Due to similarities with IC/PBS and other chronic pain syndromes, the European Society for the Study of IC/BPS (ESSIC) provided a new definition, which was more descrip- tive of the clinical syndrome and the underlying pathol- ogy. This expanded term, bladder pain syndrome (BPS), describes all patients with “chronic pelvic pain, pressure, or discomfort, perceived to be related to the urinary bladder accompanied by at least one other urinary symptom: persis- tent urgency or urinary frequency.” 6 To include all patients
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Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a devastating urological chronic pelvic pain condition with an unknown etiology. Evidence-based psychological strategies are becoming more successful for symptom management as we learn more about the targets for intervention. Previous research has established an indirect relationship between depression and pain through catastrophizing, but there have yet to be studies examin- ing the emerging role of emotion regulation in this relationship. Methods: Women with IC/BPS were recruited from tertiary care clinics in Canada and the U.S. between 2013 and 2018. Patients completed questionnaires, including demographics and scores for pain, depression, catastrophizing, and difficulties in emotion regulation at baseline, six months, and one year. Serial mediation was used to test models of pain, catastrophizing, and depression. Results: A total of 135 women with IC/BPS completed all three time points. The only significant indirect path was from baseline depres- sion to catastrophizing at six months to pain at one year (b=0.10; confidence interval [CI] 0.0049–0.2520). A followup analysis dem- . A followup analysis dem- onstrated that helplessness was the key factor of catastrophizing driving this relationship (b=0.17; CI 0.0282–0.3826).
Objective: The primary objective of this study is to report on the long-term efficacy and tolerability of pentosan polysulphate sodium (PPS) in patients with bladder pain syndrome (BPS). The secondary objective is to find the predictors of the long-term outcome. Methods: This is a single institution, retrospective study. The study period was from 1994 to 2008. All patients fulfilled the clinical criteria of BPS, as suggested by European Society for the Study of Interstitial Cystitis. We included only patients with de novo BPS diagnosis and no previous PPS or other treatment. The efficacy of PPS was measured with the global response assessment scale (GRA). Patients were stratified into 2 groups based on the duration of the treatment. Group 1 took the drug for less than 12 months. Group 2 took the drug for more than 12 months.
The most recent and accepted definition of IC/BPS from the 2014 AUA guidelines states it is “an unpleasant sensation (pain, pressure, discomfort), perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks’ duration, in the absence of infection or other identifiable cause”. 2,4 IC/BPS is a disease complex that is diagnosed after the exclusion of an infectious or neoplastic process. 2,4 In reality, it appears to take a significant amount of time for patients to obtain a diagnosis. 4 Theoretically, once the diagnosis has been made, a strategy to flow patients through a treatment algorithm, such as those based on the EAU, AUA, RCOG/BSUG or CUA guidelines, should be the optimal way to manage this
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matched case-control study did show a higher prevalence of sexual abuse prior to age 17 in IC/BPS patients (24.0%) com- pared to asymptomatic control subjects (14.7%), the differ- ence in our collective sample only reached modest statistical significance (p = 0.047). Patients reporting childhood sexual abuse reported more pain, depression and poorer quality of life than patients not reporting such abuse. The maladaptive coping mechanism of catastrophizing, anxiety, stress, mental quality of life, sexual functioning or social support relation- ships in the IC/BPS group showed no differences. When the McGill pain descriptors were evaluated separately, the sensory component of pain was more predominant in the IC/BPS patients reporting sexual abuse compared to those without, perhaps adding some credibility to the other argu- ments regarding possible associated mechanisms. 2,3 Similar
Pain and discomfort is also a significant symptom in IC/ BPS. However, our knowledge of the afferent mechanisms that determine perceptions of lower urinary tract symptoms is limited. It is known that afferent sensory receptors of the urothelium of the bladder communicate with the central nervous system via finely mylenated A-delta fibers and unmylenated C-fibers. A-delta fibers sense bladder filling and tension within the bladder wall, whereas C-fibers trans- mit discomfort or pain in response to excessive stretching of the bladder wall. A study performed by Aizawa et al 28
Fulranumab, a fully human recombinant monoclonal antibody (immunoglobulin G), is a potent inhibitor of hu- man NGF. Results from phase 2, randomized, placebo- controlled studies of fulranumab demonstrate a positive dose response in diabetic peripheral neuropathic pain , mixed efficacy results versus placebo and statistically significant improvement versus an opioid in pain of osteo- arthritis [16, 17], and did not separate from placebo for low-back pain . We herein report the results of a phase 2a study conducted to explore the efficacy and safety profile of fulranumab, as compared to placebo, in patients with moderate-to-severe chronic bladder pain from IC/BPS. On December 23, 2010, the United States Food and Drug Administration (FDA) placed ongoing ful- ranumab studies on clinical hold because of a concern that the entire class of anti-NGF antibodies may be associ- ated with a condition representing either rapidly progres- sing osteoarthritis or osteonecrosis . As a result, the sponsor discontinued this study prematurely, after having enrolled only 31 of the targeted 70 patients.
Methods: Patients were treated with intravesical instillation with 50 mL sterile sodium hyalurinic acid (Hyacyst, Syner-Med, Surrey, UK) (n = 32) and sodium hyaluronate 1.6% sodium chondroitin sulphate 2% (Ialuril, Aspire Pharma, UK) (n = 33). Intravesical instillations were performed weekly in first month, every 15 days in the second month and monthly in third and fourth months, for a total of 8 doses. Patients were evaluated using a visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), inter- stitial cystitis problem index (ICPI), voiding diary for frequency/ nocturia, cystometric bladder capacity and voided volume at the beginning and at 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis.
only the differences between guidelines based on the same available efficacy data, but also some disconnect between patient-perceived effectiveness and the recommendations that major urological associations promote. The most glar- ing example of this disconnect is with opioid therapy. It is certainly interesting that opioids are not only one of the most prescribed medications for IC/BPS, but also perceived to be one of the most effective according to patients exposed to this treatment. Opioids are not recommended in the EAU guidelines, while the AUA guidelines “suggest” that opioid therapy can be considered for “multimodal pain therapy” and list six essential principles that should be followed if/
There are several variables associated with active SI in the patient sample, the most notable being the psychoso- cial variables of depression and catastrophizing (i.e., ICSI 0.24; ICPI 0.24; pain 0.25; catastrophizing 0.35; depression 0.64; p<0.01). There is no evident correlation pattern where construct redundancy for regression is possible. Further, correlations for the psychosocial risk factors and SI across controls and cases showed for controls, that SI was asso- ciated with greater pain (r=0.31; p<0.01) and depression (r=0.59; p<0.01). Whereas for patients, SI was associated with pain (r=0.24; p<0.01), depression (r=0.64; p<0.01), and catastrophizing (r=0.35; p<0.01). Finally, correlations were also conducted to examine age effects on SI, showing that patient age was associated with greater length of diagnosis (r=0.26; p<0.01), but not with increased SI (r=-0.06; p=0.41) or depression (r=-0.09; p=0.25).
Although the symptoms of urgency and frequency are described by both OAB and IC populations, there may be a qualitative difference in the way these symptoms are experienced. IC/BPS patients may experience a more constant urge to void as opposed to the ICS definition of a "compelling need to urinate which, is difficult to postpone." 52,53 The prototypical OAB patients urge to void is driven to prevent episodes of incontinence however in the IC/BPS population, patients void to stop or to relieve pain. Overall the patients perceive some improvement in urgency not corroborated by the specific urgency associated questions. As mirabegron is
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A standardized REB approved protocol was used across sites and institutional clearance was obtained. Participants were approached individually either before or after their Urology Outpatient clinical appointments and were provided basic information about the study by a research nurse. Those patients who were interested in participating were then briefed about the study. If they indicated interest, they were sent home with a questionnaire package that they completed and sent back to the Pain Research Lab at Queen’s University. The questionnaire package contained a letter of information, consent form, postage-paid return envelope, the measures described below, as well as additional measures that are not part of the scope of the present study. Data from these participants were collected at baseline, six months, and at one year.
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was modified from the DVSS questionnaire to capture child- hood BBD-like symptoms. The modified BBDQ addresses the following domains: constipation, urine holding, urinary continence, urinary urgency, obstruction, and dysuria. The modification asked the subject to recall if the symptoms were present in childhood, specifically between the ages of 8 and 10. Data regarding the patients’ demographics, symptom duration, Interstitial Cystitis Symptoms Index (ICSI), Interstitial Cystitis Problem Index (ICPI) scores, 26 Pelvic Pain
Urologic chronic pelvic pain syndrome (UCPPS) may be defined to include interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The hallmark symptom of UCPPS is chronic pain in the pelvis, urogenital floor, or external genitalia often accompanied by lower urinary tract symptoms. Despite numerous past basic and clinical research studies there is no broadly identifiable organ-specific pathology or understanding of etiology or risk factors for UCPPS, and diagnosis relies primarily on patient reported symptoms. In addition, there are no generally effective therapies. Recent findings have, however, revealed associations between UCPPS and “ centralized ” chronic pain disorders, suggesting UCPPS may represent a local manifestation of more widespread pathology in some patients. Here, we describe a new and novel effort initiated by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the U.S. National Institutes of Health (NIH) to address the many long standing questions regarding UCPPS, the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. The MAPP Network approaches UCPPS in a systemic manner, in which the interplay between the genitourinary system and other physiological systems is emphasized. The network ’ s study design expands beyond previous research, which has primarily focused on urologic organs and tissues, to utilize integrated approaches to define patient phenotypes, identify clinically-relevant subgroups, and better understand treated natural history and pathophysiology. Thus, the MAPP Network provides an unprecedented, multi-layered characterization of UCPPS. Knowledge gained is expected to provide important insights into underlying pathophysiology, a foundation for better segmenting patients for future clinical trials, and ultimately translation into improved clinical management. In addition, the MAPP Network ’ s integrated multi-disciplinary research approach may serve as a model for studies of urologic and non-urologic disorders that have proven refractory to past basic and clinical study.
30. Blair, C.K.; Morey, M.C.; Desmond, R.A.; Cohen, H.J.; Sloane, R.; Snyder, D.C.; Demark-Wahnefried, W. Light-intensity activity attenuates functional decline in older cancer survivors. Med. Sci. Sports Exerc. 2014;46:1375. DOI: 10.1249/MSS.0000000000000241. 31. Craig, C.L.; Marshall, A.L.; Sjostrom, M.; et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35:1381e95. 32. Van den Beuken-van Everdingen, M.; de Rijke, J.; Kessels, A.; Schouten, H.; van Kleef, M.; Patijn, J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Annals of Oncology. 2007;18(9):1437–1449. DOI: 10.1093/annonc/mdm056. 33. Inoue, S, Kobayashi, F, Nishihara, M, Arai, Y.C, Ikemoto, T, Kawai, T, et al. Chronic pain in the Japanese community—prevalence, characteristics and impact on quality of life. PLoS One. 2015;10(6). DOI: 10.1371/journal.pone.0129262.e0129262.
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Recently, evidence supporting central sensitization using functional and structural brain imaging were reported in vulvodynia and IC/BPS. Previously, Pukall et al.  showed that increased perception and activation of pain- related brain regions were observed in women with vulvar vestivulitis syndrome, compared to normal women, after tacticle stimulation of the vulvar vestibule. Other studies have reported that vulvodynia patients show increased grey matter density in pain-modulating and stress-related regions of the brain as well as alterations in the intrinsic connectivity of regions comprising the sensorimotor, sali- ence, and default mode resting state networks [56, 57]. Similarly, women with IC/BPS showed alterations of oscil- lation frequency and functional connectivity of brain re- gions previously reported in other chronic pain conditions  and various white matter (right anterior thalamic ra- diation, left forceps major, and right longitudinal fascic- ulus, right superior and bilateral inferior longitudinal fasciculi) abnormalities that correlated with severity of pain, urinary symptoms, and impaired QoL . Fig. 2 shows common therapeutic approaches and points of di- vergence among IC/BPS, IC/BPS + vulvodynia, and vulvo- dynia patient groups.
The Severity of Symptoms assessment was carried out using the PUF Questionnaire . In addition, the 'Pain score' was also recorded on a Visual analogue scale (VAS) on a scale of 0 to 10. All the controls had a 'pain score' of 0 (No Pain). In PBS patients, the 'pain score' ranged between 1 (mild pain) to 3 (severe pain) on the PUF scale and 3 to 8 on the visual analogue scale. The mean 'pain score' of PBS group was 2.5(PUF) and 5.9(VAS). The 'Fre- quency score' was obtained from PUF questionnaire and was rated as 0 (3 – 6 voids per day), 1 (7 – 10), 2 (11 – 14), 3 (15 – 19) and 4 (20 +). Similarly, 'Urgency score' obtained from PUF questionnaire and was graded as 0 (No urgency), 1 (Mild), 2 (Moderate) and 3 (Severe). All of the PBS patients complained of frequency (>5 in 12 h), nocturia (>2), urgency and suprapubic /pelvic pain with- out any signs of detrusor overactivity on urodynamics. The IDO patients presented with overactive bladder symp- toms – urgency, with or without urge incontinence, fre- quency and nocturia and showed involuntary detrusor contractions during the filling phase of urodynamics . Flexible or rigid cystoscopic bladder biopsies were obtained from a consistent site, just above and lateral to the ureteric orifices. A urine specimen was sent for culture before each cystoscopy. All patients had sterile urine cul- tures at the time of cystoscopy and biopsy.
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Results in chronic pelvic pain/painful bladder syndrome Few studies have evaluated the effect of PTNS on CPP/PBS [27-32]. According to Van Balken , this technique seems to be effective in as much as 42% of patients with CPP. In the same group of patients, Kim  found that 90% showed an improvement >25% in the VAS score for pain, with 60% reaching improvement >50%. Kabay  evaluated the efficacy of PTNS in the treatment of patients with category IIIB chronic non-bacterial prostatitis. 89 patients were randomized to receive either PTNS (n = 45) or sham treatment (n = 44). A complete response on pain
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Whorwell et al. were first to document that patients with IBS frequently experience symptoms of an ‘irritable bladder’ . This relationship has since been reported several times [11, 12]. It can be argued that IBS is not associated to OAB specifically, but to symptoms of the lower urinary tract in general . However, the relation to post-infectious and sporadic IBS has not been separ- ately evaluated in earlier studies. The present study provides the first evidence to suggest that unlike spor- adic IBS, post-infectious IBS is not associated with an increased risk of OAB. It is not clear if this association is pathogen specific, or if it may be inferred to other forms of enteric infection.
We report the case of a 42 year old secretary, complaining about a longer history of neck pain and limited move- ment of the cervical spine. Surprisingly, the adequate radi- ologic examination revealed a bilateral ossification of the stylohyoid ligament complex. After surgical resection the patient was free of any complaints and went back to work. Although no general accepted criteria for classification exist, pain in the area of the neck/shoulder girdle is known for a work-relation and for presenting an economic prob- lem in occupational health. In Germany, according to official statistics of compensation claims of the year 1993, the number of disorders especially affecting the cervical spine accounted for 2584 of all occupational conditioned disabilities and formed 18% of all indications concerning occupational disorders. Disorders of the spine represent the greatest item in terms of statistics concerning incapac- ity for work, and the medical condition causing neck and shoulder pain leads to average sickness duration of 26.1 days, in total breeding a gross domestic product deficit of 7.1 billion Euro.