1
|
Schrepf A, Naliboff B, Williams DA, Stephens-Shields AJ, Landis JR, Gupta A, Mayer E, Rodriguez LV, Lai H, Luo Y, Bradley C, Kreder K, Lutgendorf SK. Adverse Childhood Experiences and Symptoms of Urologic Chronic Pelvic Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study. Ann Behav Med 2019; 52:865-877. [PMID: 30212850 DOI: 10.1093/abm/kax060] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Adverse Childhood Experiences (ACEs) such as sexual and physical violence, serious illness, and bereavement have been linked to number of chronic pain conditions in adulthood, and specifically to urologic chronic pelvic pain syndrome (UCPPS). Purpose We sought to characterize the prevalence of ACEs in UCPPS using a large well-characterized cohort in comparison with a group of healthy controls. We also sought to determine the association of ACE severity with psychological factors known to impact pain and to determine whether ACEs are associated with patterns of improvement or worsening of symptom over a year of naturalistic observation. Methods For longitudinal analyses we used functional clusters identifying broad classes of (a) improved, (b) worsened, and (c) stable groups for genitourinary pain and urinary symptoms. We employed a mediation/path analysis framework to determine whether ACEs influenced 1 year outcomes directly, or indirectly through worse perceptions of physical well-being. Results ACE severity was elevated in UCPPS (n = 421) participants compared with healthy controls (n = 414; p < .001), and was most strongly associated with factors associated with complex chronic pain, including more diffuse pain, comorbid functional symptoms/syndromes, and worse perceived physical well-being (all p < .001). Finally, worse physical well-being mediated the relationship between ACE severity and less likelihood of painful symptom improvement (OR = .871, p = .007)) and a greater likelihood of painful symptom worsening (OR = 1.249, p = .003) at 1 year. Conclusions These results confirm the association between ACEs and UCPPS symptoms, and suggest potential targets for therapeutic interventions in UCPPS. Clinical Trial registration NCT01098279.
Collapse
Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Bruce Naliboff
- Department of Medicine, University of California, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Alisa J Stephens-Shields
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Arpana Gupta
- Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Emeran Mayer
- Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Yi Luo
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Catherine Bradley
- Department of Urology, University of Iowa, Iowa City, IA, USA.,Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Department of Psychological and Brain Sciences and Urology, University of Iowa, Iowa City, IA, USA
| | | |
Collapse
|
2
|
Crawford A, Tripp DA, Nickel JC, Carr L, Moldwin R, Katz L, Muere A. Depression and helplessness impact interstitial cystitis/bladder pain syndrome pain over time. Can Urol Assoc J 2018; 13:328-333. [PMID: 31364973 DOI: 10.5489/cuaj.5703] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) is a devastating urological chronic pelvic pain condition with an unknown etiology. Evidence-based psychological strategies are becoming more successful for symptom management as we learn more about the targets for intervention. Previous research has established an indirect relationship between depression and pain through catastrophizing, but there have yet to be studies examining the emerging role of emotion regulation in this relationship. METHODS Women with IC/BPS were recruited from tertiary care clinics in Canada and the U.S. between 2013 and 2018. Patients completed questionnaires, including demographics and scores for pain, depression, catastrophizing, and difficulties in emotion regulation at baseline, six months, and one year. Serial mediation was used to test models of pain, catastrophizing, and depression. RESULTS A total of 135 women with IC/BPS completed all three time points. The only significant indirect path was from baseline depression to catastrophizing at six months to pain at one year (b=0.10; confidence interval [CI] 0.0049-0.2520). A followup analysis demonstrated that helplessness was the key factor of catastrophizing driving this relationship (b=0.17; CI 0.0282-0.3826). CONCLUSIONS Reducing feelings of helplessness and increasing patient feelings of control are important ways to limit the effect of low mood on patient pain experience. De-catastrophizing interventions should be part of the referral strategy for IC/BPS symptom management.
Collapse
Affiliation(s)
- Alison Crawford
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Dean A Tripp
- Departments of Psychology, Urology, & Anesthesiology, Queen's University, Kingston, ON, Canada
| | - J Curtis Nickel
- Department of Urology Queen's University, Kingston, ON, Canada
| | - Lesley Carr
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Robert Moldwin
- Department of Urology, Hosftra University School of Medicine, New Hyde Park, NY, United States
| | - Laura Katz
- Michael G. DeGroote Pain Clinic, McMaster University Hospital, Hamilton, ON, Canada
| | - Abi Muere
- Department of Psychology, Queen's University, Kingston, ON, Canada
| |
Collapse
|
3
|
Naliboff BD, Stephens AJ, Lai HH, Griffith JW, Clemens JQ, Lutgendorf S, Rodriguez LV, Newcomb C, Sutcliffe S, Guo W, Kusek JW, Landis JR. Clinical and Psychosocial Predictors of Urological Chronic Pelvic Pain Symptom Change in 1 Year: A Prospective Study from the MAPP Research Network. J Urol 2017; 198:848-857. [PMID: 28528930 PMCID: PMC5720154 DOI: 10.1016/j.juro.2017.05.065] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE We examined baseline clinical and psychosocial characteristics that predict 12-month symptom change in men and women with urological chronic pelvic pain syndromes. MATERIALS AND METHODS A total of 221 female and 176 male patients with urological chronic pelvic pain syndromes were recruited from 6 academic medical centers in the United States and evaluated at baseline with a comprehensive battery of symptom, psychosocial and illness-impact measures. Based on biweekly symptom reports, a functional clustering procedure classified participant outcome as worse, stable or improved on pain and urinary symptom severity. Cumulative logistic modeling was used to examine individual predictors associated with symptom change as well as multiple predictor combinations and interactions. RESULTS About 60% of participants had stable symptoms with smaller numbers (13% to 22%) showing clear symptom worsening or improvement. For pain and urinary outcomes the extent of widespread pain, amount of nonurological symptoms and poorer overall health were predictive of worsening outcomes. Anxiety, depression and general mental health were not significant predictors of outcomes but pain catastrophizing and self-reported stress were associated with pain outcome. Prediction models did not differ between men and women and for the most part they were independent of symptom duration and age. CONCLUSIONS These results demonstrate for the first time in a large multisite prospective study that presence of widespread pain, nonurological symptoms and poorer general health are risk factors for poorer pain and urinary outcomes in men and women. The results point to the importance of broad based assessment for urological chronic pelvic pain syndromes and future studies of the mechanisms that underlie these findings.
Collapse
Affiliation(s)
- Bruce D Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California.
| | - Alisa J Stephens
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery and Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois
| | - J Quentin Clemens
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Susan Lutgendorf
- Department of Psychological and Brain Sciences and Urology, University of Iowa, Iowa City, Iowa
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Craig Newcomb
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Siobhan Sutcliffe
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - J Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
The therapeutic approach to different forms of cystitis: impact on public health. Urologia 2017; 84:8-15. [PMID: 28862726 DOI: 10.5301/uj.5000262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/20/2022]
Abstract
Interstitial cystitis/bladder pain syndrome, recurrent urinary tract infections and other forms of cystitis significantly impact the quality of life of patients with chronic bladder disorders and impose a considerable economic burden on health systems. Effective management is essential to provide symptom relief and to reduce the negative impact of chronic bladder disorders. Identifying the appropriate pharmacological or non-pharmacological approach is essential, and there is a growing evidence base for the use of intravesical hyaluronic acid and chondroitin sulfate in several bladder conditions, including recurrent urinary tract infections.
Collapse
|
5
|
Tyagi P, Kashyap M, Majima T, Kawamorita N, Yoshizawa T, Yoshimura N. Intravesical liposome therapy for interstitial cystitis. Int J Urol 2017; 24:262-271. [DOI: 10.1111/iju.13317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/22/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Pradeep Tyagi
- Department of Urology; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - Mahendra Kashyap
- Department of Urology; University of Pittsburgh; Pittsburgh Pennsylvania USA
| | - Tsuyoshi Majima
- Department of Urology; Nagoya University Graduate School of Medicine; Nagoya Aichi Japan
| | - Naoki Kawamorita
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Miyagi Japan
| | | | - Naoki Yoshimura
- Department of Urology; University of Pittsburgh; Pittsburgh Pennsylvania USA
| |
Collapse
|
6
|
Schrepf A, O'Donnell MA, Luo Y, Bradley CS, Kreder KJ, Lutgendorf SK. Inflammation and Symptom Change in Interstitial Cystitis or Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study. Urology 2016; 90:56-61. [PMID: 26768711 DOI: 10.1016/j.urology.2015.12.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore inflammatory factors that influence symptom changes in interstitial cystitis or bladder pain syndrome (IC or BPS). This longitudinal, prospective study examined the association of inflammation elicited by Toll-like receptor (TLR) stimulation in peripheral blood mononuclear cells (PBMCs) and diurnal cortisol rhythms with changes in painful and urinary symptoms of IC or BPS and symptom flares over a 48-week period. MATERIALS AND METHODS Participants were 24 women meeting criteria for IC or BPS who supplied blood for isolation of PBMCs and 3 days of salivary cortisol samples prior to a baseline visit. Participants completed the Genitourinary Pain Index (pain and urinary subscales) and reported symptom flares every 2 weeks for 48 weeks. Mixed effects longitudinal and regression models were used to determine if inflammatory variables were associated with the changes in IC or BPS symptoms (time × variable interactions), and the probability of a symptom flare. RESULTS Elevated TLR-4 inflammation (P = .031) and elevated TLR-2 inflammation (P = .045) from PBMCs, and flattened diurnal cortisol slope (P = .012) were each associated with less improvement in genitourinary pain over time. Additionally, elevated TLR-4 inflammation was associated with less improvement in urinary symptoms (P = .018), whereas TLR-2 inflammation and cortisol slopes were not (both P > .16). In contrast, no inflammatory measure was associated with an increased likelihood of reporting a symptom flare (all P > .25). CONCLUSION TLR-mediated inflammation and diurnal cortisol slope may be useful as markers of symptom changes in IC or BPS.
Collapse
Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | | | - Yi Luo
- Department of Urology, University of Iowa, Iowa City, IA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA; Department of Urology, University of Iowa, Iowa City, IA
| | - Karl J Kreder
- Department of Urology, University of Iowa, Iowa City, IA
| | - Susan K Lutgendorf
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA; Department of Urology, University of Iowa, Iowa City, IA; Department of Psychological and Brain Science, University of Iowa, Iowa City, IA.
| |
Collapse
|