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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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Naveed M, Changxing L, Ihsan AU, Shumzaid M, Kamboh AA, Mirjat AA, Saeed M, Baig MMFA, Zubair HM, Noreen S, Madni A, Xiaohui Z. Therapeutic interventions to urologic chronic pelvic pain syndrome and UPOINT system for clinical phenotyping: How far are we? Urologia 2022; 89:315-328. [PMID: 34978224 DOI: 10.1177/03915603211065301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The assessment and management of urologic chronic pelvic pain syndrome (UCPPS), is controversial. It is classified by voiding symptoms, pelvic pain, and bladder pain, which is weekly treated, weekly understood, and bothersome. In the aspect of clinical efforts and research to help people with this syndrome have been hampered by the deficiency of a widely reliable, accepted, and a valuable tool to evaluate the patient symptoms and quality of life (QoL) impact. However, the etiology comes into sight is multifactorial, and available treatment options have been imprecise considerably in present years. We compiled the published literature on the assessment of the syndrome, a tentative role of pharmacological and non-pharmacological (conservative, alternative, and invasive therapy) interventions in eradicating the disease as well as improving symptoms. The previously published literature on animal models has established the association of immune systems in the etiology, pathogenesis, and progression of the disease. The UPOINT system for clinical phenotyping of UCPPS patients has six predefined domains that direct multimodal therapy, which would lead to significant symptom improvement in the medical field. The narrative review aims to scrutinize the fluctuating scientist's views on the evaluation of patient and multimodal treatment of the UPOINT system.
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Affiliation(s)
- Muhammad Naveed
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Li Changxing
- Department of Human Anatomy, Medical College of Qinghai University, Xining, China
| | - Awais Ullah Ihsan
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Muhammad Shumzaid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore, Pakistan
| | | | | | - Muhammad Saeed
- Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | | | | | - Sobia Noreen
- Faculty of Pharmacy. The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Asadullah Madni
- Faculty of Pharmacy. The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Zhou Xiaohui
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
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4
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Ness TJ, DeWitte C, DeBerry JJ, Hart MP, Clodfelder-Miller B, Gu JG, Ling J, Randich A. A Model in Female Rats With Phenotypic Features Similar to Interstitial Cystitis/Bladder Pain Syndrome. FRONTIERS IN PAIN RESEARCH 2021; 2:791045. [PMID: 35295535 PMCID: PMC8915626 DOI: 10.3389/fpain.2021.791045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022] Open
Abstract
This report describes methodological and exploratory investigations of the zymosan-induced neonatal bladder inflammation (NBI) model of interstitial cystitis/bladder pain syndrome (IC/BPS) in female rats. These results validate and extend the currently employed model by evaluating critical timepoints for obtaining treatment effects and identified that a second insult as an adult including repeat intravesical zymosan, intravesical lipopolysaccharide, acute footshock stress, neuropathic nociception (facial) or somatic inflammation (hindpaw) all resulted in magnified visceromotor responses to urinary bladder distension (UBD) in rats which had experienced NBI when compared with their controls. NBI also resulted in increased tone and reactivity of pelvic floor musculature to UBD, as well as increased responsiveness to intravesical potassium chloride solutions, abnormal anxiety measures (elevated plus maze) and an increased number of submucosal petechial hemorrhages following 30 min of hydrodistension of the bladder. These phenotypic findings have correlates to the clinical features of IC/BPS in humans and so support use of this model system to examine mechanisms of and treatments for IC/BPS.
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Quantitative assessment of nonpelvic pressure pain sensitivity in urologic chronic pelvic pain syndrome: a MAPP Research Network study. Pain 2020; 160:1270-1280. [PMID: 31050659 DOI: 10.1097/j.pain.0000000000001505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Experimental pain sensitivity was assessed in individuals with urologic chronic pelvic pain syndrome (UCPPS) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. A series of computer-controlled pressure stimuli were delivered to the thumbnail bed, an asymptomatic site distant from the area of UCPPS pain that is considered to be indicative of overall body pain threshold. Stimuli were rated according to a standardized magnitude estimation protocol. Pain sensitivity in participants with UCPPS was compared with healthy controls and a mixed pain group composed of individuals with other chronic overlapping pain conditions, including fibromyalgia, chronic fatigue, and irritable bowel syndromes. Data from 6 participating MAPP testing sites were pooled for analysis. Participants with UCPPS (n = 153) exhibited an intermediate pain sensitivity phenotype: they were less sensitive relative to the mixed pain group (n = 35) but significantly more sensitive than healthy controls (n = 100). Increased pain sensitivity in patients with UCPPS was associated with both higher levels of clinical pain severity and more painful body areas outside the pelvic region. Exploratory analyses in participants with UCPPS revealed that pain sensitivity increased during periods of urologic symptom flare and that less pressure pain sensitivity at baseline was associated with a greater likelihood of subsequent genitourinary pain improvement 1 year later. The finding that individuals with UCPPS demonstrate nonpelvic pain hypersensitivity that is related to clinical symptoms suggests that central nervous system mechanisms of pain amplification contribute to UCPPS.
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6
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Zemskov AM, Berezhnova TA, Zemskova VA, Dyadina KS, Kulintsova YV, Larin AV. Immune-metabolic genesis of pathological processes. RESEARCH RESULTS IN PHARMACOLOGY 2019. [DOI: 10.3897/rrpharmacology.5.38386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This article deals with metabolic-immune processes at rest and under stress conditions, which, in turn, results in the development of immune-dependent and immune-associated disorders. The article analyzes study results and conclusions of various literature sources and experimental data in healthy individuals and patients suffering from non-specific inflammatory lung diseases; purulent-inflammatory diseases and their combinations, primary and secondary progressive multiple sclerosis in the acute stage and remission. Research studies investigated the impact of the type, stage, combination of diseases on the parameters of the immunologic and metabolic statuses, as well as their correlations. The authors also analyzed metabolic effects of immunomodulators. Based on the analysis of the literature and own clinical and experimental data, the authors identified the ability of metabolic factors to regulate immunological processes. A correlative analysis of examination results of the patients with various diseases helped detect the unity of the immune-metabolic mechanisms of pathology. The data on the therapeutic effect of various modulators through differentiated biochemical chains and vice versa – the metabolic effect through immunological mechanisms –were analyzed in the study. Thus, one can testify that there is the phenomenon of a mediated effect of some immunocorrectors on the reactivity through metabolic chains. The fact that a number of modulators and metabolics can simultaneously affect the biochemical and immunological parameters of patients proved the above phenomenon. There was revealed a significant correlation interaction of the immune-metabolic parameters with various types of purulent-inflammatory diseases, which proves the formation of a single mechanism of pathology.
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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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8
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Shiraishi K, Tabara M, Matsuyama H. High Inguinal Microsurgical Denervation of the Spermatic Cord for Chronic Scrotal Content Pain: A Novel Approach for Adult and Pediatric Patients. Urology 2019; 131:144-149. [PMID: 31136771 DOI: 10.1016/j.urology.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To improve the technique and results of microsurgical denervation of the spermatic cord (MDSC) for men with chronic scrotal content pain, we describe a novel approach at the level of the internal inguinal ring for the complete transection of the nerves running both inside and outside the spermatic cord for adults and children. METHODS A retrospective review of 52 patients (64 testicular units) who underwent high inguinal MDSC was performed. Visual analogue scale (VAS, 1-10) scores were compared with before and every 3 months after the surgery. Depressive symptoms were assessed by the Beck Depression Inventory. Hormonal evaluations were performed before and 6 months after the surgery. RESULTS The average patient age was 52.4 years (12-78); including 6 pediatric cases. The mean operative time was 67 minutes per testicular unit, and there were no major complications. The mean pre- and post-MDSC VAS scores were 8.3 and 2.5, respectively (P < .0001). Forty-six (88%) cases showed positive responses after MDSC, and multivariate analysis showed that pain outside the scrotum and depressive symptoms were predictors of MDSC failure (P < .05, odds ratio: 15.27 and 12.56, respectively). CONCLUSION For both adult and pediatric patients, high inguinal MDSC is an effective and safe management option, including testicular function, for the chronic scrotal content pain that is refractory to medical management. We find that the high inguinal approach is easier in our experience than the subinguinal approach because of fewer divisions of veins, a larger diameter of the spermatic artery.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan.
| | - Masanori Tabara
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Hideyasu Matsuyama
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
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9
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Kulintsova Y, Zemskov A, Berezhnova T. Immunotherapy in the treatment of chronic cystitis. RESEARCH RESULTS IN PHARMACOLOGY 2018. [DOI: 10.3897/rrpharmacology.4.31847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The article deals with to the new approaches to the immunotherapy of chronic cystitis. Cystitis appears to be a disease linked to the decreased immunity of the population.
Materials and Methods: The study included 200 patients with chronic cystitis, and was performed in three stages. At the first stage, all 200 patients were questioned to determine whether they do or do not have the basic immunopathological syndromes. At the second stage, the patients of 6 clinical groups underwent a routine immunologic examination using tests to evaluate basic populations, lymphocyte subpopulations, immune globulins, circulating immune complexes, average weight molecules, absorbing and metabolic phagocytic ability, pro- and anti-inflammatory cytokines by using flow cytofluorometry methods. The third stage included distribution of the major group of patients with chronic cystitis in the relapse stage into subgroups of 25 patients each who received conventional therapy.
Results and Discussion: The study has the following findings: the formation of risk groups depends on immunopathological syndromes and clinical-laboratory markers of disease peculiarities; signal tests of immunologic disorders and their correlative links with metabolic stress parameters were specified and formalized as diagnostic formulas; high clinical-bacteriological and low hemato-immunological efficacy of the conventional therapy patients with chronic cystitis and the capacity of the local and systemic modulators, such as kipferon, superlimf and imunofan, galavit, and their combinations, to normalize the parameters under study during 7-10 days were demonstrated. When combining the correctors, it was possible to achieve new quality independent of the properties of individual agents included in the composition; the reveal targets of various immune therapies were conditioned by the treatment provided, the characteristics of the correctors, the identification period – 7-10 days – 3-4 months. The analysis of the formulas of modulator targets made it possible to identify laboratory findings for their selection.
Conclusion: The data obtained during the study support the fact that there was no clinical efficacy of the conventional therapy for patients; this efficacy was maintained through to the administration of the combination of modulators in the acute period. Substantiated differentiated immunotherapy resulted in implementing the proper algorithm of observations, which prevented recurring of chronic cystitis in 3-4 months.
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McKernan LC, Walsh CG, Reynolds WS, Crofford LJ, Dmochowski RR, Williams DA. Psychosocial co-morbidities in Interstitial Cystitis/Bladder Pain syndrome (IC/BPS): A systematic review. Neurourol Urodyn 2017; 37:926-941. [PMID: 28990698 DOI: 10.1002/nau.23421] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/28/2017] [Indexed: 01/26/2023]
Abstract
AIMS Psychosocial factors amplify symptoms of Interstitial Cystitis (IC/BPS). While psychosocial self-management is efficacious in other pain conditions, its impact on an IC/BPS population has rarely been studied. The objective of this review is to learn the prevalence and impact of psychosocial factors on IC/BPS, assess baseline psychosocial characteristics, and offer recommendations for assessment and treatment. METHOD Following PRISMA guidelines, primary information sources were PubMed including MEDLINE, Embase, CINAHL, and GoogleScholar. Inclusion criteria included: (i) a clearly defined cohort with IC/BPS or with Chronic Pelvic Pain Syndrome provided the IC/BPS cohort was delineated with quantitative results from the main cohort; (ii) all genders and regions; (iii) studies written in English from 1995 to April 14, 2017; (iv) quantitative report of psychosocial factors as outcome measures or at minimum as baseline characteristics. RESULTS Thirty-four of an initial 642 articles were reviewed. Quantitative analyses demonstrate the magnitude of psychosocial difficulties in IC/BPS, which are worse than average on all measures, and fall into areas of clinical concern for 7 out of 10 measures. Meta-analyses shows mean Mental Component Score of the Short-Form 12 Health Survey (MCS) of 40.80 (SD 6.25, N = 2912), where <36 is consistent with severe psychological impairment. Averaged across studies, the population scored in the range seen in clinical depression (CES-D 19.89, SD 13.12, N = 564) and generalized anxiety disorder (HADS-A 8.15, SD 4.85, N = 465). CONCLUSION The psychological impact of IC/BPS is pervasive and severe. Existing evidence of treatment is lacking and suggests self-management intervention may be helpful.
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Affiliation(s)
- Lindsey C McKernan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Colin G Walsh
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - William S Reynolds
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Leslie J Crofford
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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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: 69] [Impact Index Per Article: 8.6] [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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12
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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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Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial. J Urol 2015; 194:1323-7. [PMID: 26004866 DOI: 10.1016/j.juro.2015.05.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE We prospectively evaluated the results of microsurgical spermatic cord denervation in a series of patients with chronic scrotal content pain in a multicenter study, including 1 center in Germany and 3 centers in Chile. MATERIALS AND METHODS A total of 50 patients with chronic scrotal content pain more than 3 months in duration were prospectively selected for standardized operative microsurgical spermatic cord denervation as pain treatment. In all patients preoperative management included a positive response to a spermatic cord block test with local anesthesia. Pain severity was assessed using an analog visual pain scale (range 0 to 10) for 30 consecutive days. A total of 52 testicular units were operated on using a subinguinal approach. In all cases a surgical microscope was used to identify the arteria testicularis. RESULTS No intraoperative complications were observed and no testicular units were lost. Two reoperations were performed, including 1 for hematocele and 1 for hydrocele. Six months after surgery 40 patients (80%) were completely pain-free. In 6 patients (12%) intermittent testicular discomfort persisted, which could be managed by acetaminophen on demand. Four patients (8%) had no change in pain severity after surgery. CONCLUSIONS After proper selection of patients microsurgical spermatic cord denervation seems to be a safe and efficient procedure to treat chronic scrotal content pain. Considering the limitations of the study, a randomized, controlled trial with longer followup is highly warranted.
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