Interstitial Cystitis (IC) treatment using CAM Modalities

Abstract The prevalence of interstitial cystitis (IC) has seen different treatment methods that have been aimed at reducing the level of pain and ensuring that the patients are comfortable. However, the continued failure of most of the conventional methods to treat the condition has necessitated physicians to recommend complementary and alternative methods of managing the condition. An analysis of the complementary and alternative methods (CAM) modalities is therefore, critical in understanding the different conceptual attributes that are significant in addressing the problem.

IC is a condition that is characterized by chronic pain or discomfort in the bladder and the surrounding pelvic region. It differs depending on the pain, frequency or both pain and frequency. The condition affects the patient and in some cases may lead to stress since it impacts the work-life, family and sexual enjoyment for the women. In most cases there are different methods of managing the condition but although they have been highly documented, physicians and patients are slowly appreciating the need for CAM to manage the conditions.

It makes it critical to examine the different methods and their contribution especially in patients who have refractory and debilitating conditions in the society. This paper assesses the different recommended CAM modalities; their use and success rate among patients suffering from IC in the society. The paper uses a qualitative method of research where different methods were examined for their use and prevalence among physicians and patients across the society.

The results showed that there has been an increase in the use of CAM methods in the treatment of interstitial cystitis which has seen a reduction in pain among most of the individuals in the society. Introduction When analyzing the CAM methods, it is important to highlight the level of prevalence of the condition in the society as it affects more than 3-8million Americans. However, most of the patients are women and although it may occur at any age, most cases are between 42 and 46 years of age.

Women constitute more than 90% of the total cases highlighting the importance of highlighting the main management methods that do not include medication or conventional processes that can be used (Tutolo et al, 2016). The management practices need to be instituted in terms of the pain and frequency of the condition in an individual. The CAM methods have therefore shifted from a specific model to multifaceted methods that incorporate a series of models aimed at controlling the condition.

It is also imperative to ensure that an individual approach has been developed to ensure that the patient is treated depending on their specific complications. A one size fits all approach in CAM rarely applies since there are differences in the conditions and models that the patients face. It is essential to understand the patient’s dynamics and institute a program that aligns with their individual needs (Atchley et al, 2015).

Attributes such as depression also make it critical to understand the different models that are instituted by patients in the models used to manage the condition. On the other hand, before a diagnosis of IC it is important to rule out conditions that manifest in similar signs such as an infection or urinary stones which may be affected by the CAM method that is used. There are a variety of CAM modalities that can be used to treat IC that include: 1.

biologically-based therapies, including dietary modification, nutraceutical and herbal supplement usage; 2. mind-body interventions, like cognitive behavioral therapy, psychotherapy, yoga or biofeedback exercises; 3. manipulative and body-based approaches, i.e., massage techniques, bladder retraining and physical therapy; 4. energy therapies, like Qigong, Reiki and bioelectromagnetic-based therapy; 5. whole medical systems, i.e., traditional Chinese medicine, acupuncture and naturopathy (Moquin, Blackman, Mitty & Flores, 2009). To understand how these CAM modalities are effective, however, it is important to understand what IC is.

IC has been defined as suprapubic pain stemming from a bladder filling all the way, while accompanied by a range of symptoms that can include a higher rate of day-time and night-time urination frequency (Pang & Ali, 2015, p. 653). IC cannot be diagnosed if a urinary tract infection is diagnosed or if some other pathology is identified. The major difficulty of treating IC, therefore, is that its etiology is poorly understood. There is no clear reason or explanation for the suprapubic pain associated with the bladder filling.

Moreover, nearly 200 different therapies have been developed and implemented to treat IC, yet none of them is fully successful across the board for all patients (Rovner et al., 2000). For that reason CAM therapies are viewed by patients and physicians as an attractive option (O’Hare et al., 2013). The literature shows that CAM treatments are on the rise among patients of IC and that many more physicians today are recommending CAM for IC patients than ever before (Pang & Ali, 2015).

The primary reason for this is that IC etiology is so poorly understood that some physicians believe alternative methods may have a beneficial psychological impact on patients (Kaptchuck, 2002).

This could be just a placebo effect—for example, a patient suffering from an issue that has no known origin and thus has no known effective treatment is given an intervention that is rooted more in traditional culture (such as Chinese medicine) than in modern science; the patient believes there is something special about the intervention (the mystery of the intervention links with the mystery of the ailment) and thus a placebo effect is achieved; that is, at least, one theory put forward by Kaptchuck (2002). Hyodo et al.

(2005) for example have found that patients receive an emotionally supportive stimulus from CAM methods of intervention for ailments that seem untreatable via other interventions. However, other researchers have put forward evidence indicating that there is more to CAM than a mere placebo effect and that in fact the methods do work effectively in treating IC patients (O’Hare et al., 2013; Pang & Ali, 2015).

For that reason, this study will now describe the most common and most effective CAM treatments for IC patients and what the research on them has revealed over the years. IC Diet Dietary modification is one of the most common CAM that is applied by individuals across the society (O’Hare et al., 2013). As Hanno et al. (2011) have shown, the dietary modification approach is considered a first line approach in the CAM treatment of IC.

Likewise, the American Urology Association has considered the dietary modification intervention as the main form of therapy (Colaco & Evans, 2015). The dietary modification method is characterized by avoidance of foods that are known to cause irritation to the bladder. Avoidance of coffee, citrus and other acidic foods is highly recommended as these foods are likely to cause the pain that most of the patients have.

However, it is critical to understand and look to ensure that one develops the best therapeutic methods essential in ensuring that there is proper modification methods instituted, as not everyone will respond in the same way to dietary modification (Atchley et al, 2015; O’Hare et al., 2013; Pang & Ali, 2015). The symptoms vary depending on the patients and the diets need to be tailored towards ensuring that the conditions that the patient faces are considered.

This makes it imperative to use elimination diet to determine which foods are irritants for each patient. The differences need to be specifically underlined through creating a proper scope and modeling essential for outlining the critical controls developed. Research has shown that most of the patients like the dietary method of management since it helps in reducing the effects of the condition (Koziol, Clark, Gittes & Tan, 1993).

Proper dietary methods eliminates pain in most of the patients as they eliminate foods that are high in acidity and look to develop the best means towards developing proper models to reduce the effects in their bodies. Acidity is the main attribute that leads to problems in most patients and clinicians look to institute programs that are aimed at changing these attributes for patients.

Elimination of diet of bladder irritants, decreasing the dietary acid load and urinary alkalinity are some of the methods used in controlling the level of pain from IC. Patients are given baking soda or potassium citrate that acts as treatment options towards reducing the effect of the foods taken (Atchley et al, 2015). In cases where there are refractory symptoms it is important to ensure that the patient receives the proper care and models that are essential in instituting the best practices and models of change in the set systems.

Voiding food diaries are also recommended to track the food intake and frequency of IC for patients (Pang & Ali, 2015). This helps in assessing the foods and the different symptoms that the patient suffers. Critical examination is necessary to assess if the patient suffers from an increase or decreased pain from the recommended food proportions. However, alcoholic beverages, carbonated drinks, caffeine, spicy foods and vinegar are some of the foods that a patient needs to avoid at all times.

It is critical to ensure that the proper systems have been adopted towards ensuring that the patient does not suffer from increased food intakes and poor dieting programs. The elimination of all sensitive foods and beverages should last for between 2 and 3 months with slight modifications made thereafter until the right diet for the patient is identified (Whitmore, 2002). The critical methods outlined need to meet the critical demands and models that are essentially indicated.

Doctors need to closely monitor and advice their patients towards implementing the critical controls and models essential for change in their dietary program. These are essential towards accentuating and creating a proper control process that matches the significant changes and controls needed towards managing the condition.

Though the elimination diet works for the majority of patients (O’Hare et al., 2013) more research is however needed to assess the success of the method since most of the people do not commit to the model for many years or a long period of time. Although research indicates that there are improvements in the condition of the patients, there is a gap that exists in outlining the critical recommendations and models that are needed in developing the best approaches (Pang & Ali, 2015).

Critical evidence is required towards outlining the best practices through an evidence-based approach that would outline the critical controls and constructs needed within the management program. Cognitive Behavioral Therapy and Psychotherapy Cognitive behavioral therapy (CBT) aims at developing coping strategies that are essential in helping the patients cope with the pain and overcome the growing challenges. This is mainly achieved through altering the pain beliefs and altering their psyche towards achieving better results.

An adoption of interdisciplinary methods have been developed which essentially develop a critical construct essential in effectively reducing the conditions of helpless, increasing perceived control and developing a positive mindset (Kanter et al, 2016). Cognitive behavioral therapy is not a treatment method but helps in ensuring that the patient develops a different model towards overcoming pain and reintegrating a different construct essential in their connections and overcoming stress.

Depression is one of the main effects of IC since it affects the social connections and livelihoods of the patients (Di Capua-Sacoto et al, 2016). It is therefore, critical to ensure that stress reduction as one of the main control processes has been created towards changing and actualizing the specific systems developed. The willingness of the patient to overcome the challenge and overcome the uncomfortable conditions is a critical part of the overall model developed.

The changes in the healthy direction are mainly determined by the ability to overcome the pain-related anxiety, acceptance of pain and overcoming psychosocial disability. In developing proper cognitive behavioral therapy, support is one of the critical attributes that need to be instituted. Patients need to have strong support structures that help them in finding the proper models and maintaining the set attributes as indicated. Psychological flexibility and changes need to be embraced by the patient to ensure that the critical constructs have been developed (Kanter et al, 2016).

There is reliable change that needs to be underlined through the different attributes of functioning and maintaining a positive focus towards developing proper behavioral patterns essential in handling the condition. Cognitive behavioral therapy has been identified as one of the most successful methods with over 47% success rate among patients (Kanter et al, 2016). Critical controls therefore, need to be underlined towards specifically developing and creating better processes and models of change in the systems provided.

The model is mainly designed to ensure that the ability of an individual to overcome the pain through the methods developed is instituted. It is one of the critical components that need to be combined with other CAM models to ensure that the patient does not suffer from increasing problems in the conditional model devised (Di Capua-Sacoto et al, 2016). The improvement and changes that are showed need to be measured through assessing the improvement in the levels of pain acceptance and other changes in the models instituted.

Cognitive behavioral therapy as a method for pain management has been slated to be more than 97% successful since the patients are able to overcome the massive challenges and devise methods towards changing and instituting the main attributes of change indicated (Leong, 2014). The treatment methods need to be effectively modeled towards creating an individualized program that is essential for individuals within the set systems. The constructs that are indicated have to be underlined through the measures and tools indicated in the treatment methods indicated accordingly.

The success rate of cognitive behavioral therapy especially for patients suffering from pain indicates that is one of the best CAM models that should be applied by patients. Physicians are increasingly recommending these methods but patients should consult with the physicians to understand the best models of psychotherapy that work for individualized treatment.

CBT is especially intriguing as a method because it provides patients with a goal that is behavioral, which helps them to conform their lives and daily habits to a standard that is identified by the patient and the physician as the most acceptable goal for that individual.

Therefore, this is an action-oriented approach to managing IC that can help patients to alter their daily lives and habits and thereby produce a new health management lifestyle that in turn helps the individual to be more mindful of avoiding foods and beverages that might trigger the IC or of simply attaining a healthier lifestyle overall. Physical Therapy and Exercises Physical therapy and exercises is also one of the main methods that can be used in cases of IP.

The myofascial physical method is applied in this case to ensure that the patient develops control of the trigger points and ensures that they have control over the condition. There are different areas or muscle points that can be engaged in this case to improve the condition of the patient depending on the exercise regime instituted. The CAM model in this case aims at resolving the contractions and lengthening the muscle contractures in the pelvic floor (Kanter et al, 2016; Pang & Ali, 2015).

The underlying models of physical therapy and exercises are mainly aimed at ensuring that the patient gains from the critical models as indicated in the patterns or frequency of the patient. It is essential to develop the best exercises that have a high success rate through integrating a proper physical therapy method essential to change the dynamics indicated. Reducing pelvic pain and urinary frequency are the main critical processes that need to be effectively developed towards ensuring that the proper physical exercise methods are instituted.

It is important to ensure that one consults a physical therapist to ensure that the exercises are effective as intervention methods for the patient. Massaging of the pelvic floor is also one of the methods that can be used to reduce the pelvic pain. Proper methods however need to be applied towards ensuring that the critical approaches have been devised thereby creating the specific controls and approaches essential for the patient. The practices need to be tailored through an individualized method and program depending on the varying pain and frequency.

The critical controls need to be adopted since the method helps in releasing the painful scars and connective tissue restrictions that lead to pain for the patient. Patients with IC suffer from continued pain that limits most of their overall models and activities thereby leading to connective tissue restrictions in the body (Pang & Ali, 2015). This critically influences the models that are applied and inculcated through the main scope and essential tools created.

The patient needs to be closely monitored to ensure that they gain from the methods and feedback from the patient is essential. Physical therapy is essential since the patient is involved in the alternative method that is instituted. There is total focus and involvement of the patient within the methods devised thereby creating a specific control process as matched in the systems applied accordingly.

Physical therapy is essentially in line with other CAM modalities in that it allows the patient to focus primarily on the body and on ways to better maintain a healthy disposition. Active lifestyles have long been associated with health (Nooijen et al., 2012) and patients who receive physical therapy will be more likely to engage in active lifestyles thanks to the therapy they receive in this modality. The more active the patient, the less likely the IC is to flare up in many cases examined in this research (Pang & Ali, 2015).

For that reason, it is a recommended modality by many physicians and one that can be tailored to meet the needs of the patient. However, more information is needed to fully understand the different types of physical therapy that may be most beneficial, or if a combination of therapies can work to help eliminate the symptoms of IC altogether.

For example, if acupuncture might be conjoined with a form of physical therapy or massaging to ease the symptoms, more headway into understanding the phenomenon of IC and its treatment could be obtained. Alternative and complementary over the counter medications There are alternative over the counter medication that can be used as options towards controlling the pain and irritation that the patients feel in their pelvic floor. CystoProtek is one of the medications that help in reducing bladder wall dysfunction and inflammation (Regauer, 2016).

The medication combines with the naturally occurring molecules in the body and helps in addressing the pathogenic pathways that are spread in the body. It is one of the medications that have been widely used to treat the condition and helps in reducing the symptoms for IC considerably. In a research conducted, 51% of the men reported that there were reduced effects while 48.5 % of the women also reported reduced irritation (Chaao et al, 2015).

The medication has the individual molecules that replenish the bladder lining and help in reducing the level of irritability. The mucopolysaccharides that are spread in the drugs help in replenishing and creating a conducive environment essential in decreasing bladder inflammation (Chaao et al, 2015). It is therefore, critical to develop the proper controls that are essential in instituting the specific models and changing the main traits and models indicated.

The drug helps in ensuring that the patient does not suffer continuously from conditions that can easily be overcome with proper medication in the body. Prelief medication or an anti-acid is also one of the methods that is used in treating the condition. Prelief medication helps in the alkalinization process for the patient who is essential in reducing the effects of acidic foods within the body (Anderson and Zinkraf, 2013).

Coffee, alcoholic drinks, carbonated drinks and other acidic foods were found to be controlled through taking the prelief medication that is essential in ensuring that patients have the best controls and models needed accordingly (Kim et al, 2016). The caffeinated and spicy foods form part of the overall models that are instituted and modeled towards ensuring that the patient does not suffer from sustained irritation. It is one of the main methods that are used since it helps the patients without any side effects.

It is a critical method for CAM as it represents one of the main models that are used in patient care and improves the symptoms of a patient (Dunlap et al, 2013). Most of the patients note that it is critical especially when coupled with water as it helps in reducing the pain. The model therefore, represents one of the critical controls essential in giving the patients relief from the painful and irritable conditions faced.

Herbal therapy is viewed as a type of medicinal intervention that still requires more study (Pang & Ali, 2015). There are currently mixed reviews as to the extent of its effectiveness as an application. However, when used in conjunction with other therapies, the symptoms of IC are more likely to dissipate over time. Bladder retraining The method mainly focuses of extending the voiding interval and restricting against the bodily urges when they present.

It was found out that in 15 out of 21 patients with IC the method reduced the frequency intervals by approximately 30mins every 3-4 weeks (Anderson and Zinkraf, 2013). It has been indicated to be a critical method in addressing the problem since it forms part of the overall controls that patients need to institute towards ensuring that they meet the frequency levels and gain control in the models instituted.

The critical controls underlined formed a critical process that was specifically matched and indicated the main features and controls essential towards overseeing change in the tools developed (O’Hare, et al, 2013). The method mainly focuses on controlling the pelvic floor muscles through visualizing the muscles on the computer. It is a method that works well when it is coupled with exercises and physical therapy models.

The critical controls need to be matched and modeled towards meeting the set standards and tools essential for change in the systems accordingly (Atchley et al, 2015). Depending on the patient the critical controls and methods which are developed need to match the patient needs at all times. The critical constructs are specifically underlined and created towards instituting the main thematic processes and means of change within the management practices indicated. Bladder retraining and biofeedback are critical methods that have been used as interventions against the condition.

The use of the methods while incorporating other models underlines the importance of a proper functional process that can lead to more success for the patient. Bladder retraining can help patients to cope with IC over an extended period of time (Pang & Ali, 2015); however, it can also provide them with discomfort during the actual training period, especially if they are not well-educated as to the effects of the training that they are likely to endure.

Physicians should be careful to discuss with patients some of the side effects of bladder training, such as extreme discomfort in many cases. It can be an effective technique, but there is also a need to better understand if other modalities are not more effective at reducing the symptoms of IC or of eliminating it altogether. Acupuncture Acupuncture is a nerve stimulation method that helps in addressing problems in frequency, urgency and pain for patients with IC.

The model uses needles that are specifically inserted in the nerve centers and help in controlling and alleviating pain and other blockages. It is a critical method that uses different techniques aimed at deriving the same results. Research has shown that most of the patients that use acupuncture are ready to use it continually as the main management practice for IC (Anderson and Zinkraf, 2013).

It is has been found to be as effective as physical therapy since it helps in deriving the critical controls and models of change in the systems accordingly. Patients are given the best model of change that aligns with the individual attributes and means essential in deriving the critical means and controls for change within the problematic areas. The areas close to the pelvic floor are mainly stimulated to ensure that it alleviates any blockages that may be causing pain for the patient.

The different nerve centers are actively engaged with the method helping in giving patients the best form of care as an alternative management method against IC. Research showed that more than 50% note that the acupuncture method was recommended by a physician or other patients with a similar condition (Pang & Ali, 2015). It is however, critical to note that although it is a safe method if conducted in a safe and proper environment, proper care and caution is needed towards ensuring that the best practices and models are developed.

The individual traits need to be mapped and underlined in the systems and controls that are developed. Acupuncture can subjectively and objectively improve patients’ morale and relief with respect to IC (Pang & Ali, 2015). However, there is not a great deal of evidence associated with this particular intervention and more data is needed before a proper assessment can be given.

The problem with this intervention is that many individuals, especially in the West, are less likely to see it as a positive modality out of fear or lack of familiarity with what it does and how it works. As with bladder retraining, some education may be required and the physician should be able to provide that education.

At the same time, more clinical trials are needed to fully grasp the extent to which acupuncture may be an effective modality for treating IC and for which demographics of patients it is most likely to be effective. Methodology This study used the qualitative literature review design with a focus on reviewing the existing literature on CAM methods of treatment for IC in order to better understand what the current status of knowledge on CAM interventions is for IC patients and physicians.

The literature search was conducted using key terms such as “IC CAM,” “CAM methods IC,” “interstitial cystitis alternative treatment,” “interstitial cystitis complementary alternative methods,” and so on. Key word searches were conducted in online scholarly databases with Google Scholar being used as the primary search tool engine. As Falagas, Pitsouni, Malietzis and Pappas (2008) have shown, Google Scholar is a suitable method for obtaining links to relevant articles related to key word search times.

Scholar provides links to databases such as PubMed and myriad others. Literature was initially selected based on publication year, going back ten years, and references from this initial batch of literature were used for snowball sampling purposes. The literature reviewed by the researchers of the initial batch of articles collected was reviewed and cross-indexed to examine how information was generated on CAM approaches going more than twenty years. The articles were reviewed first by examining the title and abstract and then by conducting a thorough reading of the articles.

Common themes that emerged were gathered into a database in an Excel spreadsheet. CAM methods were identified by commonality of reference with main methods identified by researchers ranked at the top of the database. The CAM methods were then researched individually in Google Scholar to obtain a further pool of articles that could then be assessed. Exclusion criteria included articles that focused on counter-evidence, positing that CAM treatments were ineffective.

These were not included primarily in this study because as has already been noted by Katpchuck (2002) there is believed to be a placebo effect among patients using CAM, and so any further evidence to this point would be simply a re-iteration of what has already been acknowledged. Instead, inclusion criteria for studies were based on relevance to CAM and IC treatment, focus on methodologies, tests, trials and explanations. Systematic reviews, quantitative studies, and qualitative research was included.

All ethical guidelines were followed in conducting the research and the critical tools and processes essential towards developing the best strategic models were developed in the research accordingly. For example, when assessing which articles to use in the study, design, methodology and purpose were primarily ascertained as important. So long as the researcher was indicating a purpose of evaluating the effectiveness of CAM or discussing CAM as a preferable treatment for IC patients, the study was deemed useful.

Data from the studies was collected into Excel spreadsheets with statistics from studies noted and recorded in the Excel database to indicate which methods had which outcomes among patients, which methods were most favored among patients, which were most recommended by physicians and so on. These data profiles were then categorized and indexed according to popularity of ranking. These rankings then became the source of analysis, which is discussed in the next section.

Results The scholarly literature on the subject of CAM treatments for IC has shown that approximately 40% of IC patients admitted to have tried other methods of treatment and medication with no proper recovery. Physicians also recommended the use of the CAM methods for patients who were not feeling any change through the medication for over 80% of the cases. There was also a recorded increase by approximately 35% of physicians who noted that the new methods were better suited and more critical in the care among patients than traditional medicine.

Dietary modification was one of the most prevalent methods used by the patients with more than 44% noting that they had tried the method or were using it as one of their major options. The bladder retraining method and physical therapy were also popular methods among patients noting a rate of 49% of the total number of patients to have used this method. There was approximately 31% of the patients who noted that they had received the advice from their physicians.

Acupuncture was the least common method with most people being uncomfortable with the method as they were unsure of the techniques used. It was identified by approximately 5% of the patients as a risky and uncomfortable method of treating the condition. Discussion The results indicate the change in the level of use for CAM in the society as more people are using the treatment. The CAM methods have gained in prevalence across the society due to increased popularity among patients as well as physicians.

Physicians recommend the CAM methods to the patients as changes are developed and critical constructs are identified in the tools and means identified accordingly. It is therefore, critical to develop the methods further and more research to be done of different traits and conditions of patients after using CAM techniques as this would increase its use among patients. An analysis of different fields of care where CAM methods are feasible, more people are preferring these methods to medications since they are better in treating some of the critical conditions.

Interstitial cystitis is no different and critical care needs to be taken towards ensuring that the best practices and methods have been instituted and actualized within the systems indicated accordingly. There are many traits that need to be actualized with proper controls and processes being mapped under the set systems accordingly. It is these significant processes that need to be critically measured towards developing the best practices for the future use of CAM methods.

However, critical evidence is required towards outlining the best practices with respect to an evidence-based approach that would outline the controls and constructs needed within the management program. It is still as of yet unclear whether there is a general CAM for IC that will work for all patients. Likewise, developing a basic CAM method for IC is still something that patients and physicians could benefit from. Currently, there is a first line, second line, and third line approach to treating IC.

Treatment may end up lasting months or even years as patients and physicians search for an intervention that is suitable. It may be that no generalized approach will be forthcoming. In such a case, it is imperative that more data be collected on patients with particular characteristics so that physicians can see which methods worked best for patients of various categorical qualities.

Cataloguing the data and creating a database of characteristics of patients who benefited from particular CAM methods would be a positive first step in treating IC via CAM with a systemized evidence-based approach. Conclusion and recommendations In conclusion, CAM methods in managing IC need a multimodal management model for one to get the highest success rates. Patients are slowly looking for the best combination of management practices that meet their needs as individuals within the society.

Critical controls have to be underlined through actualizing and creating proper channels and controls that match the needs of individuals depending on their needs.