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Lai HH, Bayman EO, Bishop MO, Landis JR, Harte SE, Clemens JQ, Rodiguez LV, Sutcliffe S, Taple BJ, Naliboff BD, Network TMR. LONGITUDINAL CHANGES IN THE PELVIC PAIN ONLY AND WIDESPREAD PAIN PHENOTYPES OVER ONE YEAR IN THE MAPP-I UROLOGIC CHRONIC PELVIC PAIN SYNDROME (UCPPS) COHORT. Urology 2022; 161:31-35. [PMID: 35021046 DOI: 10.1016/j.urology.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine how often urologic chronic pelvic pain syndrome (UCPPS) patients progressed from Pelvic Pain Only at baseline to Widespread Pain, or vice versa, during one-year longitudinal follow-up. METHODS Men and women with UCPPS enrolled in the MAPP-I Epidemiology and Phenotyping Study completed a self-report body map to indicate their locations of pain every 2 months over 12 months. Patients were categorized at each assessment into one of three pain phenotypes: 1) Pelvic Pain Only, 2) an Intermediate group, 3) Widespread Pain. Only patients who completed 3 or more follow-ups were included in this longitudinal analysis. The primary outcome measure was pain classification at the majority (≥60%) of follow-up assessments. Longitudinal trends of somatic symptom burden were also assessed. RESULTS Among the 93 UCPPS participants with Pelvic Pain Only at baseline, only 2% (n=2) showed a Widespread Pain phenotype for the majority of assessments over 12 months. Among the 121 participants who had Widespread Pain at baseline, 6% (n=7) demonstrated Pelvic Pain Only for the majority of assessments over 12 months. Over half of participants (≥53%) stayed in their baseline phenotypic group. Somatic symptom burden remained stable over 12 months for each of the groups with high intra-class correlation coefficient (0.67 to 0.82). CONCLUSIONS It was uncommon for UCPPS patients to progress from Pelvic Pain Only to Widespread Pain, or vice versa, over 12 months. These data suggest that Pelvic Pain Only and Widespread Pain are distinct UCPPS phenotypes that are relatively stable over 12 months of follow up.
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Affiliation(s)
- H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University School of Medicine, St Louis, MO.
| | - Emine O Bayman
- Department of Biostatistics, University of Iowa, Iowa City, IA; Department of Anesthesiology, University of Iowa, Iowa City, IA
| | | | - J Richard Landis
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | | | - Larissa V Rodiguez
- Departments of Urology, and Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
| | - Siobhan Sutcliffe
- Departments of Surgery (Public Health Sciences), Washington University School of Medicine, St Louis, MO
| | - Bayley J Taple
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bruce D Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Deutsch G, Deshpande H, Lai HH, Kutch JJ, Ness TJ. Cerebral Perfusion and Sensory Testing Results Differ in Interstitial Cystitis/Bladder Pain Syndrome Patients with and without Fibromyalgia: A Site-Specific MAPP Network Study. J Pain Res 2022; 14:3887-3895. [PMID: 34992450 PMCID: PMC8711634 DOI: 10.2147/jpr.s343695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Fibromyalgia is a common co-morbidity in patients with interstitial cystitis/bladder pain syndrome. Quantitative sensory testing measures and regional cerebral blood flow measures have been noted to differ from healthy controls in both subjects with fibromyalgia and those with interstitial cystitis when studied independently. The present study examined such measures in subjects with the diagnosis of interstitial cystitis both with and without the co-diagnosis of fibromyalgia to determine whether differences in these measures may be associated with co-morbidity. Patients and Methods Female subjects with the diagnosis of interstitial cystitis with (n = 15) and without (n = 19) the co-diagnosis of fibromyalgia as well as healthy control subjects (n = 41) underwent quantitative sensory testing. A subset of these patients (9 with and 9 without fibromyalgia) underwent brain perfusion studies using arterial spin labeled functional magnetic resonance imaging. An analysis was performed of absolute regional cerebral blood flow of regions-of-interest when experiencing a full bladder compared with an empty bladder. Results Subjects with both interstitial cystitis and fibromyalgia were more hypersensitive than those without fibromyalgia as well as healthy controls in most sensory measures except heat. Subjects with interstitial cystitis, but no fibromyalgia, differed from healthy controls only in toleration of the ischemic forearm task. Other co-morbidities were more common in those subjects with both interstitial cystitis and fibromyalgia. Bladder fullness was associated with significantly greater whole brain gray matter blood flow in subjects with interstitial cystitis and fibromyalgia when compared with that of subjects with interstitial cystitis without fibromyalgia. Examination of regional cerebral blood flow in individual regions-of-interest demonstrated statistically significant differences between the subjects with interstitial cystitis with and those without fibromyalgia bilaterally in the thalamus, amygdala and hippocampus, as well as the right prefrontal cortex and greater responsiveness to changes in bladder fullness in the insula. Conclusion Quantitative sensory testing and brain perfusion data support that there are two phenotypes of interstitial cystitis patients, which can be differentiated by a co-diagnosis of fibromyalgia. This may affect responsiveness to treatment and suggest the utility of stratifying interstitial cystitis patients according to their co-morbidities.
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Affiliation(s)
- Georg Deutsch
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hrishikesh Deshpande
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Timothy J Ness
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Gross J, Vetter J, Lai HH. Clinical Presentation of Urologic Chronic Pelvic Pain Syndrome (UCPPS) Varies With Presenting Age - Implication on Patient Evaluation. Urology 2021; 158:66-73. [PMID: 34302833 DOI: 10.1016/j.urology.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the clinical presentation of UCPPS from a large clinical practice grouped by their presenting age to improve the evaluation of this condition. METHODS A total of 223 male and female patients seeking care for their UCPPS were recruited to study their urologic and non-urologic presentation. Their evaluation included cystoscopy and multiple questionnaires to assess their pelvic pain, non-urologic pain, urinary symptoms, somatic symptoms, and psychosocial health. Patients were then grouped by age into the following groups: less than 30 years of age, between the ages of 30 and 60, and older than 60. These groups were then compared on multiple domains. RESULTS Patients between the ages of 60 and 30 were most likely to have concomitant COPC (such as fibromyalgia or migraine headaches), more widespread distribution of non-urologic pain, higher somatic symptom burden, and depression. Patients 30 years old or younger were more likely to have more severe urologic and non-urologic pain, and urinary pain symptoms that are less typical of IC/BPS (eg, pain worsened during or after urination). Patients older than 60 were more likely to have Hunner lesion (55.6% vs 23.8% vs 8.6% among those who had cystoscopy, in decreasing age, P < .001). CONCLUSION Our findings support the evaluation of non-urologic pain, COPC and psychosocial health in middle-aged patients; Hunner lesion in older patients; and a higher clinical suspicion of other confusable diagnoses when younger patients present with atypical symptoms.
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Affiliation(s)
- James Gross
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States; Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States.
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Abstract
BACKGROUND Overactive bladder is a heterogenous condition with poorly characterized clinical phenotypes. To discover potential patient subtypes in patients with overactive bladder (OAB), we used consensus clustering of their urinary symptoms and other non-urologic factors. METHODS Clinical variables included in the k-means consensus clustering included OAB symptoms, urinary incontinence, anxiety, depression, psychological stress, somatic symptom burden, reported childhood traumatic exposure, and bladder pain. RESULTS 48 OAB patients seeking care of their symptoms were included. k-means consensus clustering identified two clusters of OAB patients: a urinary cluster and a systemic cluster. The systemic cluster, which consisted of about half of the cohort (48%), was characterized by significantly higher psychosocial burden of anxiety (HADS-A, 9.5 vs. 3.7, p < 0.001), depression (HADS-D, 6.9 vs. 3.6, p < 0.001), psychological stress (PSS, 21.4 vs. 12.9, p < 0.001), somatic symptom burden (PSPS-Q, 28.0 vs. 7.5, p < 0.001), and reported exposure to traumatic stress as a child (CTES, 17.0 vs. 5.4, p < 0.001), compared to the urinary cluster. The systemic cluster also reported more intense bladder pain (3.3 vs. 0.8, p = 0.002), more widespread distribution of pain (34.8% vs. 4.0%, p = 0.009). The systemic cluster had worse urinary incontinence (ICIQ-UI, 14.0 vs. 10.7, p = 0.028) and quality of life (SF-36, 43.7 vs. 74.6, p < 0.001). The two clusters were indistinguishable by their urgency symptoms (ICIQ-OAB, OAB-q, IUSS, 0-10 ratings). The two OAB clusters were different from patients with IC/BPS (worse urgency incontinence and less pain). CONCLUSIONS The OAB population is heterogeneous and symptom-based clustering has identified two clusters of OAB patients (a systemic cluster vs. a bladder cluster). Understanding the pathophysiology of OAB subtypes may facilitate treatments.
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Gornet ME, Chandawarkar A, Herati A, Dellon AL. Interstitial Cystitis/Bladder Pain Syndrome as Referred Pain From Injured T12/L1 Nerves: Symptomatic Improvement With Resection of Ilioinguinal and Iliohypogastric Nerves. Urology 2020; 149:24-29. [PMID: 33279610 DOI: 10.1016/j.urology.2020.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the specific contribution of ilioinguinal (II) and iliohypogastric (IH) nerve injury and referred pain to interstitial cystitis/bladder pain syndrome and patient-reported chronic pelvic pain, and to enumerate the effects of II and IH nerve resection on the pain and voiding symptoms in patients with IC/BPS. MATERIALS AND METHODS This was a prospective cohort study of 8 patients with ICS/BPS who had prior abdominal surgery. All patients received diagnostic image guided T12/L1 nerve blocks, followed by II and IH nerve resections. Validated O'Leary-Sant ICS symptom indices (OSPI) and pelvic pain and urgency/frequency patient symptoms scale (PUF) scores were collected at specified intervals pre- and post-operatively. RESULTS Median scores at pre-operative (OSPI 13.9, PUF 20.4) and 1 week time points (OSPI 5.9, PUF 11), as well as differences between pre-operative and 10 month time points (OSPI 3.7, PUF 6) were all statistically significant (P = .008 and .009 at 1 week, and .007 and .008 at 10 months, for OSPI and PUF respectively). The mean difference in score from pre-operative to longest follow-up as measured by the OSPI was -14.4 (P < .001) and by PUF -10.3 (P < .001). All time points registered demonstrated improvement in pain scores. There were no surgical complications or adverse events. CONCLUSION II and IH nerve resection may be an effective and durable treatment option for those with prior abdominal surgery who have referred interstitial cystitis/bladder pain syndrome pain from these injured nerves.
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Affiliation(s)
- Megan E Gornet
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD
| | - Akash Chandawarkar
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
| | - Amin Herati
- Department of Urology, Johns Hopkins University, Baltimore, MD
| | - A Lee Dellon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD; Department of Neurosurgery, Johns Hopkins University, Baltimore, MD.
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North CS, Hong BA, Lai HH, Alpers DH. Assessing somatization in urologic chronic pelvic pain syndrome. BMC Urol 2019; 19:130. [PMID: 31823813 PMCID: PMC6902613 DOI: 10.1186/s12894-019-0556-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/11/2019] [Indexed: 12/29/2022] Open
Abstract
Background This study examined the prevalence of somatization disorder in Urological Chronic Pelvic Pain Syndrome (UCPPS) and the utility of two self-report symptom screening tools for assessment of somatization in patients with UCPPS. Methods The study sample included 65 patients with UCPPS who enrolled in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Study at Washington University. Patients completed the PolySymptomatic PolySyndromic Questionnaire (PSPS-Q) (n = 64) and the Patient Health Questionnaire-15 Somatic Symptom Severity Scale (PHQ-15) (n = 50). Review of patient medical records found that only 47% (n = 30) contained sufficient documentation to assess Perley-Guze criteria for somatization disorder. Results Few (only 6.5%) of the UCPPS sample met Perley-Guze criteria for definite somatization disorder. Perley-Guze somatization disorder was predicted by definite PSPS-Q somatization with at least 75% sensitivity and specificity. Perley-Guze somatization disorder was predicted by severe (> 15) PHQ-15 threshold that had > 90% sensitivity and specificity but was met by only 16% of patients. The moderate (> 10) PHQ-15 threshold had higher sensitivity (100%) but lower specificity (52%) and was met by 52% of the sample. Conclusions The PHQ-15 is brief, but it measures symptoms constituting only one dimension of somatization. The PSPS-Q uniquely captures two conceptual dimensions inherent in the definition of somatization disorder, both number of symptoms and symptom distribution across multiple organ systems, with relevance for UCPPS as a syndrome that is not just a collection of urological symptoms but a broader syndrome with symptoms extending beyond the urological system.
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Affiliation(s)
- C S North
- The Altshuler Center for Education & Research at Metrocare Services, The University of Texas Southwestern Medical Center, 1250 Mockingbird Lane, Suite 330, Dallas, TX, 75247-4914, USA. .,Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Suite NE5.102, Dallas, TX, 75390-9070, USA.
| | - B A Hong
- Department of Psychiatry, School of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - H H Lai
- Departments of Surgery and Anesthesiology, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - D H Alpers
- Department of Internal Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Changes in brain white matter structure are associated with urine proteins in urologic chronic pelvic pain syndrome (UCPPS): A MAPP Network study. PLoS One 2018; 13:e0206807. [PMID: 30517112 PMCID: PMC6281196 DOI: 10.1371/journal.pone.0206807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022] Open
Abstract
The Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network has yielded neuroimaging and urinary biomarker findings that highlight unique alterations in brain structure and in urinary proteins related to tissue remodeling and vascular structure in patients with Urological Chronic Pelvic Pain Syndrome (UCPPS). We hypothesized that localized changes in diffusion tensor imaging (DTI) measurements might be associated with corresponding changes in urinary protein levels in UCPPS. To test this hypothesis, we created statistical parameter maps depicting the linear correlation between DTI measurements (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) and urinary protein quantification (MMP2, MMP9, NGAL, MMP9/NGAL complex, and VEGF) in 30 UCPPS patients from the MAPP Research Network, after accounting for clinical covariates. Results identified a brainstem region that showed a strong correlation between both ADC (R2 = 0.49, P<0.0001) and FA (R2 = 0.39, P = 0.0002) with urinary MMP9 levels as well as a correlation between both ADC (R2 = 0.42, P = 0.0001) and FA (R2 = 0.29, P = 0.0020) and urinary MMP9/NGAL complex. Results also identified significant correlations between FA and urinary MMP9 in white matter adjacent to sensorimotor regions (R2 = 0.30, P = 0.002; R2 = 0.36, P = 0.0005, respectively), as well as a correlation in similar sensorimotor regions when examining ADC and urinary MMP2 levels (R2 = 0.42, P<0.0001) as well as FA and urinary MMP9/NGAL complex (R2 = 0.33, P = 0.0008). A large, diffuse cluster of white matter was identified as having a strong correlation between both ADC (R2 = 0.35, P = 0.0006) and FA (R2 = 0.43, P<0.0001) with urinary NGAL levels. In contrast, no significant association between DTI measurements and VEGF was observed. Results suggest that elevated MMP9 or MMP9/NGAL in UCPPS may be related to degenerative neuronal changes in brainstem nuclei through excitotoxicity, while also facilitating synaptic plasticity in sensorimotor regions.
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Lai HH, Naliboff B, Liu AB, Amundsen CL, Shimony JS, Magnotta VA, Shaffer JJ, Gilliam RL, Wiseman JB, Helmuth ME, Andreev VP, Kirkali Z, Harte SE. The LURN Research Network Neuroimaging and Sensory Testing (NIST) Study: Design, protocols, and operations. Contemp Clin Trials 2018; 74:76-87. [PMID: 30248454 PMCID: PMC6203612 DOI: 10.1016/j.cct.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
The Neuroimaging and Sensory Testing (NIST) Study of the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is a cross-sectional, case-control study designed to investigate whether disrupted brain connectivity and sensory processing are associated with abnormal lower urinary tract symptoms (LUTS) in patients with overactive bladder syndrome (OAB). The NIST Study tests the hypotheses that patients with urinary urgency will demonstrate: (1) abnormal functional and structural connectivity of brain regions involved in urinary sensation on magnetic resonance imaging (MRI), and (2) hypersensitivity to painful (pressure) and non-painful (auditory) sensory stimuli on quantitative sensory testing (QST), compared to controls. Male and female adults (18 years or older) who present at one of the six participating LURN clinical centers for clinical care of their LUTS, with symptoms of urinary urgency with or without urgency urinary incontinence, are eligible to participate. The NIST Study is the largest MRI and QST study of its kind, yielding a neuroimaging and sensory testing dataset unprecedented in OAB research. Advanced multi-modal techniques are used to understand brain functional and structural connectivity, including gray matter volume, and sensory function. Unlike previous MRI studies which involved invasive catheterization and repeated cycles of non-physiologic bladder filling and emptying via a catheter, we use a water ingestion protocol to mimic more physiological bladder filling through natural diuresis. Furthermore, these data will be used in concert with other phenotyping data to improve our understanding of clinically meaningful subtypes of patients with LUTS in order to improve patient care and management outcomes.
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Affiliation(s)
- H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Alice B Liu
- Department of Urology, University of Washington, Seattle, WA, United States
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St. Louis, MO, United States
| | - Vincent A Magnotta
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Joseph J Shaffer
- Department of Radiology, University of Iowa, Iowa City, IA, United States
| | - Robin L Gilliam
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States
| | | | | | - Victor P Andreev
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Steven E Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, MI, United States
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Tu FF, Kane JN, Hellman KM. Noninvasive experimental bladder pain assessment in painful bladder syndrome. BJOG 2018; 124:283-291. [PMID: 28012262 DOI: 10.1111/1471-0528.14433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare bladder sensitivity between patients with pelvic pain and patients who were pain free, undergoing noninvasive, controlled bladder distension via diuresis. We also sought to measure potential mechanisms underlying bladder sensitivity. DESIGN Prospective observational study. SETTING Community teaching hospital. POPULATION Reproductive-age women with non-bladder chronic pelvic pain (CPP, n = 23), painful bladder syndrome (PBS, n = 23), and pelvic pain-free controls (n = 42) METHODS: Participants were compared on cystometric capacity, pelvic floor pressure-pain thresholds (PPTs), pelvic muscle function, O'Leary-Sant bladder questionnaire, and psychosocial instruments using Wilcoxon rank-sum tests. Multivariate regression was used to identify factors underlying bladder pain phenotypes. MAIN OUTCOME MEASURES Pelvic floor pain thresholds; self-reported bladder distension pain. RESULTS Participants with PBS exhibited higher bladder distension pain than those with CPP, with both groups reporting higher pain levels than controls (P < 0.05). No significant associations were found between bladder distension pain and pelvic muscle structure or pain sensitivity measures; however, bladder distension pain positively correlates with both vaginal PPTs adjacent to the bladder (r = 0.46) and pain with transvaginal bladder palpation (r = 0.56). Pain at maximal distension was less influenced by somatic sensitivity than bladder symptoms (r = 0.35 versus r = 0.59; P < 0.05). Multivariate regression identified three independent components of bladder symptoms in PBS: bladder distension pain, bladder sensation, and somatic symptoms. CONCLUSIONS Diuresis-induced bladder pain differentiates CPP from PBS. Experimental bladder pain is not predicted by pelvic floor sensitivity. Compared with patient-reported outcomes it appears less influenced by psychological factors. Further study is needed to determine whether screening for experimental bladder pain sensitivity could predict future risk of PBS. TWEETABLE ABSTRACT Controlled, water ingestion-provoked bladder pain can objectively identify visceral pain sensitivity.
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Affiliation(s)
- F F Tu
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - J N Kane
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - K M Hellman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
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10
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Zuckerman RM, Silton RL, Tu FF, Eng JS, Hellman KM. Somatic symptoms in women with dysmenorrhea and noncyclic pelvic pain. Arch Womens Ment Health 2018; 21:533-541. [PMID: 29525829 PMCID: PMC6126970 DOI: 10.1007/s00737-018-0823-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/27/2018] [Indexed: 12/30/2022]
Abstract
Somatic symptoms are a robust, transdiagnostic risk factor for pain conditions. However, the extent to which somatic symptoms contribute to the manifestation of the women's pain syndromes, such as dysmenorrhea and noncyclic pelvic pain (NCPP), is unclear due to high rates of co-occurrence. Therefore, the present study investigated the primary hypothesis that somatic symptoms would be elevated in NCPP and distinctly influence the relationship between dysmenorrhea and co-occurring NCPP. A secondary analysis was performed on cross-sectional questionnaire data from 1012 nonpregnant reproductive-aged women. Eligible analyzed participants (n = 834) were categorized into four groups: healthy, dysmenorrhea, NCPP, and NCPP with co-occurring dysmenorrhea (NCPP+dysmenorrhea). A parallel mediation analysis was run to evaluate the primary hypothesis that somatic symptoms are the primary factor associated with increased NCPP accounting for dysmenorrhea. The NCPP+dysmenorrhea group had higher somatic, anxiety, and depression symptom T-scores (respectively 61, 61, 60) compared to the healthy controls (46, 51, 51; p's < .001) and the dysmenorrhea group (50, 53, 54; p's < .001). The pain and psychological symptoms were significantly correlated across the entire sample (r's = .29, - .64, p's < .01). Results from parallel mediation analysis showed that somatic symptoms were distinctly associated with NCPP+dysmenorrhea. Women with NCPP+dysmenorrhea have increased psychological and somatic symptoms compared to women with dysmenorrhea alone. Given that NCPP often co-occurs with dysmenorrhea, failure to account for comorbidity in previous studies has likely led to an overestimation of psychological symptoms in dysmenorrhea. Future studies should evaluate whether somatic sensitivity is a modifiable risk factor for NCPP.
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Affiliation(s)
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL, 60660, USA.
| | - Frank F Tu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, USA
| | - Joshua S Eng
- Department of Child and Family Health Studies, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kevin M Hellman
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, USA
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11
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Van Moh F, Vetter J, Lai HH. Comparison of urologic and non-urologic presentation in interstitial cystitis/bladder pain syndrome patients with and without Hunner lesions. Neurourol Urodyn 2018; 37:2911-2918. [DOI: 10.1002/nau.23812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Frederick Van Moh
- Division of Urologic Surgery; Department of Surgery; St. Louis Missouri
| | - Joel Vetter
- Division of Urologic Surgery; Department of Surgery; St. Louis Missouri
| | - H. Henry Lai
- Division of Urologic Surgery; Department of Surgery; St. Louis Missouri
- Department of Anesthesiology; Washington University School of Medicine; St. Louis Missouri
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12
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Chen IC, Lee MH, Lin HH, Wu SL, Chang KM, Lin HY. Somatoform disorder as a predictor of interstitial cystitis/bladder pain syndrome: Evidence from a nested case-control study and a retrospective cohort study. Medicine (Baltimore) 2017; 96:e6304. [PMID: 28471951 PMCID: PMC5419897 DOI: 10.1097/md.0000000000006304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) has several well-known comorbid psychiatric manifestations, including insomnia, anxiety, and depression. We hypothesized that somatoform disorder, which is a psychosomatic disease, can be used as a sensitive psychiatric phenotype of IC/BPS. We investigated whether somatoform disorder increases the risk of IC/BPS.A nested case-control study and a retrospective cohort study were followed up over a 12-year period (2002-2013) in the Taiwan Health Insurance Reimbursement Database. In the nested case-control study, 1612 patients with IC/BPS were matched in a 1:2 ratio to 3224 controls based on propensity scores. The odds ratio for somatoform disorder was calculated using conditional logistic regression analysis. In the retrospective cohort study, 1436 patients with somatoform disorder were matched in a 1:2 ratio to 2872 patients with nonsomatoform disorder based on propensity scores. Cox regression analysis was used to estimate the hazard ratio associated with the development of IC/BPS in patients with somatoform disorder, and the cumulative survival probability was tested using the Kaplan-Meier analysis.We found that the odds ratio for somatoform disorder was 2.46 (95% confidence interval [CI], 1.05-5.76). Although the average time until IC/BPS development in the control subjects was 11.5 ± 1.3 years, this interval was shorter in patients with somatoform disorder (6.3 ± 3.6 years). The hazard ratio for developing IC/BPS was 2.50 (95% CI 1.23-5.58); the adjusted hazard ratio was 2.26 (95% CI 1.002-5.007). The patients and controls also differed significantly in their cumulative survival probability for IC/BPS (log rank P < .05).Evidence from the nested case-control study and retrospective cohort study consistently indicated that somatoform disorder increases the risk for IC/BPS. Our study suggests that somatoform disorder can be used as a sensitive psychiatric phenotype to predict IC/BPS. Any past history of somatoform disorder should be documented while examining patients with IC/BPS.
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Affiliation(s)
- I-Chun Chen
- Department of Psychiatry, Taichung Veterans General Hospital
| | - Ming-Huei Lee
- Department of Urology, Feng-Yuan Hospital, Ministry of Health and Welfare, Fengyuan District
| | - Hsuan-Hung Lin
- Central Taiwan University of Science and Technology, Beitun District, Taichung City, Taiwan
| | - Shang-Liang Wu
- Centre for Environment and Population Health, Griffith University
- Nathan Campus, Griffith University, Nathan QLD, Australia
| | | | - Hsiu-Ying Lin
- Department of Anaesthesiology, Feng-Yuan Hospital, Ministry of Health and Welfare, Fengyuan Dist., Taichung City, Taiwan
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13
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Lai HH, Jemielita T, Sutcliffe S, Bradley CS, Naliboff B, Williams DA, Gereau RW, Kreder K, Clemens JQ, Rodriguez LV, Krieger JN, Farrar JT, Robinson N, Landis JR. Characterization of Whole Body Pain in Urological Chronic Pelvic Pain Syndrome at Baseline: A MAPP Research Network Study. J Urol 2017; 198:622-631. [PMID: 28373134 DOI: 10.1016/j.juro.2017.03.132] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE We characterized the location and spatial distribution of whole body pain in patients with urological chronic pelvic pain syndrome using a body map. We also compared the severity of urinary symptoms, pelvic pain, nonpelvic pain and psychosocial health among patients with different pain patterns. MATERIALS AND METHODS A total of 233 women and 191 men with urological chronic pelvic pain syndrome enrolled in a multicenter, 1-year observational study completed a battery of baseline measures, including a body map describing the location of pain during the last week. Participants were categorized with pelvic pain if they reported pain in the abdomen and pelvis only. Participants who reported pain beyond the pelvis were further divided into 2 subgroups based on the number of broader body regions affected by pain, including an intermediate group with 1 or 2 additional regions outside the pelvis and a widespread pain group with 3 to 7 additional regions. RESULTS Of the 424 enrolled patients 25% reported pelvic pain only and 75% reported pain beyond the pelvis, of whom 38% reported widespread pain. Participants with a greater number of pain locations had greater nonpelvic pain severity (p <0.0001), sleep disturbance (p = 0.035), depression (p = 0.005), anxiety (p = 0.011), psychological stress (p = 0.005) and negative affect scores (p = 0.0004), and worse quality of life (p ≤0.021). No difference in pelvic pain and urinary symptom severity was observed according to increasing pain distribution. CONCLUSIONS Three-quarters of the men and women with urological chronic pelvic pain syndrome reported pain outside the pelvis. Widespread pain was associated with greater severity of nonpelvic pain symptoms, poorer psychosocial health and worse quality of life but not with worse pelvic pain or urinary symptoms.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery and Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri.
| | - Thomas Jemielita
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa School of Medicine, Iowa City, Iowa
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California School of Medicine, Los Angeles, California
| | - David A Williams
- Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Robert W Gereau
- Department of Surgery and Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St. Louis, Missouri
| | - Karl Kreder
- Department of Urology, University of Iowa School of Medicine, Iowa City, Iowa
| | - J Quentin Clemens
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Larissa V Rodriguez
- Departments of Urology and Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - John N Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - John T Farrar
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nancy Robinson
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - J Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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14
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Leue C, Kruimel J, Vrijens D, Masclee A, van Os J, van Koeveringe G. Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis. Nat Rev Urol 2016; 14:153-163. [PMID: 27922040 DOI: 10.1038/nrurol.2016.227] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.
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Affiliation(s)
- Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Joanna Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Adrian Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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15
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Autobiography of Barry A. Hong. J Clin Psychol Med Settings 2016. [DOI: 10.1007/s10880-016-9472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, Hanno P, Fraser MO, Homma Y, Garrido G, Gomes MJ, Elneil S, van de Merwe JP, Lin ATL, Tomoe H. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn 2016; 36:984-1008. [PMID: 27564065 DOI: 10.1002/nau.23072] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/23/2016] [Indexed: 12/27/2022]
Abstract
AIMS Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected by chronic pelvic pain syndromes. The standard aims to facilitate research, enhance therapy development and support healthcare delivery, for healthcare providers, and patients. This document looks at the whole person and all the domains (organ systems) in a systematic way. METHODS A dedicated working group (WG) was instituted by the ICS Standardisation Steering Committee according to published procedures. The WG extracted information from existing relevant guidelines, consensus documents, and scientific publications. Medline and other databases were searched in relation to each chronic pelvic pain domain from 1980 to 2014. Existing ICS Standards for terminology were utilized where appropriate to ensure transparency, accessibility, flexibility, and evolution. Consensus was based on majority agreement. RESULTS The multidisciplinary CPPS Standard reports updated consensus terminology in nine domains; lower urinary tract, female genital, male genital, gastrointestinal, musculoskeletal, neurological aspects, psychological aspects, sexual aspects, and comorbidities. Each is described in terms of symptoms, signs and further evaluation. CONCLUSION The document presents preferred terms and definitions for symptoms, signs, and evaluation (diagnostic work-up) of female and male patients with chronic pelvic pain syndromes, serving as a platform for ongoing development in this field. Neurourol. Urodynam. 36:984-1008, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Kristene E Whitmore
- Chair of Urology and Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jane M Meijlink
- International Painful Bladder Foundation, Naarden, Netherlands
| | - Marcus J Drake
- Department of Urology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Helena Frawley
- Physiotherapy at La Trobe University, Melbourne, Cabrini Health, Melbourne, Australia
| | - Jørgen Nordling
- Department of Urology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Philip Hanno
- Department of Urology, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew O Fraser
- Department of Urology Surgery, Duke University and Durham Veterans Affairs Medical Centers, Durham, North Carolina
| | - Yukio Homma
- Department of Urology, The University of Tokyo, Tokyo, Japan
| | - Gustavo Garrido
- Head of Voiding Dysfunctions and Urodynamics Section, Urology Division, Hospital de Clínicas, University of Buenos Aires, Argentina
| | - Mario J Gomes
- Department of Urology, St. António Hospital, Oporto, Portugal
| | - Sohier Elneil
- Department of Urogynecology, University College Hospital, National Hospital for Neurology and Neurosurgery, GB
| | | | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
| | - Hikaru Tomoe
- Department of Urogynecology, Chair of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Japan
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17
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Lai HH, Vetter J, Jain S, Andriole GL. Systemic Nonurological Symptoms in Patients with Overactive Bladder. J Urol 2016; 196:467-72. [PMID: 26997309 DOI: 10.1016/j.juro.2016.02.2974] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE We compare the systemic (nonurological) symptoms between patients with overactive bladder and subjects without overactive bladder. We also compare the urinary symptoms, quality of life and psychosocial measures between the 2 subgroups of patients with overactive bladder with a high vs low systemic symptom burden. MATERIALS AND METHODS Patients diagnosed with overactive bladder (51) and age matched individuals without overactive bladder (30) were administered the polysymptomatic, polysyndromic questionnaire to assess the numbers and distribution of systemic symptoms across multiple organ systems. Validated instruments were administered to evaluate urinary symptoms (ICIQ-UI, ICIQ-OAB, OAB-q, USS), quality of life (UDI-6, IIQ-7, OAB-q) and psychosocial difficulties (depression, anxiety, stress, sexual trauma, sleep, fatigue). Patients with overactive bladder were divided into 2 subgroups (with and without widespread systemic symptoms) and their responses were compared. RESULTS Patients with overactive bladder reported significantly more systemic (nonurological) symptoms compared to controls (mean ± SD 17.5 ± 12.3 vs 6.4 ± 7.9 symptoms, p <0.001). Differences were observed across multiple organ systems (neurologic, cardiopulmonary, gastrointestinal, sexual, musculoskeletal and gynecologic, p <0.05). About a third of patients with overactive bladder (31.4%) reported widespread systemic symptoms across multiple organ systems (mean 32.0 symptoms). The presence of widespread systemic symptoms among patients with overactive bladder was correlated with worse incontinence/overactive bladder symptoms (ICIQ-UI, OAB-q), poorer quality of life (UDI-6, IIQ-7, OAB-q) and more psychosocial difficulties (depression, anxiety, fatigue and higher stress, p <0.05). CONCLUSIONS The increased presence of nonurological symptoms in overactive bladder suggests an underlying systemic etiology and pathogenetic mechanisms that may contribute to overactive bladder. This study highlights the importance of understanding systemic factors in urological conditions otherwise thought to be organ specific.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sanjay Jain
- Renal Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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18
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Risk of associated conditions in relatives of subjects with interstitial cystitis. Female Pelvic Med Reconstr Surg 2016; 21:93-8. [PMID: 25349937 DOI: 10.1097/spv.0000000000000139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Urological chronic pelvic pain syndrome includes interstitial cystitis/painful bladder syndrome (IC/PBS), a chronic bladder pain condition of unknown etiology. Interstitial cystitis/painful bladder syndrome can co-occur with a number of associated conditions such as irritable bowel syndrome and fibromyalgia. The purpose of this study was to estimate the heritability of approximately 20 associated conditions in first-degree relatives (and if appropriate, second- and third-degree relatives) of patients with IC/PBS to identify shared genetic contributions for the disease combinations. METHODS We used the Utah Population Database, a unique population-based genealogical database that has been linked to electronic health records for the University of Utah Health Sciences Center back in 1994. Interstitial cystitis/painful bladder syndrome probands were identified by the International Classification of Diseases, Ninth Revision code for chronic interstitial cystitis and had genealogy information for 12 of their 14 immediate ancestors. We calculated excess risk of an associated condition in relatives of patients with IC/PBS using relative risk estimates. RESULTS We identified 248 IC/PBS probands. We found that 2 associated conditions, myalgia and myositis/unspecified (fibromyalgia) as well as constipation, were in significant excess in the patients with IC/PBS themselves, their first-degree relatives, and their second-degree relatives. The excess risk among relatives between IC/PBS and these associated conditions also held in the converse direction. Excess risk of IC/PBS was observed in the first- and second-degree relatives in probands with myalgia and myositis/unspecified (fibromyalgia) and in probands with constipation. CONCLUSIONS These results suggest that myalgia and myositis/unspecified (fibromyalgia) as well as constipation are likely to share underlying genetic factors with IC/PBS.
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19
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Cho KJ, Lee NS, Lee YS, Jeong WJ, Suh HJ, Kim JC, Koh JS. The Changes of Psychometric Profiles after Medical Treatment of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2015; 13:269-74. [PMID: 26598585 PMCID: PMC4662180 DOI: 10.9758/cpn.2015.13.3.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 12/03/2022]
Abstract
Objective To investigate the relationship of somatization and depression with the degree of lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH) and changes in psychometric profiles including somatization and depression after treatment of LUTS/BPH. Methods Subjects were evaluated at baseline and at week 12 following routine treatment for LUTS/BPH using the International Prostate Symptom Score (IPSS) to measure the severity of LUTS/BPH, the Overactive Bladder Symptom Score (OABSS) to measure the severity of OAB, the Patient Health Questionnaire-9 (PHQ-9) to assess depression, and the Patient Health Questionnaire-15 (PHQ-15) to evaluate somatization. The correlation of somatization and depression with the degree of LUTS/BPH symptoms at baseline and changes in somatization and depression after LUTS/BPH treatment were assessed using relevant statistical analyses. Results One hundred and twenty patients agreed to participate in this study, and 101 (84.2%) completed the 12-week trial and responded to the study questionnaires. At baseline, total IPSS score was correlated with PHQ-9 (r=0.475, p=0.005) and PHQ-15 (r=0.596, p<0.001) scores. The results after the 12-week treatment clearly show significant improvement in both PHQ-9 (p <0.001) and PHQ-15 (p=0.019) scores, and the PHQ-9 (r=0.509, p=0.048) and PHQ-15 (r=0.541, p=0.016) scores were positively correlated with total IPSS. Conclusion Our preliminary results indicated that severity of LUTS is correlated with severity of somatization and depression. Further, the improvement of LUTS after treatment may have positive impacts on somatization and depression.
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Affiliation(s)
- Kang Jun Cho
- Department of Urology, College of Medicine, The Catholic University of Korea
| | - Nam Suk Lee
- Department of Urology, College of Medicine, The Catholic University of Korea
| | - Yong Seok Lee
- Department of Urology, College of Medicine, The Catholic University of Korea
| | - Woon Jin Jeong
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Hong Jin Suh
- Department of Urology, College of Medicine, The Catholic University of Korea
| | - Joon Chul Kim
- Department of Urology, College of Medicine, The Catholic University of Korea
| | - Jun Sung Koh
- Department of Urology, College of Medicine, The Catholic University of Korea
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Equal Improvement in Men and Women in the Treatment of Urologic Chronic Pelvic Pain Syndrome Using a Multi-modal Protocol with an Internal Myofascial Trigger Point Wand. Appl Psychophysiol Biofeedback 2015; 41:215-24. [DOI: 10.1007/s10484-015-9325-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Re: Risk of Associated Conditions in Relatives of Subjects with Interstitial Cystitis. J Urol 2015; 194:1644-5. [DOI: 10.1016/j.juro.2015.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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The Classification of Hysteria and Related Disorders: Historical and Phenomenological Considerations. Behav Sci (Basel) 2015; 5:496-517. [PMID: 26561836 PMCID: PMC4695775 DOI: 10.3390/bs5040496] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/31/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
This article examines the history of the conceptualization of dissociative, conversion, and somatoform syndromes in relation to one another, chronicles efforts to classify these and other phenomenologically-related psychopathology in the American diagnostic system for mental disorders, and traces the subsequent divergence in opinions of dissenting sectors on classification of these disorders. This article then considers the extensive phenomenological overlap across these disorders in empirical research, and from this foundation presents a new model for the conceptualization of these disorders. The classification of disorders formerly known as hysteria and phenomenologically-related syndromes has long been contentious and unsettled. Examination of the long history of the conceptual difficulties, which remain inherent in existing classification schemes for these disorders, can help to address the continuing controversy. This review clarifies the need for a major conceptual revision of the current classification of these disorders. A new phenomenologically-based classification scheme for these disorders is proposed that is more compatible with the agnostic and atheoretical approach to diagnosis of mental disorders used by the current classification system.
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23
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Woodworth D, Mayer E, Leu K, Ashe-McNalley C, Naliboff BD, Labus JS, Tillisch K, Kutch JJ, Farmer MA, Apkarian AV, Johnson KA, Mackey SC, Ness TJ, Landis JR, Deutsch G, Harris RE, Clauw DJ, Mullins C, Ellingson BM. Unique Microstructural Changes in the Brain Associated with Urological Chronic Pelvic Pain Syndrome (UCPPS) Revealed by Diffusion Tensor MRI, Super-Resolution Track Density Imaging, and Statistical Parameter Mapping: A MAPP Network Neuroimaging Study. PLoS One 2015; 10:e0140250. [PMID: 26460744 PMCID: PMC4604194 DOI: 10.1371/journal.pone.0140250] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 09/23/2015] [Indexed: 12/27/2022] Open
Abstract
Studies have suggested chronic pain syndromes are associated with neural reorganization in specific regions associated with perception, processing, and integration of pain. Urological chronic pelvic pain syndrome (UCPPS) represents a collection of pain syndromes characterized by pelvic pain, namely Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) and Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), that are both poorly understood in their pathophysiology, and treated ineffectively. We hypothesized patients with UCPPS may have microstructural differences in the brain compared with healthy control subjects (HCs), as well as patients with irritable bowel syndrome (IBS), a common gastrointestinal pain disorder. In the current study we performed population-based voxel-wise DTI and super-resolution track density imaging (TDI) in a large, two-center sample of phenotyped patients from the multicenter cohort with UCPPS (N = 45), IBS (N = 39), and HCs (N = 56) as part of the MAPP Research Network. Compared with HCs, UCPPS patients had lower fractional anisotropy (FA), lower generalized anisotropy (GA), lower track density, and higher mean diffusivity (MD) in brain regions commonly associated with perception and integration of pain information. Results also showed significant differences in specific anatomical regions in UCPPS patients when compared with IBS patients, consistent with microstructural alterations specific to UCPPS. While IBS patients showed clear sex related differences in FA, MD, GA, and track density consistent with previous reports, few such differences were observed in UCPPS patients. Heat maps illustrating the correlation between specific regions of interest and various pain and urinary symptom scores showed clustering of significant associations along the cortico-basal ganglia-thalamic-cortical loop associated with pain integration, modulation, and perception. Together, results suggest patients with UCPPS have extensive microstructural differences within the brain, many specific to syndrome UCPPS versus IBS, that appear to be localized to regions associated with perception and integration of sensory information and pain modulation, and seem to be a consequence of longstanding pain.
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Affiliation(s)
- Davis Woodworth
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Emeran Mayer
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kevin Leu
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Cody Ashe-McNalley
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Bruce D. Naliboff
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jennifer S. Labus
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Kirsten Tillisch
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Digestive Diseases and Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jason J. Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
| | - Melissa A. Farmer
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
| | - A. Vania Apkarian
- Department of Physiology, Northwestern University, Chicago, Illinois, United States of America
| | - Kevin A. Johnson
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Sean C. Mackey
- Department of Neurology, Stanford University, Palo Alto, California, United States of America
| | - Timothy J. Ness
- Department of Anesthesiology, University of Alabama, Birmingham, Alabama, United States of America
| | - J. Richard Landis
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Georg Deutsch
- Department of Radiology, University of Alabama, Birmingham, Alabama, United States of America
| | - Richard E. Harris
- Department of Anestesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Daniel J. Clauw
- Department of Anestesiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chris Mullins
- Division of Kidney, Urologic, and Hematologic Diseases; National Institute of Diabetes and Digestive and Kidney Diseases; National Institutes of Health, Bethesda, Maryland, United States of America
| | - Benjamin M. Ellingson
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomedical Physics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Oppenheimer Center for the Neurobiology of Stress, and PAIN, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Lai HH, Morgan CD, Vetter J, Andriole GL. Impact of childhood and recent traumatic events on the clinical presentation of overactive bladder. Neurourol Urodyn 2015; 35:1017-1023. [PMID: 26332868 DOI: 10.1002/nau.22872] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/28/2015] [Indexed: 12/30/2022]
Abstract
AIMS (1) To describe the Prevalence of childhood and recent trauma in patients with overactive bladder (OAB), and (2) assess the impact of traumatic events on the clinical presentation and the severity of OAB symptoms, quality of life, and psychosocial health. METHODS Patients diagnosed with OAB (n = 51) and age-matched healthy controls (n = 30) were administered the Childhood Traumatic Events Scale and Recent Traumatic Events Scale, assessing exposure and perceived impact of common traumatic events. Among OAB patients, validated instruments were administered to correlate traumatic exposure to evaluate adult urinary symptoms (ICIQ-UI, ICIQ-OAB, OAB-q, UDI-6, IIQ-7, USS), mood dysregulation (HADS), sleep and fatigue (PROMIS), and Psychological stress (PSS). RESULTS Childhood sexual trauma was more prevalent in patients with OAB compared to controls (29.4% vs. 6.7%, P = 0.041). OAB patients also rated their childhood sexual exposure as more traumatic compared to controls (mean ratings of 1.7 vs. 0.4, P = 0.050). There was no difference in childhood deaths (P = 0.24), parental upheaval (P = 0.87), violence (P = 0.099), illness/injury (P = 0.683), or any recent traumatic events between OAB and control subjects. Childhood trauma predicted worse bladder pain (P = 0.005), worse non-urologic pain (P = 0.017), poorer mood (P = 0.001), higher anxiety (P = 0.029), higher physical symptom burden (P < 0.001), and higher psychological stress (P < 0.039). However, childhood trauma did not correlate with the severity of OAB symptoms (urgency, frequency, incontinence). CONCLUSIONS Thirty percent of OAB patients reported childhood sexual trauma. These patients report more pain symptoms, poorer mood, and greater somatic burden. These data highlight the potentiating role of psychosocial stressors from childhood in the adult suffering from OAB. Neurourol. Urodynam. 35:1017-1023, 2016. © 2015 Wiley periodicals, Inc.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
| | - Clinton D Morgan
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Joel Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Jones KD, Maxwell C, Mist SD, King V, Denman MA, Gregory WT. Pelvic Floor and Urinary Distress in Women with Fibromyalgia. Pain Manag Nurs 2015; 16:834-40. [PMID: 26259883 DOI: 10.1016/j.pmn.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/27/2015] [Accepted: 06/04/2015] [Indexed: 02/08/2023]
Abstract
Fibromyalgia (FM) patients were recently found to have more symptom burden from bothersome pelvic pain syndromes that women seeking care for pelvic floor disease at a urogynecology clinic. We sought to further characterize pelvic floor symptoms in a larger sample of FM patients using of validated questionnaires. Female listserv members of the Fibromyalgia Information Foundation completed an online survey of three validated questionnaires: the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Pain, Urgency and Frequency Questionnaire (PUF), and the Revised Fibromyalgia Impact Questionnaire (FIQR). Scores were characterized using descriptive statistics. Patients (n = 204 with complete data on 177) were on average 52.3 ± 11.4 years with a mean parity of 2.5 ± 1.9. FM severity based on FIQR score (57.2 ± 14.9) positively correlated with PFDI-20 total 159.08 ± 55.2 (r = .34, p < .001) and PUF total 16.54 ± 7 (r = .36, p < .001). Women with FM report significantly bothersome pelvic floor and urinary symptoms. Fibromyalgia management should include evaluation and treatment of pelvic floor disorders recognizing that pelvic distress and urinary symptoms are associated with more severe FM symptoms. Validated questionnaires, like the ones used in this study, are easily incorporated into clinical practice.
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Affiliation(s)
- Kim Dupree Jones
- School of Nursing, Oregon Health & Science University, Portland, Oregon.
| | - Charlene Maxwell
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Scott D Mist
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Virginia King
- Aethena Gynecology Associates, Vancouver, Washington
| | - Mary Anna Denman
- Department of Urogynecology, Oregon Health & Science University, Portland, Oregon
| | - W Thomas Gregory
- Department of Urogynecology, Oregon Health & Science University, Portland, Oregon
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26
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Naliboff BD, Stephens AJ, Afari N, Lai H, Krieger JN, Hong B, Lutgendorf S, Strachan E, Williams D. Widespread Psychosocial Difficulties in Men and Women With Urologic Chronic Pelvic Pain Syndromes: Case-control Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network. Urology 2015; 85:1319-27. [PMID: 26099876 PMCID: PMC4479402 DOI: 10.1016/j.urology.2015.02.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/05/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the extent, severity, and sex differences of psychosocial deficits in men and women with urologic chronic pelvic pain syndromes (UCPPS), which in the past have been considered separate bladder (interstitial cystitis-painful bladder syndrome) and prostate (chronic prostatitis-chronic pelvic pain syndrome) disorders. Evaluations of men and women separately suggest UCPPS is associated with increased anxiety and depression. However, studies directly testing deficits in broader psychosocial domains such as cognitive processes, intimate relationships, and trauma history, or tests of sex differences in the pattern of difficulties associated with UCPPS have not been performed. METHODS A total of 233 female and 191 male UCPPS patients and 235 female and 182 male healthy controls (HCs) were recruited from 6 academic medical centers in the United States and evaluated with a comprehensive battery of symptom, psychosocial, and illness impact measures. Primary comparisons of interest were between UCPPS patients and HCs and between men and women with UCPPS. RESULTS In addition to greater negative effect, male and female UCPPS patients show higher levels of current and lifetime stress, poorer illness coping, increased self-report of cognitive deficits, and more widespread pain symptoms compared with sex- and education-matched HCs. Similar problems were found in male and female UCPPS patients although female UCPPS patients showed increased self-report of childhood adversity and more widespread symptoms of pain and discomfort. CONCLUSION Given the significance of psychosocial variables in prognosis and treatment of chronic pain conditions, the results add substantially to our understanding of the breath of difficulties associated with UCPPS and point to important areas for clinical assessment.
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Affiliation(s)
- Bruce D Naliboff
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA.
| | - Alisa J Stephens
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Niloo Afari
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - John N Krieger
- Department of Urology, University of Washington, Seattle, WA
| | - Barry Hong
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | | | - Eric Strachan
- Department of Psychiatry and Biobehavioral Sciences, University of Washington, Seattle, WA
| | - David Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI; Department of Medicine, University of Michigan, Ann Arbor, MI
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27
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Reply by Authors. J Urol 2014. [DOI: 10.1016/j.juro.2014.05.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Assessing psychological factors, social aspects and psychiatric co-morbidity associated with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men -- a systematic review. J Psychosom Res 2014; 77:333-50. [PMID: 25300538 DOI: 10.1016/j.jpsychores.2014.09.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain disease with high prevalence rates and substantial health care costs. An interdisciplinary classification system is commonly used (UPOINT) which includes psychosocial factors. Nevertheless, psychosocial influences on CP/CPPS only recently became a research focus. Therefore, we aimed to synthesize the existing data and to identify further research topics. Then, based on our results, diagnosis and treatment can be improved. METHODS In a systematic review conducted according to the PRISMA reporting guidelines we searched different databases (MEDLINE, EMBASE, PsychINFO) using the broad search terms "chronic pelvic pain syndrome AND men". Two raters independently screened the literature and assessed the risk of bias. RESULTS We included 69 original research articles which considered psychosocial variables. We found studies investigating different psychosocial factors (pain catastrophizing, stress, personality factors, social aspects), co-morbid psychiatric disorders (depression, anxiety and trauma-related disorders, somatization disorder, substance abuse) and Quality of Life (QoL). In addition, there is a high risk of bias in most studies e.g. concerning the study design or the measures. CONCLUSIONS There is evidence suggesting that psychological factors are important in understanding CP/CPPS. However, research concentrated on a few aspects while the others were not covered adequately. We found evidence of a higher number of psychosocial factors and psychiatric co-morbidities than is currently included in the UPOINT system. More high quality research is needed to understand the interplay of psychosocial factors in CP/CPPS. Furthermore, these factors should be incorporated into treatment approaches.
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Fazio RL, Wunderlich T, Wilson N, Akeson S. MMPI-2-RF characteristics of individuals with interstitial cystitis. J Psychosom Res 2014; 77:359-62. [PMID: 25294780 DOI: 10.1016/j.jpsychores.2014.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/15/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to describe the psychological functioning of interstitial cystitis/bladder pain syndrome patients utilizing MMPI-2-RF scoring. METHODS The MMPI-2 was administered to 60 individuals who reported a diagnosis of IC. Responses were scored in the MMPI-2-RF format. Fifty-one protocols were deemed valid. RESULTS Elevations were discovered on scales FBS-r (symptom validity), RC1 (somatic complaints), and MLS (malaise). Participants were split into two groups based on extreme elevations on RC1; the high RC1 group produced higher scores on 39 scales including clinically significant elevations on 17 scales. CONCLUSION Over 25% of this sample had an emotional component to their physical concerns. This knowledge about the psychological characteristics of IC patients may have clinical utility for physicians and other treatment providers. The results argue strongly for psychological evaluation as a component of IC diagnosis and treatment. Those with significant emotional overlay to their somatic complaints may be best managed through psychological interventions and minimally invasive treatments.
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Affiliation(s)
- Rachel L Fazio
- School of Professional Psychology at Forest Institute, United States.
| | - Ted Wunderlich
- School of Professional Psychology at Forest Institute, United States
| | - Nicolas Wilson
- School of Professional Psychology at Forest Institute, United States
| | - Steven Akeson
- School of Professional Psychology at Forest Institute, United States
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Yang YJ, Koh JS, Ko HJ, Cho KJ, Kim JC, Lee SJ, Pae CU. The influence of depression, anxiety and somatization on the clinical symptoms and treatment response in patients with symptoms of lower urinary tract symptoms suggestive of benign prostatic hyperplasia. J Korean Med Sci 2014; 29:1145-51. [PMID: 25120327 PMCID: PMC4129209 DOI: 10.3346/jkms.2014.29.8.1145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/08/2014] [Indexed: 11/20/2022] Open
Abstract
This is the first study to investigate the influence of depression, anxiety and somatization on the treatment response for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the Korean versions of the International Prostate Symptom Score (IPSS), the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the PHQ-15. The primary endpoint was a responder rate defined by the total score of IPSS (≤ 7) at the end of treatment. The LUTS/BPH severity was significantly higher in patients with depression (whole symptoms P = 0.024; storage sub-symptom P = 0.021) or somatization (P = 0.024) than in those without, while the quality of life (QOL) was significantly higher in patients with anxiety (P = 0.038) than in those without. Anxious patients showed significantly higher proportion of non-response (odds ratio [OR], 3.294, P = 0.022) than those without, while somatic patients had a trend toward having more non-responders (OR, 2.552, P = 0.067). Our exploratory results suggest that depression, anxiety and somatization may have some influences on the clinical manifestation of LUTS/BPH. Further, anxious patients had a lower response to treatment in patients with LUTS/BPH. Despite of limitations, the present study demonstrates that clinicians may need careful evaluation of psychiatric symptoms for proper management of patients with LUTS/BPH.
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Affiliation(s)
- Yong June Yang
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyo Jung Ko
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Kang Joon Cho
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo-Jung Lee
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chi-Un Pae
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Lai HH, North CS, Andriole GL, Cupps L, Song D, Ness TJ, Hong BA. Urological symptoms in a subset of patients with urological chronic pelvic pain syndrome and a polysymptomatic, polysyndromic pattern of presentation. J Urol 2013; 191:1802-7. [PMID: 24361369 DOI: 10.1016/j.juro.2013.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE We characterized urological symptoms in a subset of patients with urological chronic pelvic pain syndrome who have a high somatic symptom burden and a wide symptom distribution fitting a polysymptomatic, polysyndromic presentation pattern. MATERIALS AND METHODS A total of 81 patients with urological chronic pelvic pain syndrome enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases MAPP Research Network Study at Washington University in St. Louis and University of Alabama at Birmingham sites. They completed a symptom questionnaire to assess the somatic symptom burden and its distribution, and GUPI (Genitourinary Pain Index) to assess urological chronic pelvic pain syndrome symptoms, impact on quality of life and self-reported treatment seeking behaviors for urological chronic pelvic pain symptoms. The polysymptomatic, polysyndromic symptom pattern was defined by self-report of numerous painful and nonpainful somatic symptoms across many organ systems and by symptom categories on the polysymptomatic, polysyndromic questionnaire. RESULTS Patients with urological chronic pelvic pain syndrome and the symptom pattern reported more severe genitourinary pain on a Likert scale, more frequent pain in the last week and more widespread pain distribution in the genital and pelvic areas than patients with urological chronic pelvic pain syndrome without the pattern. Patients with the symptom pattern also had significantly higher scores on the GUPI pain subscale, quality of life subscale (worse) and total questionnaire scores than patients without the pattern. Patients with the pattern reported significantly more treatment seeking behavior than others. CONCLUSIONS The polysymptomatic, polysyndromic pattern might be an important phenotypic factor to assess in the evaluation of urological chronic pelvic pain syndrome with clinical and research implications. This may be a distinct clinical subgroup among patients with urological chronic pelvic pain syndrome.
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Affiliation(s)
- H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Carol S North
- Departments of Psychiatry and Surgery/Division of Emergency Medicine, North Texas Veterans Affairs Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gerald L Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lori Cupps
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - David Song
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy J Ness
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Barry A Hong
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Westling AM, Tu FF, Griffith JW, Hellman KM. The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors. Am J Obstet Gynecol 2013; 209:422.e1-422.e10. [PMID: 23973396 DOI: 10.1016/j.ajog.2013.08.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/31/2013] [Accepted: 08/16/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The factors that underlie pelvic pain are poorly understood. Specifically, the relative influence of dysmenorrhea and psychological factors in the etiology of noncyclic pelvic pain conditions, such as interstitial cystitis and irritable bowel syndrome, is unknown. To further characterize pelvic pain, we compared the frequency of menstrual, somatosensory, and psychological risk factors between women with and without severe noncyclic pelvic pain symptoms. STUDY DESIGN A total of 1012 reproductive-aged women completed a 112-item questionnaire with domains including mood, fatigue, physical activity, somatic complaint, and pain. Questionnaire items included existing items for menstrual distress and newly written items derived from qualitative interviews. The relationship of dysmenorrhea and noncyclic pelvic pain complaints (dyspareunia, dyschezia, or dysuria) was modeled using quantile regression. RESULTS Among women who menstruate regularly, those with dysmenorrhea had disproportionally more severe noncyclic pelvic pain (54/402, 13%) than women without dysmenorrhea (5/432, 1%; odds ratio, 13; 95% confidence interval, 5-33). In a multivariate-adjusted model, dysmenorrhea (β = .17), activity capability (β = .17), somatic complaint (β = .17), and bodily pain (β = .12) were the primary predictors of noncyclic pelvic pain. Depression (β = .03) and anxiety (β = .01) were not significantly predictive. The presence of dysmenorrhea, somatic complaint, and low activity capability predicted 90% of the cases of women with noncyclic pelvic pain. CONCLUSION The association between dysmenorrhea and noncyclic pelvic pain suggests that menstrual pain is an etiological factor in noncyclic pelvic pain, whereas depression and anxiety may be secondary effects. Longitudinal studies are needed to determine whether dysmenorrhea causally influences development of noncyclic pelvic pain or shares common underlying neural mechanisms.
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