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- Diagnosing IC Early Can Avoid Unnecessary Hysterectomy
Chung MK, Jarnagin B. Early identification of interstitial cystitis may avoid unnecessary hysterectomy. JSLS. 2009 Jul-Sep;13(3):350-7.
By combing through the medical literature on IC and hysterectomy back to 1990, these investigators showed that hysterectomy is performed more often in patients with undiagnosed IC than in patients with a confirmed diagnosis. IC, the review also showed, often coexists with conditions, such as endometriosis, that can require a hysterectomy. But the authors warned readers of this journal for laparoscopic surgeons to consider the diagnosis of IC in women who have pelvic pain before a hysterectomy is done. IC should also be considered in patients who have pelvic pain even after a hysterectomy, the authors added.
- IC, Chronic Prostatitis Patients’ Pain Stories Bring New Perspective
Hatchett L, Fitzgerald MP, Potts J, Winder A, Mickelberg K, Barrell T, Kusek JW; Urologic Pelvic Pain Collaborative Research Network. Life impact of urologic pain syndromes. J Health Psychol. 2009 Sep;14(6):741-50.
IC and chronic prostatitis/chronic pelvic pain (CP/CPPS) patients’ pain stories showed that fatigue is a symptom that hasn’t been well recognized. In writing about their disease experience, patients demonstrated the effects were wide ranging, affecting not only their physical health but also their emotional and social health and social roles. More focus on fatigue and on impact of conditions on patients lives and roles could improve both research and patient care, said the investigators.
- Mixed Results for Relationship of Sexual Abuse with Chronic Pain
Paras ML, Murad MH, Chen LP, Goranson EN, Sattler AL, Colbenson KM, Elamin MB, Seime RJ, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA. 2009 Aug 5;302(5):550-61.
This meta-analysis of already published studies found a correlation between sexual abuse and some chronic pain conditions but not others. The analysis gleaned information from and analyzed 23 studies describing 4,640 people. The authors said the literature showed a correlation between sexual abuse and functional gastrointestinal disorders, nonspecific chronic pain, psychogenic seizures, and chronic pelvic pain. The analysts found no significant correlation between sexual abuse and fibromyalgia or headache. They said rape specifically correlated with fibromyalgia. This type of study does not give definitive answers to questions about the relationship of sexual abuse with chronic pain. The type of study that can is one that follows both abused and matched nonabused subjects over many years to compare how many in each group have a pain condition develop later after the abuse. Very few of these studies are in the medical literature, and sexual abuse rates differ depending on how questions about abuse are asked.
- Big Medical Centers Not Required for Multidisciplinary Approach
Chatoor D, Soligo M, Emmanuel A. Organising a clinical service for patients with pelvic floor disorders. Best Pract Res Clin Gastroenterol. 2009;23(4):611-20.
The multidisciplinary approach to treating chronic conditions is a trend. And, these authors argue, it doesn’t have to take place just at large medical centers were difficult cases are treated. The approach is evolving because the recognition is growing in medicine that that the causes and consequences of chronic conditions are complex. And it can be adapted in places where there is local expertise. The approach is especially important in pelvic floor disorders, where the correlation between structure and function is not always straightforward, said the authors. The article gives recommendations on stepwise approaches to diagnosis and treatment of fecal incontinence, obstetric trauma, pelvic floor prolapse, and chronic pelvic pain.
- Pain Specialist Focuses on Central Nervous System in Chronic Pelvic Pain
Baranowski AP. Chronic pelvic pain. Best Pract Res Clin Gastroenterol. 2009;23(4):593-610.
Chronic pelvic pain conditions, which affect both men and women, may have common central nervous system mechanisms involved. Because the conditions affect multiple organs and may also be accompanied by musculoskeletal and autonomic nervous system abnormalities and psychological, behavioral, sexual, and social problems, multidisciplinary management is called for. This pain management specialist believes that, in chronic pelvic pain syndromes, treating the end organ (such as the bladder) has a limited role.
- Pelvic Floor Problems Call for Coordinated Care
Elneil S. Complex pelvic floor failure and associated problems. Best Pract Res Clin Gastroenterol. 2009;23(4):555-73.
Because the pelvic floor supports a whole group of pelvic organs—bladder, bowel, and uterus—treating many disorders that affect these organs needs a coordinated approach, not one that’s fragmented among different specialties, argues this author. With severe pelvic floor problems, all three organs can be affected, so assessment needs to be done carefully and patients counseled well before treatment begins. Although correcting the anatomy is important (such as with prolapse), the goal must also be to preserve or restore pelvic floor function, wrote the author. That can include behavioral and lifestyle changes, conservative treatments (such as physical therapy), drug treatment, and surgery (referring to prolapse and incontinence surgeries). Because the cases can be complex, a multidisciplinary approach is critical, she said.
- Sexual Problems in Chronic Pelvic Pain Are Worse with Anxiety, Depression
Ter Kuile MM, Weijenborg PT, Spinhoven P. Sexual Functioning in Women with Chronic Pelvic Pain: The Role of Anxiety and Depression. J Sex Med. 2009 Aug 12. [Epub ahead of print]
Women with chronic pelvic pain have more sexual difficulties than healthy women. In this study, the problems were associated with anxiety, depression, and a history of sexual abuse but not with pain and physical impairment. Whether or not the women had been abused, anxiety and depression seemed to play a role in the effect of chronic pelvic pain on sexual problems. Sexual abuse was related to sexual problems in both women with chronic pelvic pain and healthy women. The abstract did not specify the types of pelvic pain the women had or whether any women had IC.
- No Firm Answer on Biggest Quality of Life Factors
Tripp DA, Nickel JC, Fitzgerald MP, Mayer R, Stechyson N, Hsieh A. Sexual functioning, catastrophizing, depression, and pain, as predictors of quality of life in women with interstitial cystitis/painful bladder syndrome. Urology. 2009 May;73(5):987-92.
What are the major drags on quality of life for IC patients? Previously, these researchers found sexual function to be a major factor, but not this time. Notable in this study were how long patients had had symptoms and unemployment. Lower physical quality of life scores correlated with longer duration of symptoms, unemployment, and pain severity, whereas lower mental quality of life scores correlated with age and pain “catastrophizing” (anxious worry about pain). The authors said these factors might predict quality of life outcomes. “Outcomes” usually implies the result of treatment, but this study only analyzed the correlation between these factors. It did not look at whether any factor might change when pain is treated successfully, for example.
- Improving Quality of Life May Take Clinical plus Psychological Therapy
Romão AP, Gorayeb R, Romão GS, Poli-Neto OB, dos Reis FJ, Rosa-e-Silva JC, Nogueira AA. High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain. Int J Clin Pract. 2009 May;63(5):707-11.
This study showed a correlation between anxiety and depression and quality of life in women with chronic pelvic pain. The authors said this emphasizes the importance of treating anxiety and depression together with clinical treatment to improve quality of life.
- IC/PBS and CP/CPPS Are Costly Conditions
Clemens JQ, Markossian T, Calhoun EA. Comparison of Economic Impact of Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Interstitial Cystitis/Painful Bladder Syndrome. Urology. 2009 Feb 2. [Epub ahead of print]
This study, which the ICA reported on from the American Urological Association’s annual meeting in 2007, has now been published. It shows the costliness of both IC and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The researchers surveyed 43 women with IC/painful bladder syndrome (IC/PBS) and 62 men with CP/CPPS about their hospitalizations, laboratory tests, physician visits, telephone calls, medication use, and lost productivity. The researchers then estimated the direct medical costs based on standard physician fees, Medicare physicians’ fees, and drug costs and estimated the indirect costs based on patients’ reported hours lost from work during the past three months. Based on Medicare rates the annual direct costs per person were $3,631 for IC/PBS and $3,017 for CP/CPPS. Using non-Medicare rates, the costs increased substantially to $7,043 for IC/PBS and $6,534 for CP/CPPS. Sixteen of the 52 men with CP/CPPS (26%) and eight of the 43 women with IC/PBS (19%) reported lost wages as a result of their condition. The non-Medicare estimate is likely the more accurate one, said the authors, because most patients were under age 65.
- Degree of Sexual Dysfunction Is High
Zaslau S, Brown ET, Fooks H, Riggs D, Jackson B, Osborne J, Kandzari SJ. Sexual dysfunction in patients with painful bladder syndrome. W V Med J. 2008 Nov-Dec;104(6):18-21.
The degree of sexual dysfunction is high in patients with IC/PBS, according to this online survey that was originally presented in 2003 at the American Urological Association Annual Meeting. Patients who had self-reported painful bladder syndrome filled out a standard female sexual function questionnaire, which evaluates desire, arousal, lubrication, orgasm, satisfaction, and pain. The investigators compared the results from these 100 patients with those of 131 healthy volunteers and 128 patients with female sexual arousal disorder. Compared with the controls, IC/PBS patients had dysfunction in all aspects of sexual function.
- Mental Health Problems Affect Less than a Quarter of IC Patients
Clemens JQ, Brown SO, Calhoun EA. Mental Health Diagnoses in Patients With Interstitial Cystitis/Painful Bladder Syndrome and Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Case/Control Study. J Urol. 2008 Aug 14. [Epub ahead of print]
This study found fairly low rates of mental health (depression and panic) disorders in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and women with IC/painful bladder syndrome (PBS), in contrast with other studies showing a high rate of depression. Patients did, however, have higher rates of problems than their healthy counterparts. Based on their answers on the Patient Health Questionnaire, 23 percent of women with IC/PBS did compared with 3 percent of controls, and 13 percent of 174 men with CP/CPPS had disorders compared with 4 percent of controls. The only things that correlated well with having disorders were simply the fact of having IC/PBS or CP/CPPS and having an income higher than $50,000. Age, gender, race/ethnicity, and education did not correlate with having a disorder. Eighteen percent of the men and 37 percent of the women took medications for anxiety, depression, or stress compared with 7 percent of the control men and 13 percent of the control women.
- Sexual Problems Worse in Older Patients
Zaslau S, Riggs DR, Perlmutter AE, Jackson BJ, Osborne J, Kandzari SJ. Sexual dysfunction in patients with painful bladder syndrome is age related and progressive. Can J Urol. 2008 Aug;15(4):4158-62.
These investigators analyzed results of a standard sexual function questionnaire given to women who met criteria for painful bladder syndrome (PBS). Sexual function was worse in PBS patients than in healthy women and it was also worse in those older than 50 than in those under 30. The older PBS patients had more problems with arousal, lubrication, and pain. Pain scores were worse in every successive age group. Pain was the most significant sexual dysfunction in these patients.
- Cost of IC is High, Especially for Patients Getting Strong Pain Control
Stanford EJ, Chen A, Wan GJ, Lunacsek OE, Sand PK. Treatment modalities, health care resource utilization, and costs in patients diagnosed with interstitial cystitis. Am J Obstet Gynecol. 2008 Jul;199(1):71.e1-10.
These pelvic surgeons did an analysis of a managed care claims database and found that healthcare costs were higher for IC patients who were treated with narcotics plus nonnarcotic analgesics than those who were treated with more common oral medications for IC, such as pentosan polysulfate (Elmiron), amitriptyline (Elavil), and hydroxyzine (Atarax). Physician visits were fewest among patients treated with Elmiron, amitriptyline, and hydroxyzine. Patients who got treated with DMSO plus cystoscopy or bladder irrigation or narcotics plus nonnarcotic analgesics had more physician visits than others. These results might imply that management is more efficient with the oral drugs, but it might also imply that patients who have more pain and need more pain-oriented therapy have worse conditions and need more care.
- Behavioral Therapy May Improve Sexual Function
Breton A, Miller CM, Fisher K. Enhancing the sexual function of women living with chronic pain: A cognitive-behavioural treatment group. Pain Res Manag. 2008 May-Jun;13(3):219-24.
Women with chronic pain who attended a group cognitive behavioral therapy program showed improvement in sexual function, despite no change in pain levels during penetration or change in fatigue levels. The group therapy was led by a psychologist and physical therapist. This was a qualitative and not a controlled study. The authors said that the results suggest that a “cognitive shift,” communication, and partner involvement may be the reasons for improvement.
Revised October 27, 2009
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