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Treatment of Visceral Pain

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Painful bladder or rectal spasms may occur in some conditions.

For painful bladder spasms, non-steroidal anti-inflammatory drugs (NSAIDs: discussed in a separate article) may be helpful due to the possible role that prostaglandins play in bladder muscle contraction. ([i] [ii]  [iii])

Painful rectal spasms may respond to diltiazem, a calcium channel blocker that reduces smooth-muscle contraction, which has been effective in the management of proctalgia fugax (shooting pains in the rectum). ([iv])

Chlorpromazine (a neuroleptic) ([v]), and benzodiazepines ([vi]) have also been used and their efficacy noted anecdotally.

[i] Abrams P H, Fenely R C, British Journal of Urology 1975 ;47:909-915 The actions of Prostaglandins on the smooth muscle of the human urinary tract in vitro.

[ii] Cardozo L D, Stanton S L. Journal of Urology 1980;123: 399-401 A comparison between bromocriptine and indomethecin in the treatment of detrusor instability. Journal of Urology 123: 399-401

[iii] Hanks G W, Portenoy R K, MacDonald N, O'Niel W M. 1993 Difficult pain problems, in Doyle D, Hanks G W, MacDonald N (eds): Oxford Textbook of Palliative Medicine. Oxford, Oxford University Press, 257-274.

[iv] Castell DO. American Journal of Cardiology. 1985; 55: 21OB-213B Calcium blocking agents for gastrointestinal disorders.

[v] Twycross R G, Lack S A. 1984 Symptom control in far-advanced cancer: Pain Relief. Pitman, London.

[vi] Hanks G W. 1984 Psychotropic drugs. Clinics in Oncology; 3:135-151.