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Mazza M, Margoni S, Mandracchia G, Donofrio G, Fischetti A, Kotzalidis GD, Marano G, Simonetti A, Janiri D, Moccia L, Marcelli I, Sfratta G, De Berardis D, Ferrara O, Bernardi E, Restaino A, Lisci FM, D'Onofrio AM, Brisi C, Grisoni F, Calderoni C, Ciliberto M, Brugnami A, Rossi S, Spera MC, De Masi V, Marzo EM, Abate F, Boggio G, Anesini MB, Falsini C, Quintano A, Torresi A, Milintenda M, Bartolucci G, Biscosi M, Ruggiero S, Lo Giudice L, Mastroeni G, Benini E, Di Benedetto L, Caso R, Pesaresi F, Traccis F, Onori L, Chisari L, Monacelli L, Acanfora M, Gaetani E, Marturano M, Barbonetti S, Specogna E, Bardi F, De Chiara E, Stella G, Zanzarri A, Tavoletta F, Crupi A, Battisti G, Monti L, Camardese G, Chieffo D, Gasbarrini A, Scambia G, Sani G. This pain drives me crazy: Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome. World J Psychiatry 2024; 14:954-984. [PMID: 38984334 PMCID: PMC11230088 DOI: 10.5498/wjp.v14.i6.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Interstitial cystitis/bladder pain syndrome (IC/BPS) is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic, abdominal, and/or pelvic pain. Although the term cystitis suggests an inflammatory or infectious origin, no definite cause has been identified. It occurs in both sexes, but women are twice as much affected. AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS. METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS, we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy: ("interstitial cystitis" OR "bladder pain syndrome") AND ("mood disorder" OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk). RESULTS On September 27, 2023, the PubMed search produced 223 articles, CINAHL 62, and the combined PsycLIT/ PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36. Search on ClinicalTrials.gov produced 14 studies, of which none had available data. Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS, i.e. 63 articles spanning from 2000 to October 2023. These studies identified depression and anxiety problems in the IC/BPS population, along with sleep problems and the tendency to catastrophizing. CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS. Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.
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Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stella Margoni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giuseppe Mandracchia
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Guglielmo Donofrio
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessia Fischetti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Giuseppe Marano
- Department of Neurosciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessio Simonetti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Delfina Janiri
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lorenzo Moccia
- Department of Neurosciences, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Ilaria Marcelli
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Greta Sfratta
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Ottavia Ferrara
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Evelina Bernardi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Antonio Restaino
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | | | - Caterina Brisi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Flavia Grisoni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Claudia Calderoni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Michele Ciliberto
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Andrea Brugnami
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Rossi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Chiara Spera
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Valeria De Masi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Ester Maria Marzo
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesca Abate
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gianluca Boggio
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | - Cecilia Falsini
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Anna Quintano
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alberto Torresi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Miriam Milintenda
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Bartolucci
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Marco Biscosi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Ruggiero
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Lo Giudice
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giulia Mastroeni
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Elisabetta Benini
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Di Benedetto
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Romina Caso
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Pesaresi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Traccis
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Onori
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luca Chisari
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Monacelli
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Mariateresa Acanfora
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Eleonora Gaetani
- Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Monia Marturano
- Division of Gynecologic Oncology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Barbonetti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Elettra Specogna
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesca Bardi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Emanuela De Chiara
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gianmarco Stella
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Andrea Zanzarri
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Flavio Tavoletta
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Arianna Crupi
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giulia Battisti
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Laura Monti
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giovanni Camardese
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Chieffo
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Antonio Gasbarrini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome 00168, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health, Catholic University, Rome 00168, Italy
| | - Gabriele Sani
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
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McKernan LC, McGonigle T, Vandekar SN, Crofford LJ, Williams DA, Clauw DJ, Bruehl S, Corbett BA, Dmochowski RR, Walsh EG, Kelly AG, Sutherland SL, Connors EL, Ryden A, Reynolds WS. A randomized-controlled pilot trial of telemedicine-delivered cognitive-behavioral therapy tailored for interstitial cystitis/bladder pain syndrome. Pain 2024:00006396-990000000-00532. [PMID: 38422486 DOI: 10.1097/j.pain.0000000000003188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/17/2023] [Indexed: 03/02/2024]
Abstract
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating urologic pain condition with few treatment advances in the past 25 years. Individuals with IC/BPS often experience significant psychological distress, which worsens symptoms and functioning. To date, there have been no large-scale, randomized controlled trials (RCTs) of comprehensive psychological interventions for IC/BPS. We conducted a 2:1 RCT of an 8-session patient-informed cognitive-behavioral therapy (CBT) intervention designed for IC/BPS for reducing pain-related symptoms and improving quality of life, delivered through telemedicine. Individuals with IC/BPS (N = 78) were randomized to receive either 8 weeks of CBT specifically designed for IC/BPS (n = 52) or an attention control condition (n = 26). Urologic symptoms (Genitourinary Pain Index, GUPI), pain-related symptoms, affective distress, and quality of life were evaluated before, immediately after, and 3 months posttreatment. Both conditions reported significant but similar reductions (P = 0.922) in the a priori primary outcome of genitourinary symptoms at posttreatment (GUPI reduction = 6.6 vs 4.8, for CBT and control, respectively) and long-term follow-up (8.1 vs 6.6, for CBT and control). However, the CBT group had significantly greater improvement in Patient Global Impression of Change (PGIC) scores and was significantly more likely to be treatment responders (PGIC ≥ 6) (37% vs 8%, P = 0.019 for CBT and control), with a large relative effect size (OR = 6.68). A subgroup analysis of CBT recipients showed that responders (PGIC
6) displayed significant reductions in genitourinary symptoms (P = 0.023), pain intensity (P = 0.027), and pain interference (P = 0.013) posttreatment. Telemedicine-delivered pain CBT for IC/BPS shows promise for improving outcomes, and this trial demonstrates the need for larger RCTs of CBT for IC/BPS.
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Affiliation(s)
- Lindsey C McKernan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Simon N Vandekar
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Leslie J Crofford
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Blythe A Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Elizabeth G Walsh
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Anna Grace Kelly
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Psychology, George Mason University, Fairfax, VA, United States
| | - Susanna L Sutherland
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Erin L Connors
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Anna Ryden
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - William Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, United States
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Mykoniatis I, Tsiakaras S, Samarinas M, Anastasiadis A, Symeonidis EN, Sountoulides P. Monoclonal Antibody Therapy for the Treatment of Interstitial Cystitis. Biologics 2022; 16:47-55. [PMID: 35619987 PMCID: PMC9129098 DOI: 10.2147/btt.s290286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
Abstract
An emerging theory regarding the potentially autoimmune nature of painful bladder syndrome/interstitial cystitis (PBS/IC) had led to several studies being conducted to assess the possible therapeutic effect of immunotherapeutic options for PBS/IC. This review presents the available evidence regarding the potential autoimmunity-based pathogenesis of PBS/IC and focuses on a main representative of the immunotherapeutic modalities for PBS/IC, aiming to summarize, evaluate, and present available data regarding the potential therapeutic role of monoclonal antibodies for PBS/IC patients. A non-systematic narrative and interpretative literature review was performed. The monoclonal antibodies included in the review were the anti-tumor necrosis factor-α (anti-TNF-α) agents adalimumab, which showed no difference compared to placebo, and certolizumab pegol, which showed statistically important differences in all outcome measures compared to placebo at the 18-week follow-up visit. Anti-nerve growth factor (anti-NGF) agents were also reviewed, including tanezumab, which showed both positive and negative efficacy results compared to placebo, and fulranumab, the study of which was discontinued owing to adverse events. In summary, monoclonal antibody therapy remains to be further researched in order for it to be proposed as a promising future treatment option for PBS/IC.
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Affiliation(s)
- Ioannis Mykoniatis
- First Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Correspondence: Ioannis Mykoniatis, First Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece, Email
| | - Stavros Tsiakaras
- First Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Samarinas
- Department of Urology, General Hospital “Koutlibanio”, Larissa, Greece
| | - Anastasios Anastasiadis
- First Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos N Symeonidis
- First Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Sountoulides
- First Urology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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