Guzmán & Michel Naser

  2. Public Health School, Faculty of Medicine, Universidad de Chile, Santiago, Chile

    Veronica Iglesia

  3. Membrane Laboratory, Physiology and Biophysics Department, Faculty of Medicine, Universidad de Chile, Santiago, Chile

    Daniela Castro Caperan & Nestor Lagos

  4. Hospital Clínico Universidad de Chile de Santiago, Santos Dumont 999, Independencia, Santiago, Chile, 8380456

    Daniela Castro Caperan

Authors
  1. Valentin Manríquez
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  2. Daniela Castro Caperan
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  3. Rodrigo Guzmán
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  4. Michel Naser
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  5. Veronica Iglesia
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  6. Nestor Lagos
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Corresponding author

Correspondence to Daniela Castro Caperan.

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Manríquez, V., Castro Caperan, D., Guzmán, R. et al. First evidence of neosaxitoxin as a long-acting pain blocker in bladder pain syndrome. Int Urogynecol J 26, 853–858 (2015). https://doi.org/10.1007/s00192-014-2608-2

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  • DOI: https://doi.org/10.1007/s00192-014-2608-2

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