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Overactive Bladder and co-occurring Interstitial Cystitis/Bladder Pain Syndrome: The role of central sensitization in clinical presentation.

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Sources of Funding: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K23DK103910, the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Foundation research fund, the National Center for Advancing Translational Sciences under CTSA award number UL1TR000445, and by the Vanderbilt Office of Clinical and Translational Scientist Development. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Vanderbilt University, the National Center for Advancing Translational Sciences, the National Institutes of Health or the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.

Introduction

Many clinical characteristics overlap between Overactive Bladder (OAB) and Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) suggesting possible common pathophysiologic mechanisms. Central sensitization, which is an induced state of spinal hypersensitivity and well-recognized mechanism of centrally amplified pain perception, may be such a mechanism. Psychosocial and pain characteristics are important aspects of central sensitization disorders, but are often overlooked in women with OAB. Our aim was to examine whether these characteristics differ among OAB patients with a self-reported history of IC/BPS, OAB alone, and controls.

Methods

We enrolled 39 adult women initiating third-line OAB therapy and 25 healthy controls to complete clinical and psychosocial assessment. We identified a subset of women with OAB who self-identified as having a history of IC/BPS (n=13). Using Fischers exact test and linear regression, we then compared differences in bladder symptoms, psychosocial functioning, and pain sensitivity across these three groups (OAB = 26, OAB & IC/BPS = 13, and control = 25).

Results

Women with OAB with or without IC/BPS reported significantly greater urinary symptoms and psychosocial and pain burden than controls (Tables 1 and 2). The subset of women with IC/BPS demonstrated significantly increased symptom severity, higher rates of co-morbid somatic conditions, emotional distress, and poorer quality of life when compared to other groups. This group also reported a greater degree of widespread pain and symptoms attributable to central sensitization than those with OAB alone.

Conclusions

In this group of women undergoing third-line therapy for OAB, a personal history of IC/BPS was associated with worsened psychosocial, bladder, and pain function compared to those with OAB or controls. However, women with OAB alone also demonstrated similar characteristics, supporting the hypothesis that central sensitization may play a role in both conditions.

Funding

This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K23DK103910, the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Foundation research fund, the National Center for Advancing Translational Sciences under CTSA award number UL1TR000445, and by the Vanderbilt Office of Clinical and Translational Scientist Development. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Vanderbilt University, the National Center for Advancing Translational Sciences, the National Institutes of Health or the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.

Authors
Lindsey McKernan
Joshua Cohn
Stephen Bruehl
Roger Dmochowski
W. Stuart Reynolds
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