mesna and Pain

In order to evaluate the preventive efficacy, safety and usefulness of mesna (Sodium 2-mercaptoethane sulfonate) against ifosfamide-induced urinary disorders, a placebo-controlled double-blind comparative study was performed. Ifosfamide was administered by intravenous drip infusion at a daily dose of 2 g/m2 for 5 consecutive days, and mesna was intravenously administered at 20% of the ifosfamide dose, three times daily for 5 consecutive days. The results obtained are as follows. (a) Of 101 accrued patients, 91 patients were evaluated consisting of 45 for the mesna group and 46 for the placebo group. There was no intergroup difference in the number of the evaluated cases and patient characteristics. (b) Micturition pain and feeling of residual urine graded as moderate or severe were not observed for the mesna group, but were observed for the placebo group with incidences of 19.6% (9/46) for micturition pain and 15.2% (7/46) for feeling of residual urine; the intergroup differences in the appearance of these urinary symptoms were statistically significant (P = 0.0003 for micturition pain; P = 0.0009 for feeling of residual urine). The incidence of hematuria graded as moderate or severe was 6.7% (3/45) in the mesna group, which was significantly lower than the 32.6% (15/46) in the placebo group (P = 0.0008). (c) No side-effect attributable to mesna was observed. (d) A judgment of "useful" was obtained in 80.0% (36/45) of the patients treated with mesna, which was significantly higher than the 34.8% (16/46) of the patients treated with placebo (P = near 0). On the basis of the above results, we conclude that the preventive efficacy, safety and usefulness of mesna against ifosfamide-induced urinary disorders have been well demonstrated in this study.

Topics: Adult; Aged; Double-Blind Method; Female; Hematuria; Humans; Ifosfamide; Lung Neoplasms; Male; Mesna; Middle Aged; Pain; Urination Disorders; Urologic Diseases

Mast cells accessing the brain parenchyma through the blood-brain barrier in healthy animals are limited to pre-cortical sensory relays - the olfactory bulb and the thalamus. We have demonstrated that unilateral repetitive stimulation of the abdominal wall generates asymmetry in midline thalamic mast cell (TMC) distribution in cyclophosphamide-injected rats, consisting of contralateral side-prevalence with respect to the abdominal wall stimulation. TMC asymmetry 1) was generated in strict relation with cystitis, and was absent in disease-free and mesna-treated animals, 2) was restricted to the anterior portion of the paraventricular pars anterior and reuniens nuclei subregion, i.e., the rostralmost part of the paraventricular thalamic nucleus, the only thalamic area associated with viscero-vagal and somatic inputs, via the nucleus of the solitary tract, and via the medial contingent of the spinothalamic tract, respectively, and 3) originated from somatic tissues, i.e., the abdominal wall where bladder inflammation generates secondary somatic hyperesthesia leading to referred pain in humans. Present data suggest that TMCs may be involved in thalamic sensory processes, including some aspects of visceral pain and abnormal visceral/somatic interactions.

Topics: Afferent Pathways; Animals; Autonomic Pathways; Blood-Brain Barrier; Brain; Chemotaxis, Leukocyte; Cyclophosphamide; Cystitis; Disease Models, Animal; Functional Laterality; Immunosuppressive Agents; Male; Mast Cells; Mesna; Nociceptors; Pain; Protective Agents; Proto-Oncogene Proteins c-fos; Rats; Rats, Sprague-Dawley; Thalamus; Visceral Afferents

An experimental rat model for the study of venous pain induced by 4-hydroxy-cyclophosphamide (4-OH-CP) derivatives was developed and validated. Using various metabolites and chemical variants of 4-OH-CP it was found that pain induction was independent from the compound's alkylating activity but possibly related to the spontaneous generation of minute amounts of acrolein from the 4-OH-CP molecule. Accordingly, the pain could be prevented by the addition of thiol compounds such as mesna or N-acetyl-cysteine.

Topics: Acetylcysteine; Animals; Antineoplastic Agents; Cyclophosphamide; Mesna; Pain; Rats; Veins