OAB and IC Patients Report High Psychological Stress Levels
Lai H, Gardner V, Vetter J, Andriole GL. Correlation between psychological stress levels and the severity of overactive bladder symptoms. BMC Urol. 2015 Mar 8;15(1):14. doi: 10.1186/s12894-015-0009-6.
In this study, patients with overactive bladder (OAB) reported psychological stress levels as high as patients with interstitial cystitis/bladder pain syndrome (IC/BPS), and both groups had stress levels significantly higher than healthy control subjects. There was also a correlation between stress levels in OAB patients and urinary incontinence (ie, the higher the stress levels, the greater the symptoms). These findings shed light on the role of psychological stress in OAB patients. The role of stress has been well defined in previous studies specific to IC/BPS patients. Even though OAB and IC/BPS share some of the same symptoms, there haven’t been that many studies looking specifically at the relationship between psychological stress and urinary symptoms in OAB patients.
Women With IC Sound Off on The Negative Impacts of Symptom Flares
Sutcliffe S, Bradley CS, Clemens JQ, James AS, Konkle KS, Kreder KJ, Lai HH, Mackey SC, Ashe-McNalley CP, Rodriguez LV, Barrell E, Hou X, Robinson NA, Mullins C, Berry SH. Urological chronic pelvic pain syndrome flares and their impact: qualitative analysis in the MAPP network. Int Urogynecol J. 2015 Mar 20. [Epub ahead of print] Researchers have published a report full of insights on how symptom exacerbations, or flares, affect women with IC/BPS. The unique, in-depth report is based on the results of 8 focus groups involving a total of 57 women with IC/BPS who were patients at one of four sites in the MAPP (Multidisciplinary Approach to the Study of Chronic Pelvic Pain) Research Network. The women most commonly reported painful flares lasted for days and were disruptive to participants’ lives. The flares led to missed work or school, cancelled social events, and in the worst cases, emergency room visits or disability leave. The longer-term impact of flares included negative effects on sexual functioning and family or social relationships. Some participants even reported that flares caused them to lose their jobs, or limited their chances for career or educational advancement. Women expressed a need for a sense of control over their unpredictable symptoms, and control over their reduced ability to engage socially. Given these findings, researchers said efforts should be focused on approaches to reduce the frequency, severity, and duration of flares. They also said clinicians can help women with IC achieve a sense of control by providing ready access to medications or therapy to treat flares, thereby improving their quality of life.
IC Puts Patients at Significant Risk for Anxiety, Depression, and Insomnia
Chuang YC, Weng SF, Hsu YW, Huang CL, Wu MP. Increased risks of healthcare-seeking behaviors of anxiety, depression and insomnia among patients with bladder pain syndrome/interstitial cystitis: a nationwide population-based study. Int Urol Nephrol. 2015 Feb;47(2):275-81. doi: 10.1007/s11255-014-0908-6. Epub 2015 Jan 11.
Previous studies have suggested that some patients with bladder pain syndrome/interstitial cystitis (BPS/IC) seem to be prone to some psychological disorders, such as anxiety, that could not be explained away by other potential causes, such as another unrelated medical problem or substance abuse. Now, a group of researchers in Taiwan have corroborated these findings in a large, population-based study. Their research suggests that BPS/IC indeed puts patients at risk for a range of psychological complications. The researchers evaluated the records of more than 16,000 BPS/IC patients and 32,000 control subjects and found significantly higher rates of anxiety, depression, and insomnia in the BPS/IC patient group. Interestingly, and by contrast, BPS/IC patients and controls actually had similar rates of medical disorders such as hypertension, diabetes, and kidney disease. The take-away message here is that doctors and patients alike should be on the alert to catch potentially treatable psychological conditions that may develop as a result of BPS/IC.
Sleep Issues Affect Quality of Life Among IC Patients
Troxel WM, Booth M, Buysse DJ, Elliott MN, Suskind AM, Clemens JQ, Berry SH. Sleep Disturbances and Nocturnal Symptoms: Relationships with Quality of Life in a Population-Based Sample of Women with Interstitial Cystitis/ Bladder Pain Syndrome. J Clin Sleep Med. 2014 Oct 17. pii: jc-00174-14. [Epub ahead of print] After telephone interviews with 3,397 women with IC symptoms, researchers found that problems sleeping are not only highly prevalent, but that they are associated with poorer quality of life. More than half of those interviewed experienced poor sleep quality, short duration of sleep, and IC-related sleep disturbances (i.e., pain, urgency, frequency). Further analysis showed an association between these sleep problems and poorer self-reported quality of life and physical health, and greater sexual dysfunction.
Distraction Reduces Chronic Pain Among High Catastrophizers
Schreiber KL, Campbell C, Martel MO, Greenbaum S, Wasan AD, Borsook D, Jamison RN, Edwards RR. Distraction Analgesia in Chronic Pain Patients: The Impact of Catastrophizing. Anesthesiology. 2014 Sep 26. [Epub ahead of print] Distraction techniques for pain management provided greater relief among chronic pain patients with higher levels of catastrophizing than those with lower levels. For the study, 149 chronic pain patients completed a task to take their mind off their pain. Everyone experienced pain relief during the distraction, but it was greatest among the highest catastrophizers, suggesting that the pain-enhancing effect of catastrophizing may be related to greater attention to pain, and that distraction may be a useful tool for pain management.
Chronic Pelvic Pain Affects Sleep Quality
Cosar E, Cakır Güngör A, Gencer M, et. al. Sleep disturbance among women with chronic pelvic pain. Int J Gynaecol Obstet. 2014 May 21. pii: S0020-7292(14)00248-3. doi: 10.1016/j.ijgo.2014.03.034. [Epub ahead of print] In a study of 157 Turkish women, 80% of those with chronic pelvic pain (CPP) reported poor quality of sleep, compared to 55% of those without CPP. Sleep quality was measured using the Pittsburgh Sleep Quality Index.
Illness Perceptions Predict Catastrophizing in IC
The ability to predict who is likely to catastrophize (to think that something is worse than it is) is important because IC patients can be taught to think differently about the disease, which leads to better coping and improved quality of life. Questionnaire data from 70 women revealed that patient perceptions of IC, especially concerns about the illness and its emotional impact, were the most significant predictors of catastrophizing. Clinicians can use these findings to help identify which patients will need additional support to understand and cope with IC.
AUA Session: Infections/Inflammation of the Genitourinary Trace: Interstitial Cystitis
Title: What generates pain catastrophizing in IC/BPS?
Publication Number: PD9-12
Authors: Dean A. Tripp*, J. Curtis Nickel, Laura Katz, Kingston, Canada, Lesley K. Carr, Toronto, Canada, Robert Mayer, Rochester, NY
More Evidence for Co-Existing Conditions Among Women with IC
Fan YH, Lin AT, Lu SH, Chuang YC, Chen KK. Non-bladder conditions in female Taiwanese patients with interstitial cystitis/hypersensitive bladder syndrome. Int J Urol. 2014 Apr 13. doi: 10.1111/iju.12456. [Epub ahead of print] A study from Taiwan supports a variety of research showing that women who have IC are likely to have other pain conditions as well. In this study, 122 women with IC and 122 women with stress urinary incontinence were surveyed about symptoms of irritable bowel syndrome (IBS), temporomandibular disorder, multiple chemical sensitivities, tension and migraine headache, localized myofascial pain disorder, and fibromyalgia, and, among those with IC, symptom severity. Women with IC were more likely to meet diagnostic criteria for IBS and tension and migraine headache; there was no significant difference in the incidence of the other conditions between the two groups. Also, among those with IC, the greater the number of other conditions experienced, the more severe the IC symptoms.
Flares: A Common and Bothersome Part of IC and CPPS
Sutcliffe S, Colditz GA, Goodman MS, Pakpahan R, Vetter J, Ness TJ, Andriole GL, Lai HH. Urologic Chronic Pelvic Pain Syndrome Symptom Flares: Characterization of the Full Spectrum of Flares at Two Sites of the Mapp Research Network. BJU Int. 2014 Apr 15. doi: 10.1111/bju.12778. [Epub ahead of print] Out of 76 IC and CPPS patients surveyed, 94 percent reported having experienced flares (defined as symptoms that are much worse than usual), according to a study from the MAPP Research Network. Regardless of how long the flares lasted (seconds to months), they resulted in greater pelvic pain, urologic symptoms, daily life disruption, and bother, all of which increased in severity the longer the flare lasted. Type of symptoms—particularly pelvic pain—was also related to a greater degree of bother. Flares that lasted for several days were linked to greater health-care use.
Dealing with Loss Helps Chronic Pain Patients
Haraldseid C1, Dysvik E2, Furnes B2. The experience of loss in patients suffering from chronic pain attending a pain management group based on cognitive-behavioral therapy. Pain Manag Nurs. 2014 Mar;15(1):12-21. doi: 10.1016/j.pmn.2012.04.004. Epub 2012 Jun 6.
Part of managing chronic pain is recognizing what one has lost and adapting to those changes in a positive way. Working with six chronic pain patients, the study authors identified three general categories of loss: loss of ability to engage in meaningful activities, loss of relation with others, and loss of self. They found that participating in a cognitive behavioral therapy group helps patients identify and accept their losses, change how they think about their experiences, and move toward creating a meaningful life despite their pain.
Internalizing Stigma Affects Self Esteem and Coping Ability in Chronic Pain
Waugh OC, Byrne DG, Nicholas MK. Internalized Stigma in People Living with Chronic Pain. J Pain. 2014 Feb 15. pii: S1526-5900(14)00566-5. doi: 10.1016/j.jpain.2014.02.001. [Epub ahead of print] Among 92 adults with chronic pain, more than a third said they had taken to heart negative social responses (whether experienced or perceived), letting the stigma define who they are as a person. Internalizing the stigma of chronic pain had negative psychological consequences, including low self-esteem, a greater tendency to catastrophize (thinking the worst of) pain, and a decreased sense of control over pain. The authors emphasize that understanding how personal devaluation and invalidation affects the chronic pain population is important to treatment.
Healthcare: Cost and Use Higher For IC
Chung SD1, Liu SP2, Li HC3, Lin HC4. Health Care Service Utilization among Patients with Bladder Pain Syndrome/Interstitial Cystitis in a Single Payer Healthcare System. PLoS One. 2014 Jan 29;9(1):e87522. doi: 10.1371/journal.pone.0087522.
This study from Taiwan found that people with IC have a significantly higher number of healthcare related visits and costs than those without IC. The study looked at healthcare use during a one-year period in terms of the number of outpatient visits and inpatient days, as well as the costs of outpatient and inpatient treatment, among 350 IC patients and 1,750 age-matched controls. Overall, those with IC had 174% more outpatient visits and 150% higher total costs than the controls.
CP Patients and Their Spouses Need Support Programs to Improve QoL
Tripp DA, Nickel JC, Shoskes D, Koljuskov A. A 2-year follow-up of quality of life, pain, and psychosocial factors in patients with chronic prostatitis/chronic pelvic pain syndrome and their spouses. World J Urol. 2013 Aug;31(4):733-9. doi: 10.1007/s00345-013-1067-6. Epub 2013 Apr 9.
After a 2-year study of physical and mental quality of life (QoL) among 21 men with chronic prostatitis and their spouses, Canadian researchers found that while QoL in both areas increased over time, mental QoL was lower among the patients. Both patients and their spouses experienced depression and anxiety, but again, it was worse among patients. In addition, patient catastrophizing, pain, and disability did not improve during the 2-year period. In light of these findings, the researchers recommend the development and implementation of mental health strategies to help couples suffering from CP.
IC Impacts Work Productivity and Income
Megan K. Beckett, Marc N. Elliott, J. Quentin Clemens, Brett Ewing, Sandra H. Berry. Consequences of Interstitial Cystitis/Bladder Pain Symptoms on Women’s Work Participation and Income: Results from a National Household Sample. Journal of Urology. doi:10.1016/j.juro.2013.07.018 Published online 18 July 2013.
Back in May, ICA reported from the American Urological Association (AUA) 2013 annual meeting about new findings from the RAND Interstitial Cystitis Epidemiology (RICE) study. The researchers, which included ICA Medical Advisory Board member J. Quentin Clemens, assessed the impact of IC symptom severity, depressive symptoms, and co-morbidities on work participation and income in 2767 women who have suffered from IC for 13 years. The results showed that the greater impact symptoms had on quality of life, the more depressive symptoms, and the more co-morbidities women had, the greater the impact on work loss and productivity. However, IC symptom severity alone had no impact on measured work outcomes. The researchers concluded that clinical management of IC should include psychosocial tools that improve patient coping and self-management along with typical medical therapies.
Look for ICA to release its own self-management tool, ICHope, in the next few weeks!
Co-existing Conditions Reduce IC Patients’ Quality of Life
Suskind AM, Berry SH, Suttorp MJ, Elliott MN, Hays RD, Ewing BA, Clemens JQ. Health-related quality of life in patients with interstitial cystitis/bladder pain syndrome and frequently associated comorbidities. Qual Life Res. 2012 Oct 7. [Epub ahead of print] Having non-urologic conditions like fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome in addition to interstitial cystitis is associated with a lower health-related quality of life. This conclusion comes from a study in which 276 women with IC were interviewed by telephone about their demographics and self-reported medical conditions, and were asked questions from the SF-36 health survey and the interstitial cystitis symptom index. Using multivariate linear regression analysis, the researchers found that the presence of fibromyalgia and chronic fatigue and irritable bowel syndromes has a significant association with quality of life, with an impact equal to the bladder symptoms themselves. These results emphasize the importance of a multidisciplinary approach to treating patients with IC/BPS and other conditions.
Suicidal Thoughts Linked to Severity of Depression, Not IC Symptoms
Hepner KA, Watkins KE, Elliott MN, Clemens JQ, Hilton LG, Berry SH. Suicidal ideation among patients with bladder pain syndrome/interstitial cystitis. Urology. 2012 June 1. [Epub ahead of print] Using data from the RAND Interstitial Cystitis Epidemiology Study, researchers found that 11 percent of the 1,019 women asked about suicidal ideation (SI, meaning having thoughts about suicide), had thought about it in the past two weeks. These women were likely to be younger, unemployed, unmarried, uninsured, less educated, and have a lower income that those who did not have SI; they also reported worse IC symptoms and mental and physical health. They were more likely that those without SI to have had mental health treatment, but no more or less likely to have had IC treatment. Although additional studies are recommended, the researchers conclude that the severity of depression symptoms, not the severity of BPS/IC symptoms, is what increases the likelihood of SI.
QOL Decreases with Multiple Pain Sites
Tripp DA, Nickel JC, Wong J, Pontari M, Moldwin R, Mayer R, et al. Mapping of pain phenotypes in female patients with bladder pain syndrome/interstitial cystitis and controls. Eur Urol. 2012 May 18. [Epub ahead of print] It makes sense that the more areas of pain a person has, the worse their quality of life, but until now, no one had actually mapped the location of IC patients’ pain and examined the effect of multiple pain sites on their quality of life. Using a whole body diagram, patients and controls indicated where they had pain throughout the body. Researchers used that information to develop four pain phenotypes, or groups, based on the number of pain sites: BPS/IC only, BPS/IC plus 1-3 other sites, BPS/IC plus 4-9, and BPS/IC plus ≥ 10. IC patients had more pain, sites of pain, urinary symptoms, catastrophizing (feelings of helplessness and pessimism), and a poorer quality of life than controls. As the number of pain sites increase, psychosocial adjustment and physical quality of life decrease. The researchers suggest that clinicians consider the location of patient pain and the potential impact of multiple pain sites when evaluating and planning treatment for IC patients.
Impact of Depression and Catastrophizing on Pain-Related Disability
Katz L, Tripp DA, Nickel JC, Mayer R, Reimann M, van Ophoven A. BJU Int. 2012 May 11. doi: 10.1111/j.1464-410X.2012.11238.x. Epub ahead of print] The pain of IC/BPS can cause disability in all areas of a patient’s life: self-care, sexual functioning, work, family and home responsibilities, and social life. The degree of disability is worse for some than for others, and according to this questionnaire-based study of 196 women with IC, negative affect (depression or anxiety) and catastrophizing (feeling helpless and hopeless) contribute significantly to disability. The researchers suggest that evaluating and addressing these psychosocial factors could help with disease management and improve quality of life for these women.
Vulvodynia Costs Patients Money and Wellbeing
Xie Y, Shi L, Xiong X, Wu E, Veasley C, Dade C. Economic burden and quality of life of vulvodynia in the United States. Curr Med Res Opin. 2012 Feb 23. [Epub ahead of print] Vulvodynia, a condition which appears to overlap with IC, has high costs both financially and in terms of quality of life, conclude researchers who analyzed these factors using a web-based survey of 302 women in the U.S. The survey was conducted from 2009 to 2010, and asked the women to enter data about their own costs and their employers’ payments related to vulvodynia for the previous month. All women entered data for at least one month, with 97 of them doing it for six months. The researchers used a commercial insurance database to determine average insurance payments for direct health care services, and assessed quality of life in a follow-up survey using Euro QOL 5 dimensions (EQ-5D). The study revealed an estimated financial cost of $31 billion to $72 billion a year, with about 68 percent of that in direct health care costs, 6 percent in direct non-health care costs and the remainder in indirect costs. In addition to the huge financial burden to the individual and society, the EQ-5D score of 0.74±0.19 indicates a relatively low quality of life.
IC Interferes Most with Women’s Sexual Function
Sacco E, D’Addessi A, Racioppi M, Pinto F, Totaro A, Bassi P. Bladder pain syndrome associated with highest impact on sexual function among women with lower urinary tract symptoms. Int J Gynaecol Obstet. 2012 Feb 21 [Epub ahead of print] Researchers studied the effects of different lower urinary tract symptoms (LUTS) on sexual function in a group of Italian women and found that those who had bladder pain syndrome had the most sexual impairment. The study used the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to compare the sexual function of 188 sexually active women with urinary incontinence, voiding phase symptoms, overactive bladder, and bladder pain syndrome with a group of age-matched women without LUTS. In general, women with LUTS had greater sexual impairment than those without them (a PISQ-12 score of 32.7 vs. 18.4), and among those with LUTS, women with BPS had the greatest impairment (46.1). Following closely behind were those with urodynamic detrusor overactivity (45.0), clinical urgency (41.4), mixed (37.7) and stress UI (28.1), dry overactive bladder (22.2), and voiding-phase LUTS (19.6).
Feeling Alone and Misunderstood? You’re Not the Only One
Nguyen RH, Ecklund AM, Maclehose RF, Veasley C, Harlow BL. Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia. Psychol Health Med. 2012 Feb 13. [Epub ahead of print] According to a National Vulvodynia Association survey of 1,847 women with vulvodynia, 45 percent had at least one other chronic pain condition: interstitial cystitis, chronic fatigue syndrome, endometriosis, fibromyalgia, or irritable bowel syndrome. Each of these conditions on its own can cause a woman to feel alone (isolated) and that others do not believe their pain exists (invalidated). This study sought to find out how many women with vulvodynia felt this way, and whether those feelings increased or decreased when they had at least one other chronic pain condition.
Of all the women surveyed, 14 percent said they felt isolated and 9 percent felt invalidated. Those who had vulvodynia and at least one other pain condition were more likely to feel both isolated and invalidated. The researchers recommend that future studies explore whether helping women with chronic pain to feel more validated and less alone will improve their wellbeing.
Ketamine Cystitis Looks Like IC
Chen CH, Lee MH, Chen YC, Lin MF. Ketamine-snorting associated cystitis. J Formos Med Assoc. 2011 Dec;110(12):787-91. Epub 2011 Dec 27.
A cystitis caused by abuse of the club drug ketamine looks very much like IC. This drug is especially popular among young people in Asia, where these urologists practice (Taiwan). Be aware that this is why your doctor may ask you about your recreational drug use, especially if you are young. The article describes the issue and reports specifically on the type of bladder damage ketamine causes. Symptoms include painful urination, fluctuating lower urinary tract symptoms (LUTS), lower abdominal or perineal pain, and impaired functional bladder capacities. Blood and pus in the urine are typical. In addition, bladder ulcers, diffuse bleeding, and low capacity are also typical—similar to IC. Treatment entails stopping abuse and use of pentosan polysulfate (Elmiron) or hyaluronic acid (Cystistat). The outcome of treatment depends on how severe the damage is.
Cystitis from Ketamine Abuse Damages Sexual Function
Jang MY, Long CY, Chuang SM, Huang CH, Lin HY, Wu WJ, Juan YS. Sexual dysfunction in women with ketamine cystitis: a case-control study. BJU Int. 2011 Dec 16. doi: 10.1111/j.1464-410X.2011.10780.x. [Epub ahead of print] Extreme ketamine abuse damages the bladder in ways that look very much like IC, and it also causes chronic pelvic pain that can damage sexual functioning. The 29 women who had this type of cystitis had higher rates of sexual dysfunction compared with the 27 nonabusing controls, except for sexual desire.
Abuse Plays Small Role, at Best, in IC
Nickel JC, Tripp DA, Pontari M, Moldwin R, Mayer R, Carr LK, Doggweiler R, Yang CC, Mishra N, Nordling J. Childhood sexual trauma in women with interstitial cystitis/bladder pain syndrome: a case control study. Can Urol Assoc J. 2011 Dec;5(6):410-5. doi: 10.5489/cuaj.11110.Studies that pegged the rates of abuse to be higher in women with IC than others fueled controversy and old prejudices about a psychologic cause and the futility of medical therapy. But the effect of early trauma isn’t significant, shows this new study with a fairly large number of patients at a number of centers in North America and Europe and careful statistical analysis. We reported on this study in the ICA eNews and the ICA Update after some results were presented at the 2010 Society for Infection and Inflammation in Urology meeting. Now, the detailed analysis has been published showing a modest effect, at best. The study included 207 IC patients and 117 controls matched for their age, partner status, and education. Participants answered questionnaires related to their disease, mental state, quality of life, and childhood traumatic events. Among the IC patients, 24 percent reported having been “raped or molested” before age 17, whereas 14.7 percent of controls did so, a difference that didn’t rise to the level of statistical significance. The IC patients who reported early sexual abuse reported greater sensory pain, depression, and poorer physical quality of life than IC patients who had not been abused. The controls who reported sexual abuse reported more depression, anxiety, stress, social maladjustment, and poorer mental quality of life than those who had not been abused. But when the analysis was corrected for potential error, these differences weren’t significant.
Interestingly, just as this article was published, a large study from the Centers for Disease Control and Prevention (CDC) on rape, sexual violence, and stalking. Estimates of rape during a woman’s lifetime were high—ranging from about 11 to nearly 30 percent in different states, with the lifetime rate nationwide estimated at 18.3 percent. About 42 percent of women who had been raped experience the first rape before age 18 and about 80 percent before at 25. The study also reported higher rates of asthma, irritable bowel syndrome, and diabetes in women who had been raped, stalked, or experienced physical violence from an intimate partner than in those who had not experienced any of these forms of violence. Although this report implies some physical consequences of sexual violence, IC was not reported among them, and although the difference for the other conditions were significant between victims and nonvictims, the proportion of victims experiencing these physical problems was by no means a majority.
These two studies certainly highlight that the rates of rape and sexual violence are too high, possibly higher than we thought, and stopping this violence may ease some physical suffering, but that won’t be a cure or even helpful to the majority of patients with IC or the other conditions mentioned in the CDC report. Doctors who see men, the large majority of perpetrators, could help in prevention while concentrating on medical therapy as part of the multidisciplinary approach to IC treatment.
Qualitative Approach May Inject Human Touch into Research
Souza PP, Salata Romão A, Rosa-E-Silva JC, Candido Dos Reis F, Nogueira AA, Poli-Neto OB. Qualitative research as the basis for a biopsychosocial approach to women with chronic pelvic pain. J Psychosom Obstet Gynaecol. 2011 Sep 16. [Epub ahead of print] These authors argue that qualitative research, not just quantitative results, could improve the humanistic and biopsychosocial approach to treatment of chronic pelvic pain.
IC Saps Sleep
Panzera AK, Reishtein J, Shewokis P. Sleep disruption and interstitial cystitis symptoms in women. Urol Nurs. 2011 May-Jun;31(3):159-65, 172.
Thanks to the 407 women with IC who responded to Alis Panzera, PhD’s sleep survey posted through the ICA website, we now know that all the patients had poor sleep because of pain, urinary urgency, and the need to urinate frequently during the night. Not surprisingly, the lack of quality sleep translated to daytime fatigue, lost productivity, depression and an overall drop in quality of life.
Pelvic Pain, No Matter What Type, Affects Quality of Life
Fenton BW, Palmieri P, Diantonio G, Vongruenigen V. Application of Patient-Reported Outcomes Measurement Information System to Chronic Pelvic Pain. J Minim Invasive Gynecol. 2011 Feb 2. [Epub ahead of print] Applying a new outcomes measurement information system to records of chronic pelvic pain patients, the authors found that chronic pelvic pain impairs quality of life, no matter what type of pelvic pain it is, even if it is myofascial pain. The Patient-Reported Outcomes Measurement Information System (PROMIS) was recently developed by NIH in patients with chronic pelvic pain.
Nearly All IC Patients Suffer Sexual Problems
Bogart LM, Suttorp MJ, Elliott MN, Clemens JQ, Berry SH. Prevalence and Correlates of Sexual Dysfunction Among Women With Bladder Pain Syndrome/Interstitial Cystitis. Urology. 2011 Jan 5. [Epub ahead of print] The RAND Interstitial Cystitis Epidemiology (RICE) study, which brought a new estimate of the number of IC patients, is now showing that nearly all IC patients with partners have one or more sexual dysfunction symptoms. Of the 1,469 women who met the more strict symptom-based definition of IC, 88 percent had at least one general sexual dysfunction symptom, and 90 percent had had one or more sexual dysfunction symptoms directly related to their IC within a month of when they were interviewed. Sexual dysfunction was closely related to having more IC symptoms, being younger, and having worse depression.
IC Damages Quality of Life More than OAB
Kim SH, Oh SJ. Comparison of voiding questionnaires between female interstitial cystitis and female idiopathic overactive bladder. Int Neurourol J. 2010 Aug;14(2):86-92. Epub 2010 Aug 31.
IC has a much greater impact on quality of life, concluded these urologists from the results of a battery of questionnaires answered by 41 female IC patients and 43 female overactive bladder (OAB) patients. The questionnaires asked about urinary symptoms, quality of life related to incontinence, and health-related quality of life. IC patients rated their general health as much worse than OAB patients did. In addition, IC patients rated the impact of their condition on life, social life, personal relationships, emotions, and sleep/energy as significantly greater than the OAB patients did. As you would expect, IC patients had more bladder pain and voiding difficulty and less incontinence.
Review Finds 110 Cases of Ketamine Abuse Affecting Bladder
Middela S, Pearce I. Ketamine-induced vesicopathy: a literature review. Int J Clin Pract. 2011 Jan;65(1):27-30.
Ketamine is an anesthetic that is also a drug of abuse that can have severe bladder consequences, resulting in IC-like bladder and lower urinary tract symptoms. The authors turned up about 110 cases that have been reported in the medical literature. Increasing concern about abuse is why doctors might ask you about drug use, especially if you are a young person. Treatment includes stopping ketamine use and IC-type therapy.
PFD Care in the UK Needs Improvement
Davis KJ, Kumar D, Wake MC. Pelvic floor dysfunction: a scoping study exploring current service provision in the UK, interprofessional collaboration and future management priorities. Int J Clin Pract. 2010 Nov;64(12):1661-70. doi: 10.1111/j.1742-1241.2010.02509.x.
Care for pelvic floor dysfunction (PFD) in the United Kingdom is fragmented, disjointed, poorly funded, and poorly integrated, found these healthcare researchers. They urge better interdisciplinary collaboration and more efficient use of resources to improve care there. They studied the issue by doing a literature review and surveying frontline practitioners, including 243 medical nursing, and physical therapy practitioners from different specialties. There is no overarching strategic approach to PFD, found the researchers. Patients’ access to services and the availability of services varies widely across disciplines, as do models of care delivery and individual practice. The researchers identified time restrictions, mixed professional attitudes, lack of standardization, and low investment priority as the major barriers to optimal care. They urged improvement in access and availability, teamwork and collaboration, funding and investment, education, training and research, and public and professional awareness.
Let Your Spouse Distract You
Ginting JV, Tripp DA, Nickel JC, Fitzgerald MP, Mayer R. Spousal support decreases the negative impact of pain on mental quality of life in women with interstitial cystitis/painful bladder syndrome. BJU Int. 2010 Nov 2. doi: 10.1111/j.1464-410X.2010.09846.x. [Epub ahead of print] For women with IC, “distracting” responses from spouses help buffer the effects of pain on mental health-related quality of life. The conclusion is based on an analysis of quality-of-life and other questionnaires that 96 women with IC completed. Spousal support training may be a useful way to improve the quality of IC patients’ lives, concluded the authors.
Pelvic Pain Damages Quality of Life
Quality of life of women with chronic pelvic pain: a cross-sectional analytical study. [Article in Portuguese] Rev Bras Ginecol Obstet. 2010 May;32(5):247-253.
This study in a Brazilian journal concludes that quality of life is lower for women with chronic pelvic pain than for healthy women. That finding is similar to other studies, but what is news about this study is the attention that chronic pelvic pain is now receiving worldwide. It’s one of only four articles in Portuguese in the Index Medicus database about chronic pelvic pain that are not just about endometriosis. Although the article does not mention IC specifically, the abstract does indicate that awareness of women’s pelvic pain conditions and their impact on women’s lives is growing. In this study of 30 women with chronic pelvic pain and 20 controls, analysis showed that women with chronic pelvic pain had lower quality of life and, more specifically, that depression and the intensity of pain were related to a worse quality of life. The authors called for making treatment of pain and depression priorities in women with chronic pelvic pain.
Dismissed, Disrespected, Distrusted, Suspected—Can We Turn This Around?
Upshur, C. C., Bacigalupe, G. and Luckmann, R. “They Don’t Want Anything to Do with You”: Patient Views of Primary Care Management of Chronic Pain. Pain Med 2010 [Epub ahead of print] Chronic pain patients feel disrespected, distrusted, and suspected of seeking drugs and that their symptoms are dismissed as trivial or as not worthy of medical care, shows this study. That has been and is still a problem for many IC patients, even in specialty care. The researchers characterized and quantified what happens when chronic pain patients look for help from their primary care physicians by interviewing 72 patients from diverse practices in small groups, using structured questions. Sixty-eight percent of the patients were women and 44 percent were Latino; their mean age was 48. Their interviews were transcribed and coded for various characteristics. Most of the patients reported suboptimal interactions when they sought care for chronic pain. They also offered some keys to better care: They were more satisfied when they thought the provider listened to them, trusted them, was accessible to address pain concerns between visits, and used patient-centered approaches to establish goals and treatment plans. Patients also recommended some chronic disease management techniques to improve pain care. A patient-centered and chronic disease management approach will improve both patient and provider satisfaction with chronic pain care, concluded the authors.
Read an interesting summary and commentary on this study at http://updates.pain-topics.org/. Scroll down to: “Why Do Patients Dislike Pain Care Providers?”
Women, Blacks with Chronic Pain Don’t Get Adequate Pain Care
Green CR, Hart-Johnson T. The adequacy of chronic pain management prior to presenting at a tertiary care pain center: the role of patient socio-demographic characteristics. J Pain. 2010 Aug;11(8):746-54.
This study found that that blacks and women, especially younger women, got less-than-adequate treatment for their chronic pain from primary care doctors, while young men got the most. The 128 patients (53 percent white, 60 percent female) in this study came to specialty pain clinics, filling out pain questionnaires when they first arrived. Based on this and their current medications, the researchers calculated each patients’ Pain Management Index score, which is a combination of pain severity and pain drug potency. (This scale is part of the World Health Organization’s pain treatment guidelines.) Blacks were prescribed significantly fewer pain medications than whites, and fewer women than men had medication at an adequate strength to control pain. The patients who had worse PMI scores tended to be female and to have lower scores on the Multidimensional Pain Inventory and higher scores on the affective (feelings) section of the McGill Pain Questionnaire. Worse scores were also associated with black race, being married, affective pain, and gender and age. Employed women tended to have lower scores. The researchers concluded that these disparities show that intervention and education are needed in primary care to improve chronic pain care. They also called for more research to see whether these disparities persist when patients get to specialty pain management.
Childhood Sexual Trauma in Women with Interstitial Cystitis/Painful Bladder Syndrome: A Case Control Study
Nickel, JC, Tripp, D, Pontari, M, Moldwin, R, Mayer, R, Carr, L, Doggweiler, R, Yang, C, Mishra, N, Nordling, J. American Urological Association (AUA) 2010 Annual Meeting, May 29 – June 3, 2010, San Francisco, CA.
In the past few years, studies drawing a correlation between abuse, especially childhood abuse, and IC prompted debate and controversy. But this study, presented in a specialty society (Society for Infection and Inflammation in Urology) meeting, showed there was no appreciable difference in rates of childhood abuse between IC patients and controls. Urologists at IC treatment centers in Canada, the United States, and Europe surveyed 207 IC patients and 117 controls, who were carefully matched to the patients for age, partner status, and education. There were no differences between the groups in the rates of nonsexual violence, divorce or separation of the parents, extreme illness, or death of a family member or friend. There was a difference in the rate of rape or molestation, but it was barely significant statistically and not significant clinically. That’s not to say that rates of rape and molestation weren’t disturbingly high. From 15 to 25 percent of those surveyed had been raped or molested as children. Nevertheless, as one urologist there remarked, we can stop blaming the victim.
Pelvis Pain, Urgency and Frequency Score and Bladder Capacity with Street Ketamine Abuse – Pilot Survey of Young Drug Abusers
Mak, S, Chan, T, Wu, B, Hou, S, Yip, K, Man, C. American Urological Association (AUA) 2010 Annual Meeting, May 29 – June 3, 2010, San Francisco, CA.
Ketamine, a popular drug of abuse among young people in Asia, causes IC-like symptoms and even bladder destruction. This report describes cases seen at a Hong Kong clinic and the outreach efforts to help stop the abuse. Abusers who used ketamine for more than two years had elevated Pelvic Pain Urgency/Frequency (PUF) scores and bother scores. Those who abused the drug more than five times a week had reduced bladder capacity. After one year of abstinence, bladder capacity increased. Use of this drug is increasing in the United States, and US urologists are seeing more patients with the problem. That is why your doctor might question you about illicit drug use, especially if you are a teen or young adult.
Early Lifetime Trauma Impacts Symptom Severity of Interstitial Cystitis and Chronic Pelvic Pain
Baxter, C, Bolus, R, Mayer, E, Ackerman, D, Rodriguez, LV. American Urological Association (AUA) 2010 Annual Meeting, May 29 – June 3, 2010, San Francisco, CA.
UCLA researchers analyzed data from patients who filled out questions on the website of UCLA’s People Reported Outcomes of Complementary, Alternative, and Integrative Medicine network. The investigators said that all but one of the 223 patients with IC or chronic pelvic pain reported some form of early (before age 18) trauma (general, physical, sexual, emotional). Total trauma correlated with psychologic problems such as anxiety, depression, and feeling helpless. But early general, physical, or sexual trauma did not correlate with higher pain scores. Early emotional trauma correlated with more severe pain. The investigators suggested that addressing these issues could significantly affect the outcome of treatment. The study has a number of limitations, however: Patients sought out the website themselves and could also choose which questions they answered, so this may not be a representative sample of IC and chronic pelvic pain patients. In addition, it’s known that current pain affects people’s recall of past trauma, so it’s unclear whether the high rate of trauma is reliable. Also, we do not know whether addressing the physical pain could affect the levels of psychological distress or the recall of past trauma.
Prevalence and Predictors of Sexual Dysfunction Among Women with Symptomes of IC/PBS
Bogart, LM, Suttorp, M, Clemens, JQ, Berry, SH. American Urological Association (AUA) 2010 Annual Meeting, May 29 – June 3, 2010, San Francisco, CA.
Studies and the ICA’s own surveys show that IC has a huge impact on the sex lives of patients and their partners. Now, the RAND Interstitial Cystitis Epidemiology Study has confirmed that. Based on interviews with 1,473 patients whose symptoms indicated they had IC, the researchers found very high levels of sexual dysfunction. Eighty-one percent said their physical health interfered with sex. For about 11 percent, it interfered all the time. For between a quarter and a third, it interfered a little of the time, and for about that many, it interfered some of the time. About 68 percent had bladder pain during sex, and about 67 percent after sex. A little more than half the patients worried that having sex would exacerbate their bladder problems. Clinicians should be educated about the extent of dysfunction in IC patients as well as about ways to identify and treat sexual dysfunction among them, said the researchers.
Korean Study Highlights IC’s Effects on Women’s Sex Life
Yoon HS, Yoon H. Correlations of interstitial cystitis/painful bladder syndrome with female sexual activity. Korean J Urol. 2010 Jan;51(1):45-9. Epub 2010 Jan 21.
This Korean study corroborates Western studies showing the detrimental effects of IC on patients’ sex lives. But this study is unusual and heartening because, in Korea, patients are rarely asked about their sexual history (a 2007 study showed only about a quarter were), and women’s sexuality is much less discussed than men’s. Korean culture, however, is changing, and doctors, it is hoped, will follow the recommendation these authors made to consider sexual function in IC treatment. Among the 87 IC patients in the study, aged 28 to 74 years, older ones were more likely to have vulvodynia but less likely to report dyspareunia (pain with intercourse). The more frequency patients had, the more likely they were to have vulvodynia and an impaired sex life. Urgency also correlated with an impaired sex life and vulvodynia with both an impaired sex life and with dyspareunia. Frequency, urgency, and pelvic pain correlated with almost all items related to quality of life.
Sexual Dysfunction in IC is Common, But Not Commonly Treated
Wehbe SA, Whitmore K, Kellogg-Spadt S. Urogenital Complaints and Female Sexual Dysfunction (Part 1). J Sex Med. 2010 Apr 1. [Epub ahead of print]
Sexual dysfunction is a common in women with IC and other urologic disorders, but it’s been underestimated and often remains untreated. That was the conclusion of a comprehensive literature review on sexual dysfunction and dyspareunia (pain with intercourse) in women with IC, overactive bladder (OAB), and high-tone pelvic floor muscle dysfunction. Identifying the sexual complaints and treating the underlying causes can significantly improve the quality of a woman’s life, these authors pointed out. Doing that takes a multidisciplinary approach tailored to meet the needs of women with urogenital complaints, they said.
Pain Control Is a Human Right
Lohman D, Schleifer R, Amon JJ. Access to pain treatment as a human right. BMC Med. 2010 Jan 20;8:8.
Failure to provide adequate pain treatment is more than a medical ethics problem—it may violate international human rights law. In 1961, governments around the world made a commitment to alleviating pain with the treaty called The 1961 Single Convention on Narcotic Drugs. The agreement wasn’t just aimed at addressing control of illicit narcotics; it also obligated countries to work toward universal access to the narcotic drugs necessary to alleviate pain and suffering. Nevertheless, even though we have inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment, point out these authors from Human Rights Watch. The barriers include unnecessarily restrictive drug control regulations and practices, fear among healthcare workers of legal sanctions for legitimate medical practice, the inflated cost of pain treatment, failure to enact policies on pain treatment and palliative care, the failure of many governments to put functioning drug supply systems in place, and poor training of healthcare workers. The authors said that these barriers can be understood, not only as a failure to provide essential medicines and relieve suffering, but also as human rights abuses. According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman, and degrading treatment.
Are Abuse and IC Related? Review Speculates on Connections
Mayson BE, Teichman JM. The relationship between sexual abuse and interstitial cystitis/painful bladder syndrome. Curr Urol Rep. 2009 Nov;10(6):441-7.
This review article speculates on how sexual abuse and IC may be related. The major theory is that abuse may prompt hypothalamic-pituitary-adrenal (HPA) axis abnormalities, which are also seen in IC patients. The author points to a study apparently showing that abused IC patients have more pain and fewer irritative voiding symptoms compared with those who were not abused. The authors did not review prospective studies that have followed abused subjects from childhood to see whether they had more chronic pain problems than others who were not abused, the gold standard for demonstrating a connection.
Controversial Study Connects Psychiatric Problems, Abuse with Urinary Tract Symptoms in Women Veterans
Klausner AP, Ibanez D, King AB, Willis D, Herrick B, Wolfe L, Mayer Grob B. The Influence of Psychiatric Comorbidities and Sexual Trauma on Lower Urinary Tract Symptoms in Female Veterans. J Urol. 2009 Dec;182(6): 2785-90.
This study provoked plenty of controversy when results were first presented at the 2008 American Urological Association annual meeting. The researchers reported that women veterans referred to a specialized urology clinic for lower urinary tract symptoms (including IC) had higher rates of psychiatric problems and sexual trauma than controls. The 121 women who were referred were compared with 1,298 women from the referral population of women. Of those referred, 64.5 percent had psychiatric diagnoses compared with 25.9 percent of controls, and 49.6 percent reported sexual trauma compared with 20.1 percent of controls. Scores on a questionnaire called the Incontinence Impact Questionnaire-7 were higher for patients with psychiatric diagnoses and sexual trauma than for referred women who did not have those histories. Scores on the Urogenital Distress Inventory-6 questionnaire, however, did not correlate with psychiatric diagnoses or sexual trama. Rather they were associated only with being younger than age 50 and having had a miscarriage. At the 2008 AUA meeting, the presenter reported that all Veterans Administration patients are asked at every visit about sexual abuse. That prompted the session chair and other urologists to speculate that patients may answer yes so as not to have to answer the question repeatedly. Urologists there also raised other concerns about the high rate of abuse reported for women veterans compared with the general population, the effect of psychoactive medications on urinary tract symptoms, and the focus on abuse in women that may, in effect, blame patients for their symptoms and divert urologists’ attention from productive research on other causes and on finding effective treatment.
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 Tuesday, May 12th, 2015