Triamcinolone injections a boon in Hunner's lesions in bladder pain syndrome

The use of Triamcinolone injections into Hunner's lesions resulted in a significant reduction in the number of pain treatments for bladder pain syndrome (BPS). This also resulted in decreased opioid use. The study was published in the Journal of Clinical Urology. 

Bladder pain syndrome is a common cause of chronic pelvic pain with associated lower urinary symptoms. It was earlier called interstitial cystitis. Patients with BPS have Hunner's lesions. Even though past research has shown the use of triamcinolone injections for BPS, there was not much literature on the repeated use of triamcinolone injections for BPS. Hence researchers conducted a study to determine if periodic triamcinolone injections into Hunner's lesion in patients with bladder pain syndrome (BPS) reduce the need for opioids and other pain treatments. The study was carried out between 2010 and 2018. 

A retrospective analysis of 28 patients was done by giving endoscopic injections of 0.5–1.0 cc of triamcinolone acetate into Hunner's lesions. Wilcoxon signed-rank test was used to compare pain regimens before and after injections.

Findings: 

• The median age at the first triamcinolone injection was 63.
• At a mean of 8-month intervals, the median number of injections/patients was 3. 
• 25% of the patients were using opioids and the median number of pain treatments before triamcinolone was 4. 
• 92.9% had improvement in pain symptoms, with one or more injections.
• There was a significant decrease in several pain treatments following triamcinolone injections.
• Fifty-seven percent were managed with triamcinolone injections alone, with no other pain treatments.
• Of the seven patients using opioids, four discontinued opioids altogether. 

Thus, the researchers concluded that repeat use of triamcinolone injections into Hunner's lesions was associated with a significant reduction in the number of pain treatments used for BPS. They also found an associated decrease in opioid use. 

Further reading: 10.1177/20514158221122521

Neu S, Locke JA, Rebullar K, Carr L, Herschorn S. Recurrent triamcinolone injections for the treatment of Hunner's lesions in the bladder pain syndrome. Journal of Clinical Urology. 2022;0(0).