to the editor: On behalf of the Interstitial Cystitis Association (ICA) and the hundreds of thousands of patients with interstitial cystitis (IC) that ICA represents, I would like to express our gratitude for the article, “Interstitial cystitis: Urgency and Frequency Syndrome,”¹ in American Family Physician. We are gratified that your family practice readership has the opportunity to review a comprehensive description of interstitial cystitis, its diagnosis, and the variety of treatment options that are available. Since many new patients with IC may not see a urologist right away, it is crucial that family physicians become more aware of this condition.

We would like to point out the omission in the article¹ of any serious discussion of pain treatment for IC. For many patients with IC, the most debilitating aspect is the chronic, unrelenting pain that leads to an exceptionally poor quality of life and, in some cases, even suicide. Because IC is not fatal or malignant, some physicians are reluctant to prescribe strong analgesics, including narcotics. Research documents that patients with chronic pain can receive great benefit from the use of opioid and nonopioid analgesics, and many patients with IC have regained their quality of life through effective pain management.^2–4 Additionally, for certain patients whose symptoms do not respond well to conventional treatments, experimental therapies (including several new medications and neuromodulation) may prove effective in pain management. The ICA has numerous informative fact sheets on IC that can be found on the ICA Web site atwww.ichelp.org.

Additionally, the author’s¹ discussion of intravesical therapies commonly used for treatment in IC mentions silver nitrate, which is considered an outmoded therapy of questionable therapeutic value, and oxychlorosene, 0.4 percent, which can be very painful for patients. Physicians should be discouraged from considering these two treatments.

In closing, I would like to add a note of historical perspective to this discussion. When the ICA was founded in 1984, there was little recognition of IC in the medical literature and even less recognition in clinical practice. Interstitial cystitis was considered to be a rare, postmenopausal condition. Even after 17 years of public education and millions of research dollars, some physicians still believe that IC is not a true disease, but some sort of “female complaint” that is not worthy of serious consideration. We appreciate your article because it allows your readers to have a clear understanding of the fact that IC is a legitimate illness that occurs not just in adult women, but in adult men and children as well. When patients present with urinary urgency, frequency and/or pain, in the absence of infection, we urge family practitioners to consider the diagnosis of IC.⁵

in reply: I would like to thank Dr. Ratner for her comments on my article “Interstitial Cystitis: Urgency and Frequency Syndrome.”¹ All interstitial cystitis patients should be made aware of the Interstitial Cystitis Association, which she represents.

The article¹ does mention the use of tricyclics, nonsteroidal anti-inflammatory drugs and, possibly, gabapentin (Neurontin) for pain relief in patients with interstitial cystitis. Although not mentioned in my article¹, I agree that strong analgesics including narcotics may need to be used to control pain and improve the quality of life in these patients.^2,3 Opioids along with other pain control measures including physical therapy with biofeedback may be warranted in some patients.

While the article¹ does mention the intravesicular treatments silver nitrate and oxychlorosene only in Table 2 and not in the body of the text, both treatments were footnoted as having no studies which showed their efficacy.⁴ Given the lack of efficacy and potential side effects, I would therefore also discourage patients from considering these two treatments.