1
|
Cameron AP, Yang CC, Bradley CS, Griffith JW, Kirkali Z, Clemens JQ, Kreder KJ, Kenton KS, Andreev VP, Amundsen CL, Jelovsek JE, Helfand BT, Lai HH. Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN): An introduction to the Urinary Urgency Phenotyping Protocol LURN II. Neurourol Urodyn 2024. [PMID: 39075835 DOI: 10.1002/nau.25566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/20/2024] [Indexed: 07/31/2024]
Abstract
AIMS The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is undertaking a new cohort study in LURN II including cases and controls. METHODS This new cohort was enrolled to specifically study urinary urgency and urgency urinary incontinence, lower urinary tract symptoms (LUTSs) that are often difficult to treat due to a lack of understanding of their phenotypes and pathophysiologies. RESULTS This paper will focus on the motivation for the second iteration of LURN and highlight the new research techniques and plans for more thorough phenotyping of this population. CONCLUSIONS This paper will outline the gaps in understanding in treating LUTSs, specifically urinary urgency.
Collapse
Affiliation(s)
- Anne P Cameron
- Michigan Medicine Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - James W Griffith
- Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Karl J Kreder
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kimberly S Kenton
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
| | - Victor P Andreev
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Cindy L Amundsen
- Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Division of Urology, Female Pelvic Medicine and Reconstructive Surgery, Duke University School of Medicine, Duke Health, Raleigh, North Carolina, USA
| | - J Eric Jelovsek
- Obstetrics and Gynecology, Duke University School of Medicine, Duke Health, Raleigh, North Carolina, USA
| | - Brian T Helfand
- Department of Urology, NorthShore University HealthSystem, Glenview, Illinois, USA
| | - H Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
2
|
Zhao K, Harandi AA, Ramgopal J, Kim J, Weissbart S. Fluid intake behavior in women with refractory overactive bladder undergoing third line therapy. Neurourol Urodyn 2024; 43:44-51. [PMID: 37961997 DOI: 10.1002/nau.25328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Fluid intake has been shown to be related to urinary symptoms, but no studies to date have investigated the effect of fluid intake on urinary symptoms in women with refractory overactive bladder (OAB). As this group of women are considered to have a possible unique pathophysiologic mechanism of OAB, we investigated the relationship between fluid intake, fluid intake behavior, and urinary symptoms in women with refractory OAB. METHODS A prospective cross-sectional study of women with refractory OAB was conducted by assessing the relationship between fluid intake and lower urinary tract symptoms (LUTS) in women undergoing third line OAB therapies. Fluid intake and behavior were measured by the questionnaire based voiding diary and urinary symptoms were measured by the International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). The relationship between fluid intake and symptom severity was assessed using Spearman's rank correlation and χ2 tests. RESULTS Of the 126 individuals undergoing third line therapy for OAB, 60 (48%) underwent intradetrusor onabotulinumtoxinA injection (BTX) injection, 42 (33%) peripheral tibial nerve stimulation, and 24 (19%) sacral neuromodulation. The mean total daily fluid intake was 2567.0 ± SD 1292.4 mL and did not differ significantly across treatment groups. Total fluid intake was weakly correlated with worse filling-type LUTS (r = 0.241, p = 0.007), and there was no relationship between LUTS and caffeinated fluid intake. Half (52%) of the subjects reported current fluid restricting behavior to control urinary symptoms, but this behavior was not correlated with LUTS severity (all p > 0.05). Patients that currently use tobacco have greater LUTS (current = 25.8 ± SD 9.5, former = 14.8 ± SD 6.1, never = 15.0 ± SD 6.1; p < 0.001). BMI was also positively correlated with worse incontinence symptoms (r = 0.351, p < 0.001). CONCLUSIONS Fluid intake along with other lifestyle factors, including tobacco use and weight, are minimally related to the symptomatology seen in women with refractory OAB. Further studies are needed to assess if behaviors change during treatment with third line therapies, and if these behavioral changes may affect treatment response.
Collapse
Affiliation(s)
- Kelley Zhao
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | - Jason Kim
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Steven Weissbart
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| |
Collapse
|
3
|
Senders A, Bauer S, Chen Y, Oken B, Fink H, Lane N, Sajadi K, Marshall L. Musculoskeletal Pain, a Possible Indicator of Central Sensitization, Is Positively Associated With Lower Urinary Tract Symptom Progression in Community-Dwelling Older Men. J Gerontol A Biol Sci Med Sci 2023; 78:997-1004. [PMID: 36149833 PMCID: PMC10235191 DOI: 10.1093/gerona/glac204] [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: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Musculoskeletal pain, a possible marker of central sensitization, is associated with higher prevalence of lower urinary tract symptoms (LUTS) among older men. We investigated whether musculoskeletal pain is associated with LUTS progression. METHODS Participants were 5 569 men age ≥65 years enrolled in the prospective, multicenter Osteoporotic Fractures in Men (MrOS) Study. Self-reported musculoskeletal pain within 12 months before baseline was categorized as any pain and multilocation pain. Pain interference within 4 weeks of baseline was assessed with the SF-12 questionnaire. LUTS were assessed repeatedly with the American Urological Association Symptom Index (AUA-SI). Men with severe LUTS at baseline were excluded. LUTS progression was defined as the first occurrence of a ≥4-point AUA-SI increase during a 2-year follow-up interval. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using multivariable pooled logistic regression. RESULTS LUTS progression was 37% higher among men with any musculoskeletal pain compared with men without pain (IRR 1.37, 95% CI: 1.21, 1.54). Positive associations were also observed between LUTS progression and pain at 1 (IRR 1.31, 95% CI: 1.13, 1.48) and ≥2 locations (IRR 1.42, 95% CI: 1.24, 1.60). Compared with men without pain interference, men with quite a bit/extreme pain interference were most likely to experience LUTS progression (minimal interference IRR 1.15, 95% CI: 1.03, 1.26; moderate interference IRR 1.28, 95% CI: 1.11, 1.45; quite a bit/extreme interference IRR 1.47, 95% CI: 1.22, 1.71). CONCLUSIONS Among men initially without severe LUTS, musculoskeletal pain is associated with an increased risk of LUTS progression. Studies using validated measures of central sensitization and LUTS progression among men are warranted.
Collapse
Affiliation(s)
- Angela Senders
- Oregon Health and Science University–Portland State University School of Public Health, Portland, Oregon, USA
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Scott R Bauer
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Healthcare System, San Francisco, California, USA
| | - Yiyi Chen
- Seagen, Inc., Bothell, Washington, USA
| | - Barry Oken
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nancy E Lane
- Department of Medicine, University of California, Davis, California, USA
| | - Kamran P Sajadi
- Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Lynn M Marshall
- Oregon Health and Science University–Portland State University School of Public Health, Portland, Oregon, USA
| |
Collapse
|
4
|
Reynolds WS, McKernan LC, Dmochowski RR, Bruehl S. The biopsychosocial impacts of anxiety on overactive bladder in women. Neurourol Urodyn 2023; 42:778-784. [PMID: 36780135 PMCID: PMC10101863 DOI: 10.1002/nau.25152] [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: 11/09/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/14/2023]
Abstract
AIMS Links between emotional state and the bladder have long been recognized, as psychological comorbidity is a common feature of overactive bladder (OAB). However, how psychological factors might contribute to the development and severity of OAB remains unclear. Therefore, we sought to examine the effect of anxiety on OAB with a specific focus on bladder hypersensitivity. METHODS In a sample of 120 adult women with OAB, we compared those with at least mild anxiety (PROMIS Anxiety score ≥55) to those with lower anxiety. Analyses focused on patient-reported questionnaires assessing urinary symptom severity and quality of life, psychological stress symptoms, general somatic symptoms, and results of quantitative sensory testing (QST), including temporal summation to heat pain (TSP). TSP was used to index elevated C-fiber responsiveness (i.e., central sensitization). RESULTS Thirty-six (30%) women had at least mild anxiety. While there were no group differences for urinary symptom severity, more anxious women reported worse OAB-specific quality of life, greater psychological stress burden, higher stress reactivity, and greater somatic symptoms. On QST, there were no differences between anxiety groups for pain threshold (43.6 ± 3.1°C vs. 44.0 ± 3.1°C, p = 0.6) and tolerance (47.3 ± 1.5°C vs. 47.4 ± 1.6°C, p = 0.7). However, those with anxiety had significantly higher TSP than those without anxiety (6.0 ± 4.8 vs. 3.7 ± 3.9, p = 0.006), indicating greater central sensitization. CONCLUSIONS Women with OAB and at least mild anxiety symptoms reported greater psychosocial burdens (i.e., psychological stress, stress reactivity, OAB-specific QOL) and somatic symptom severity and demonstrated greater central sensitization on QST than those without anxiety. These findings support the hypothesis that anxiety and psychological stress impact hypersensitivity mechanisms that may underlie and contribute to OAB, although further research is needed to better understand how and to what extent.
Collapse
Affiliation(s)
- William S Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsey C McKernan
- Departments of Psychiatry and Behavioral Sciences and of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
5
|
Sutherland S, Kelly AG, Ryden A, Dmochowski RR, Reynolds WS, McKernan LC. Compensatory coping and depression in women with interstitial cystitis/bladder pain syndrome. Neurourol Urodyn 2023; 42:322-329. [PMID: 36378850 PMCID: PMC9805512 DOI: 10.1002/nau.25089] [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: 03/24/2022] [Revised: 08/24/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Women with genitourinary pain, a hallmark symptom of interstitial cystitis/bladder pain syndrome (IC/BPS), are at a two- to four-fold risk for depression as compared to women without genitourinary pain. Despite the pervasive impact of IC/BPS on psychological health, there is a paucity of empirical research on understanding the relation between IC/BPS and psychological distress. It has been previously reported that women with overactive bladder use increased compensatory coping and these behaviors are associated with heightened anxiety and stress. However, it is unknown whether a similar pattern emerges in IC/BPS populations, as ICBPS and OAB share many similar urinary symptoms. The current study examined the relationship between compensatory coping behaviors and symptoms of psychological distress in a sample of women with IC/BPS to inform understanding of risk and potential mechanisms for intervention. METHOD This was a secondary analysis of an observational cohort of women with bladder symptoms. Fifty-five adult women with IC/BPS completed validated assessments of genitourinary symptoms, emotional distress, and bladder coping behaviors. Five compensatory coping behaviors were summed to create a total Bladder Coping Score. Linear regression examined associations between individual coping behaviors, total compensatory coping scores, and other risk variables. RESULTS Most (93%) participants reported use of at least one compensatory coping behavior. Age, education level, history of vaginal birth, and symptom severity were all associated with greater compensatory coping scores, and anxiety was not. Beyond the influence of symptom severity, higher levels of depression were significantly associated with higher compensatory coping scores. DISCUSSION Greater compensatory coping was associated with increased depression but not anxiety, suggesting different profiles of coping and psychological distress may exist among different types of bladder dysfunction.
Collapse
Affiliation(s)
- Susanna Sutherland
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - A. Grace Kelly
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Anna Ryden
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Roger R. Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Lindsey C. McKernan
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
6
|
Stress-induced analgesia: an evaluation of effects on temporal summation of pain and the role of endogenous opioid mechanisms. Pain Rep 2022; 7:e987. [PMID: 35155968 PMCID: PMC8826964 DOI: 10.1097/pr9.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
Acute stress reduced the initial pain rating in a temporal summation protocol via nonopioid mechanisms but did not affect temporal summation slope, an indicator of central sensitization. Introduction: Objectives: Methods: Results: Conclusions:
Collapse
|
7
|
Reynolds WS, Kaufman M, Bruehl S, Dmochowski R, McKernan LC. Compensatory bladder behaviors ("coping") in women with overactive bladder. Neurourol Urodyn 2022; 41:195-202. [PMID: 34524704 PMCID: PMC8738122 DOI: 10.1002/nau.24788] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023]
Abstract
AIMS There is little information on how often or within what contexts individuals with OAB use compensatory behaviors ("coping") to manage symptoms. We sought to examine how frequently women with OAB report using coping behaviors and whether these are associated with psychosocial factors. METHODS One hundred twenty adult women with OAB completed the OAB questionnaire (OAB-q), ICIQ-FLUTS questionnaire, PROMIS Anxiety and Depression, Perceived Stress Scale, patient perception of bladder condition, and demographic and clinical data. Responses from five items from the OAB-q Quality-of-Life scale asking about coping with OAB symptoms (i.e., "compensatory coping behaviors") were summed to generate a total Coping Score. Linear regression was used to identify associations between individual coping behaviors, total Coping Scores, and exposure variables. RESULTS Most (88%) subjects reported using at least one compensatory coping behavior at least "a little of the time," with "locating the nearest restroom in a new place" the most frequent. Higher BMI, lower education, using OAB medication, and urgency incontinence as well as urinary symptom severity were all associated with higher coping scores. Beyond the influence of OAB severity, higher anxiety (β = 0.15, 95% CI [0.05-0.26], p = 0.004) and stress (β = 0.16 [0.03-0.25], p = 0.02) were significantly associated with higher total coping scores, although depression was not. CONCLUSIONS Compensatory bladder behaviors (coping) were common in women with OAB and were associated with greater urinary symptom severity and higher anxiety and stress. Further study is needed to understand how coping behaviors and psychosocial factors relate, as these may represent important opportunities for interventions.
Collapse
Affiliation(s)
- W. Stuart Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsey C. McKernan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN,Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
8
|
Harte SE, Wiseman J, Wang Y, Smith AR, Yang CC, Helmuth M, Kreder K, Kruger GH, Gillespie BW, Amundsen C, Kirkali Z, Lai HH. Experimental Pain and Auditory Sensitivity in Overactive Bladder Syndrome: A Symptoms of the Lower Urinary Tract Dysfunction Research Network (LURN) Study. J Urol 2022; 207:161-171. [PMID: 34428922 PMCID: PMC9237822 DOI: 10.1097/ju.0000000000002147] [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] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to investigate the presence of nonbladder sensory abnormalities in participants with overactive bladder syndrome (OAB). MATERIALS AND METHODS Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study participants with OAB symptoms and controls were recruited from 6 U.S. tertiary referral centers. Quantitative sensory testing (QST) was performed to determine pressure pain sensitivity at the thumbnail bed and auditory sensitivity. Fixed and mixed effect multivariable linear regressions and Weibull models were used to compare QST responses between groups. Pearson correlations were used to assess the relationship between QST measures. Associations between QST and self-reported symptoms were explored with linear regression. RESULTS A total of 297 participants were analyzed (191 OAB, 106 controls; 76% white, 51% male). OAB cases were older than controls (57.4 vs 52.2 years, p=0.015). No significant differences in experimental thumbnail (nonbladder) pain or auditory sensitivity were detected between OAB cases and controls. Correlations between pressure and auditory derived metrics were weak to moderate overall for both groups, with some significantly stronger correlations for cases. Exploratory analyses indicated increased pressure pain and auditory sensitivity were modestly associated with greater self-reported bladder pain and pain interference with physical function. CONCLUSIONS As a group, no significant differences between OAB cases and controls were observed in experimental nonbladder pain or auditory sensitivity during QST. Associations between QST outcomes and clinical pain raise the possibility of centrally mediated sensory amplification in some individuals with OAB.
Collapse
Affiliation(s)
- Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jon Wiseman
- Arbor Research Collaborative for Health, Ann Arbor, MI USA
| | - Ying Wang
- Department of Anesthesia, Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Claire C. Yang
- Department of Urology, University of Washington, Seattle, WA, 98195-6510 USA
| | | | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Grant H. Kruger
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Cindy Amundsen
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - H. Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Kong JT, Bagarinao E, Olshen RA, Mackey S. Novel Characterization Of Thermal Temporal Summation Response By Analysis Of Continuous Pain Vs Time Curves And Exploratory Modeling. J Pain Res 2019; 12:3231-3244. [PMID: 31819607 PMCID: PMC6898991 DOI: 10.2147/jpr.s212137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Abstract
Background Temporal summation (TS) refers to the increased perception of pain with repetitive noxious stimuli. While thermal TS is generally considered a behavioral correlate of spinal windup, noxious heat pulses also trigger additional sensory processes which were modeled in this study. Methods Nineteen healthy volunteers (9 females, mean age 29.2, SD 10.5) underwent two identical TS experiments, spaced a week apart. The TS paradigm consisted of 10 identical heat pulses with individualized temperatures at the thenar eminence (0.5Hz). We extracted 3 features from continuous TS response curves: Lag, time to first feel pain; Slope, the rate of pain increase between the first and most painful heat pulse; and Delta, the maximum drop in pain after peak pain is reached. We then examined the within-individual stability of these features, followed by the Pearson’s correlations among these features and between the features and negative affect. Results All 3 features were stable over 1 week. Lag and Delta were negatively correlated (r = −0.5, p = 0.042). Slope did not correlate with Lag or Delta, but strongly correlated with a traditional TS measure, first pulse pain and peak pain difference (r = 0.91, p < 0.0001). Negative affects such as trait and state anxiety were negatively correlated with baseline (r = −0.49, p = 0.031) and peak stimulating temperature (r = −0.48, p = 0.039), respectively, suggesting an association between anxiety and greater pain sensitivity. Conclusion We were able to decouple spinal windup from other perceptual processes generated by phasic thermal TS paradigms and demonstrate temporal stability of these curve features. These curve features may help better characterize the complex sensory response to noxious heat pulses and serve as biomarkers to profile patients with chronic pain.
Collapse
Affiliation(s)
- Jiang-Ti Kong
- Department Of Anesthesiology, Perioperative And Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Richard A Olshen
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, CA, USA
| | - Sean Mackey
- Department Of Anesthesiology, Perioperative And Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|