Systematic Reviews
Copyright ©The Author(s) 2024.
World J Psychiatry. Jun 19, 2024; 14(6): 954-984
Published online Jun 19, 2024. doi: 10.5498/wjp.v14.i6.954
Table 1 Summary of studies investigating psychiatric symptoms in interstitial cystitis1
Ref.
Population
Design
Psychiatric symptoms
Conclusions/observations
Rabin et al[23], 200080 females, treated for IC, aged 16-75 yr (mean age = 44.6 ± 12.4 yr)CS. Questionnaires and scales administered included Demographics; General Questionnaire; Disability; ICES; Pain Scale; Self-Stigmatization Scale; CES-D52.6% of IC sample reported dep sym; levels of dep experienced by IC pts are > than general population/other chronic pain populations; regression showed dep to be associated with self-efficacy for male aging pain (P < 0.01), self-stigmatization (P < 0.05), and pain (P < 0.05)Females with IC reported physical and emotional burden and showed ↑ dep levels
Rothrock et al[24], 200265 female pts 22 to 81 yr (mean age ± SD: 51.0 ± 16.1) with IC + 40 HC 25-82 yr (mean age 52.6 ± 15.8)CS. Administered scales comprised BDI; MOS SF-36; HAM-DPts reported significantly poorer QoL than HC across all MOS domains, including emotional difficulty, and mental health (P < 0.01). Pts reported > dep sym on the BDI than HCs (95%CI: 4.1-7.1 vs 1.5-4.9, P < 0.05,) as well as on the HAM-D (95%CI: 6.1-9.6 vs 0.7-2.3, P < 0.001,). In pts, mean HAM-D score was 7.9-6.8 (range 0-25), indicating mild dep sym. Only 10.2% of pts scored in the moderate-to-severe range of dep sym on the HAM-DA diagnosis of IC is related to poorer functioning in various life domains. ↑ sym severity related to poorer physical/social functioning and mental health
Rothrock et al[25], 200364 female pts with ICCS. Scales administered included questionnaires assessing QoL, coping and symptoms; HAM-DPts coping with greater catastrophising reported ↑ impairments in dep sym, general mental health, social functioning, vitality, and ↑ pain. Seeking social support was associated with ↓ dep symMaladaptive coping strategies are associated with ↑ levels of dep sym and ↓ QoL in pts with this condition. Psychosocial interventions aimed at ↑ adaptive coping may positively impact IC
Novi et al[26], 200546 females with IC+ 46 HCCS. 46 females with IC and 46 HC were evaluated by PHQ-9 DM (MD defined as a score ≥ 10); RIISQ to find out the diagnosis of IBSCompared with HC, IC pts were more likely to be diagnosed with IBS (OR 11, 95%CI: 2.7-52, P < 0.001) and dep (OR 3.97, 95%CI: 1.17-14.1, P < 0.05)The association of IBS and dep appears to be > in females with IC
Wu et al[27], 2006749 pts with IC and < 65 yr + HC (646 females and 103 male)Lo. Costs incurred in the 1st yr after IC diagnosis and co-morbidities were compared between IC pts and HC. A multivariate two-part model was applied to estimate the IC direct medical cost, indirect cost and total cost to adjust for observed pts demographics and comorbidities. Statistical significance was evaluated by the bootstrap methodIC pts had 130% higher direct costs (P < 0.05) and 84% higher indirect costs than HC. IC pts also had a higher diagnostic prevalence of prostatitis (RR = 40.0), endometriosis (RR = 7.4), vulvodynia (RR = 6.9), chronic pelvic pain (RR = 5.8) and urinary tract infections (RR = 5.1; all P < 0.05). IC pts were also more likely to report dep (RR = 2.8) and anx (RR = 4.5) than HCs (all P < 0.05)IC is a costly disease associated with co-morbidities. More accurate diagnosis and earlier and more appropriate treatment of IC would lead to better management of co-morbidities and ↓ healthcare costs
Fan et al[28], 200847 IC pts (38 females and 9 male) +31 HCCS. 47 IC pts and a group of 31 age-matched, asymptomatic females received HAM-D and HRSA. IC pts also completed questionnaires relating to IC symptom severity, including urgency and frequency and O'Leary Sant indexMean dep scores = 16.6. 15 pts (31.9%) with mild dep symptoms, 5 (10.6%) mild-to-moderate and 20 (42.6%) moderate-to-severe dep. mean anx score = 21.0, with 21 (44.7%), 9 (19.1%) and 17 (36.2%) pts displaying mild, mild-to-moderate, and moderate-to-severe anx symptoms, respectively. Pain scale and O'Leary Sant index were significantly correlated to anx and dep scoreMost of IC pts feature significant dep and anx (85% of IC pts featured significant affective symptoms). The extent of affective symptoms would appear to correlate well with IC symptom severity
Clemens et al[29], 2008239 IC female pts and 717 matched HC (1:3 ratio)Lo (case-control). A computer search of the administrative database at Kaiser Permanente Northwest, Portland, Oregon was performed for 1 May, 1998 to 30 April, 2003. All females with a medical record diagnosis of IC (ICD-9 code 595.1) were identified. These cases were matched with 3 controls each based on age and duration in the health plan. Assigned ICD-9 diagnoses to these 2 groups were compared using ORs239 cases and 717 matched controls were analysed. 23 diagnoses were significantly > in IC pts than in HC (P = 0.005): 7/23 were other urological or gynaecological. Additional specific conditions associated with IC were gastritis (OR 12.2), child abuse (OR 9.3), FM (OR 3.0), anx disorder (OR 2.8), headache (OR 2.5), oesophageal reflux (OR 2.2), unspecified back disorder (OR 2.2) and dep (OR 2.0)IC was associated with multiple other unexplained physical symptoms and certain psychiatric conditions. The possible biological explanations for these associations remain to be established
Clemens et al[30], 2008174 male pts with chronic prostatitis/CPPS (mean age = 52) and 72 male, age-matched HC. 111 female pts with interstitial cystitis/PBS (mean age = 50) and 175 females, age-matched HCsLo (case-control). Pts and HC were analysed. Demographic information, current medication use, medical history was collected; NIH-CPSI for male subjects, and the ICSI and ICPI for females; PHQ used to assess mental healthMental health disorders were identified in 13% of the chronic prostatitis/CPPS cases and 4% of male HC (OR 2.0, P = 0.04), as well as in 23% of IC/PBS cases and 3% of females HCs (OR 8.2, P < 0.0001). Disease status (case vs control) (OR 10.4, P = 0.001) and income > 50000 USD (OR 0.34, P = 0.008) were the only 2 variables independently predictive of the presence of a mental health diagnosis. Medications for anx, dep or stress were taken by 18% of pts with chronic prostatitis/CPPS, 37% of those with IC/PBS, 7% of male HCs and 13% of females HCsDep and PA are ↑ in male and females with pelvic pain conditions than in HCs. Furthermore, anx and dep may be more difficult to treat in pts with urological pain syndromes than in HCs
Goldstein et al[31], 2008141 females diagnosed with IC (mean age = 45.9 yr)CS. Prevalence of dep was measured using the BDI-II; Prevalence of abuse was evaluated using the validated DAQ98 (70%) pts scored ≥ 14 on the BDI-II. The mean score of the total sample was 14.6 (SD 9.2), representing mild dep. Of all of those that scored in the dep range (≥ 14), the mean score was 22.4 (SD 6.4) representing moderate dep. The prevalence of sexual abuse from validated questionnaires was 36%; the prevalence of childhood sexual abuse was 21%; physical abuse was 31%Pts with IC had > prevalence of dep and sexual abuse than the general population. Females with IC should be screened for dep and abuse and referred to a mental health expert as necessary for treatment
Kim and Heitkemper[32], 2009298 females (mean age = 74.3 ± 6.20)Lo. To estimate the prevalence of IC/PBS symptoms and describe the relationships among symptoms, general sample characteristics. dep and QOL in older Korean females → ICSI/ICPI, KGDS, HRQOL, KHQ. Statistical analysis → SPSS/WIN 15.0 program; prevalence/urologic characteristics → freq, mean, and severity; correlations among demographic characteristics. ICSI-K and ICPI-K, KGDS, and KHQ → Pearson; group differences in variables by ICSI-K cut-off score 5 → ANOVAThe prevalence of mild to severe IC symptoms using ICSI-K was 54%. The percentage at risk for IC using summed scores of ICSI-K and ICPI-K) was 43.6%. The ICSI-K scores had moderate correlations with KHQ and had mild correlations with KGDS; The ICPI had strong positive correlations with KHQ and had mild correlations with KGDS. KHQ scores had mild positive correlation with KGDSAlmost half of older Korean females in this sample had IC/PBS symptoms using IC/PBS cut-off score of 5. IC symptoms and problems impacted limitation in life highly
Tsai et al[33], 201069 IC pts [mean age = 42.0 ± 16.3 (range: 20–79 yr)], 52 females (mean age = 44.2 ± 16.0 yr), 17 males (mean age = 35.2 ± 15.6 yr); P < 0.05CS. PSQI and HADS were used to evaluate quality of sleep and dep level, respectively. Multiple linear regressions were used to identify independent factors of sleep qualityMean PSQI global score was 9.5 ± 4.2 (range: 1-19); 81.2% of pts had poor sleep quality (PSQI > 5). Regression analysis suggested that IC severity (β coefficient = 0.42, P < 0.001) and level of anx and dep (β coefficient = 0.26, P < 0.05) were significant independent risk factors for poor sleep qualityPoor sleep quality is common in IC pts and severity of urological symptoms and dep levels are important independent risk factors
Giannantoni et al[34], 201014 female pts with ICLo. Controlled-trial. 14 pts received 1 BoNT/A inj under cystoscopic guidance. At pre- and 3 mo post- treatment all pts underwent urological assessment, VAS, HAM-A, HAM-D and SF-36 to assess QoLAt pre-treatment all 14 pts had ↑ daytime and nighttime urinary frequency and ↑ VAS scores. 9 pts had pathological HAM-A and HAM-D scores. At the 3-mo fup 10/14 pts reported a subjective improvement in pain. Mean VAS score, mean daytime and nighttime urinary frequency ↓ (P < 0.01, < 0.01 and < 0.01). All SF-36 and HAM-A domains significantly improved (P < 0.01). All HAM-D domains, except weight and sleep disorders, significantly improved, particularly somatoform syms (P < 0.01), cognitive performance (P < 0.01), and circadian variations (P < 0.01)In pts with refractory PBS with symptoms of anx, dep and poor QoL, BoNT/A intravesical treatment reduced BPS, improved psychological functioning, and well-being
Bogart et al[35], 20111469 females who met criteria for BPS/ICCS. A telephone screening of 146,231 households and telephone interviews with females with BPS/IC symptoms were conducted. Health-related QoL was measured using the Short-Form 36-item Health Survey physical health scale; The Patient Health Questionnaire-8 items was used to assess dep symptoms; females who had a current partner were asked the number of times they had engaged in vaginal sex in the past year and the extent to which they experienced the 6 BPS/IC-specific sexual dysfunction symptoms and 5 general sexual dysfunction symptoms in the past 4 wkOf those with a current sexual partner (75%), 88% reported general sexual dysfunction symptom and 90% reported BPS/IC-specific sexual dysfunction symptom in the past 4 wk. In the multivariate models, BPS/IC-specific sexual dysfunction was significantly associated with more severe BPS/IC symptoms, younger age, worse depression symptoms, and worse perceived general healthFemales with BPS/IC symptoms experience very high levels of sexual dysfunction and higher level of dep
Watkins et al[36], 20111469 females who met criteria for BPS/ICCS. A telephone screening of 146,231 households and telephone interviews with females with BPS/IC symptoms. A weighted probability sample of 1469 females who met BPS/IC criteria was identified. Measures of BPS/IC severity, dep symptoms, PA, and treatment utilization were administered. T and χ2 tests used to examine differences between groups> ⅓ of the sample (n = 536) had a probable diagnosis of dep, and 52% (n = 776) reported recent PA. females with a probable diagnosis of dep or current PA reported worse functioning and ↑ pain and were less likely to workRates of probable current dep and PA are high, and there is considerable unmet need for treatment
Moskovenko[37], 2011112 female pts with ICCS. Clinical evaluation↑ Neuroticism in 74 (66.1%) cases, moderate or high-reactive anxiety in 98 (87.5%), high personal anxiety in 36 (32.1%); 8.0% pts had depressive disorders > moderatePts with IC have higher odds for having psychoemotional disturbances
Peters et al[38], 2011639 females: 425 HC(s), 36 with ulcerative IC/PBS (ULC) and 178 non-ulcerative IC/PBS (N-ULC)CS. females with IC/PBS and HC(s) completed a mailed survey assessing for 21 diagnoses. IC/PBS subtype was determined by hydrodistention reports. Standardized questionnaires assessed IC/PBS symptoms (ICSI-PI) and for undiagnosed fibromyalgia, IBS, and dep (SIS; Rome III Functional Bowel Questionnaire; CES-D). Data were analysed using the Pearson chi-square, Fisher exact, Wilcoxon rank test, or Spearman rank correlation coefficientULC IC/PBS pts were older (median 63 yr; P < 0.01) and less employed (P < 0.01), but groups were similar on other demographic characteristics. N-ULC reported more chronic diagnoses (mean 3.5 ± 2.3) than ULC (2.3 ± 2.0) and controls (1.2 ± 1.5; P < 0 .01). When N-ULC and ULC IC/PBS patients were compared, more N-ULC IC/PBS patients had fibromyalgia (P = 0 .03), migraines (P = 0.03), temporomandibular joint disorder (P < 0.01), and higher CES-D (P = 0.02) and SIS scores (P = 0.01). The ULC IC/PBS group voided more frequently during the daytime (P = 0.03) and nighttime (P < 0.01) and had smaller mean bladder capacity than N-ULC (P < 0.01). No significant differences were seen between N-ULC and ULC IC/PBS patients on the ICSI-PI and Rome IIINotable differences in the number of comorbid diagnoses and symptoms were seen between IC/PBS subtypes and controls
Panzera et al[39], 2011407 females with ICLo. All participants were asked to complete PSQI and ICSI/ICPIMean global PSQI score = 13.12 (SD ± 3.61) with all pts reporting a score of 6 or above. Results from the hierarchical multiple regression revealed that after controlling for age, menstrual status, years with IC, and dep, the 4 symptom predictors of IC (pain, urinary frequency, urinary urgency, and nocturia) alone explained 21% of the variance (F(4, 398) = 8.41, P < 0.001) in sleep quality. Only pain, nocturia, and urinary urgency contributed significantly (P < 0.05)Females with IC have disrupted sleep and poor subjective sleep quality. Predominant symptoms of IC related to poor sleep include nocturia and pain
Nickel et al[40], 2011207 IC/BPS female pts and 117 HC matched for age, partner status and educationLo (case-control). All participants were asked to complete the CTES, the ICSI, the ICPI, the MPQ-SF, the CES-D, the STAI, the FSFI, the MSPSS and the MOS SF-12Before 17 yr of age, the IC/BPS cases reported > prevalence of "raped or molested" compared to HCs (24.0% vs 14.7%; P = 0.047). Within the IC/BPS group, cases reporting previous sexual abuse endorsed > sensory pain, dep and poorer physical QoL at the present time compared to IC cases without a sexual abuse historyChildhood traumatic events are reported as more common in IC/BPS pts than HCs
Hepner et al[41], 20121019 females with BPS/IC symptomsCS. In order to estimate SI prevalence in IC pts, females with and without recent SI were compared based on demographics. dep symptoms, BPS/IC symptoms, functioning, and treatment11.0% (95%CI: 8.73-13.25) reported SI in the past 2 wk. Females who endorsed SI reported worse mental health functioning, physical health functioning, and BPS/IC symptoms. Multivariate logistic regression analyses indicated that BPS/IC sym severity did not independently predict likelihood of endorsing SIBPS/IC severity may not ↑ the likelihood of SI except via severity of dep symptoms
Keller et al[42], 20129269 pts (7584 females and 1685 male) with BPS/IC and 46345 (37920 females and 8425 male) randomly selected comparison ctrlLo. Case-control. Conditional logistic regression analyses were performed to calculate the odds ratio for each of the 32 medical comorbidities (included dep disorder, psychoses, alcohol abuse and drug abuse) between pts with and ctrl without BPS/ICWith the exception of metastatic cancer, pts with BPS/IC had a significantly ↑ prevalence of all the medical comorbidities analysed than ctrl without BPS/IC. Compared with ctrl without BPS/IC, pts with BPS/IC had particularly ↑ odds of comorbid mental illnessesPts with BPS/IC had > prevalence of multiple comorbidities
Clemens et al[43], 20123397 females with IC/BPSCS. Pts completed a survey asking if they had comorbidities as IBS, FM, chronic fatigue syndrome, migraines, PA, or dep and the age of symptom onset. All pts were also asked to provide the date of IC/BPS symptom onset2185/3397 females reported a diagnosis of at least one of the nonbladder conditions. Dep tended to occur earlier (P < 0.05), whereas FM generally occurred later (P < 0.05). Mean age of onset was lowest for migraine symptoms, dep symptoms, and PA symptoms, and greatest for FM and chronic fatigue syndrome symptoms. Mean age of irritable bowel syndrome and IC/BPS symptom onset was between these other conditionsThese findings confirm the common co-occurrence of IC/BPS with chronic nonbladder conditions. In females with IC/BPS symptoms and coexistent nonbladder conditions, bladder symptoms do not uniformly predate the nonbladder symptoms
Katz et al[44], 2013196 females IC (recruited from existing IC/BPS pts databases); mean age: 52 yrCS. Examined mediation through structural equation modelling; MPQ, Pain Disability Index, CES-D; STAI; PCSNegative affect (P < 0.001) and catastrophising (P < 0.001) significantly explained the relationship between impairments and functional disability, whereas social support did notNegative affect and catastrophising partially explained disability in IC pts. Due to IC refractoriness, biopsychosocial patient management is essential. ↓ in negative affect and catastrophising will probably lead to improvements in pain-related disability. CS design does not allow for establishing causality
Keller et al[45], 2013832 IC/BPS female pts and 4160 HCs (total = 4992) tracked for a 1-yr period; mean age 48.7 ± 16.2 yrLo. Cox proportional hazards regressions (stratified by age group and index year)DD incidence = 4.69 (95%CI: 3.38-6.34) ×100 person- yr in pts with BPS/IC and 0.94 (95%CI: 0.68-1.27) ×100 person-yr in HCs. HR of DD during the 1-yr fup period for BPS/IC pts = 5.06 (95%CI: 3.21-7.96, P < 0.001). Adjusted HR for DD associated with BPS/IC = 10.33 for pts aged 40-49 (95%CI: 3.68-29.04)↑ Risk for being diagnosed with DD during 1st yr after receiving diagnosis of IC
Nickel et al[46], 2015173 IC femalesCS. case control. CES-D to assess dep, STAI for anxiety, PSS for perceived stress, PCS for catastrophising157 pts (81%) reported more sensory type pain, poorer physical QoL, and greater somatic dep and sleep disturbance than 36 (19%) pts with pelvic pain only. This last phenotype reported ↑ IBS prevalence and fibromyalgia, and more general fatigue sym and psychiatric conditionsTwo distinct pain location phenotypes, pelvic pain only and more than pelvic pain, were identified analysing IC/CPPS pts
Kairys et al[47], 201533 females with IC without comorbidities (mean age 39.5 ± 12 yr; mean symptom duration 9.1 ± 9 yrCS. Anatomical MRI data were acquired across 5 MAPP discovery sites; high resolution T1 structural images were acquired for each pt; Symptom were measure with the following questionnaires: SYM-Q; FGPI; PROMIS; sleep disturbance scale; SF-MPQ; HADS, Positive and Negative Affect Scale; Gracely Box Scales to measure pain and unpleasantness during the scanCompared to HC(s), females with IC displayed significantly more GM volume in several regions including the right S1 (P < 0.05, FWE SVC), SPL/precuneus bilaterally (left P < 0.05, FWE SVC; right P < 0.001, uncorrected) and left SMA (P < 0.001, uncorrected, Table 1, Figure 1). GM volume in the right primary somatosensory cortex was associated with greater pain (McGill pain sensory total; r = 0.396, P = 0.025), anxiety (HADS, r = 0.447, P = 0.01) and urological symptoms (r = 0.449, P = 0.01)Alterations in somatosensory GM may have an important role in pain sensitivity as well as affective and sensory aspects of IC
Chuang et al[48], 201516185 IC/BPS diagnosed during 2002-2010 [11865 (73.3%) females, 4320 (26.69%) male) vs 32370 HCs (23823 (73.60%) females, 8547 (26.40%) male); mean age 46 yrLo. Cohort study, based in part on data from NHIRD. Outcome risk assessed with Kaplan-Meier curves; Poisson regression analysis, and Cox proportional hazards modelsIR (10000 person-yr) significantly ↑ in IC pts compared to HCs (92.9 vs 38.4 for anxiety; 101.0 vs 42.2 for depression, and 47.5 vs 23.0 for insomnia). IRRs of IC-associated anxiety and dep were ↑ in male compared to females (2.6 vs 2.4 for anxiety; 3.1 vs 2.3 for dep). IC remained a significant predictor with HR and 95%CIs 2.4 (2.2-2.7) for anxiety, 2.4 (2.2-2.6) for dep, and 2.1 (1.8-2.4) for insomniaIC associated with ↑ risks of anxiety, dep, and insomnia in initially sym-free pts
Griffith et al[49], 2016424 pts with UCPPs [233 (55%) females, 191 (45%) males]; mean age 43.4 ± 15.1 yrCS. MAPP Research Network. Scale GUPI, ICSI, ICPI. Aim of the study was also to examine relationships with symptoms of depression as a comorbidity of UCPPSDep was predicted by pain (B ± SE = 0.24 ± 0.04, 95%CI: 0.16–0.32, P < 0.001) In contrast dep was not significantly related to urinary symptoms ( B, mean ± SE = 0.06 ± 0.04, 95%CI: 0.02-0.13, P = 0.127)The data suggest that pain and dep are closely linked in pts with UCPPS, and that pain and urinary symptoms should be assessed separately
Tripp et al[50], 2016(Tot 307 females pts) 190 IC mean age 49.20 ± 14.94 yr; 117 HCs mean age 47.83 ± 13.52 yrCS. MPQ, IC syms, PHQ-923% IC pts endorsed SI in the past 2 wk vs 6% in HCs. In both IC pts and HCs, ↑ SI associated with ↑ pain and ↑ dep, whereas, for IC pts, ↑ SI was associated further with pain catastrophisingThis study indicates that tertiary care pts with IC/BPS have an alarming rate of SI. Dep, catastrophising characterised by helplessness about managing pain, and pain are all significantly associated with ↑ SI. Catastrophising as a predictor of SI in IC/BPS points to its key role as a psychological predictor of negative pain-related outcomes
Kanter et al[51], 201715 females IC in a total of four focus groups. mean age = 52.6 yr, mean IC duration = 6.3 yrLo. Qualitative analysis of emerging themes. Session recording and transcription with information deidentified. Transcripts coded and analysed by three independent physicians3 concepts identified: IC/PBS is debilitating, pts experience significant isolation, SI found in all groupsPts with IC preferred organized treatment plans with diverse choices and providers who offered hope in dealing with their condition; focusing on the doctor-pt relationship to overcome isolation and suicidality, physicians may help IC pts
Abernethy et al[52], 201740 females (20 IC; 20 HCs); mean age 34 yrCS study. Catastrophising Scale, PDI, BDI, BAI. Urinary microbiomes and cytokine levels analysed with standard immunoassayPts IC scored ↑ on dep (P = 0.008) and anxiety (P = 0.019) screens compared with HCsIC pts’ urinary microbiome less likely to contain Lactobacillus species and associated with ↑ levels of proinflammatory cytokines. No correlation between Lactobacillus species and cytokine levels
Chen et al[53], 20171612 IC pts, [1283 (79.6%) females, 309 male (20.4%) mean age 48.4 ± 16.4 yr) vs 3224 HCs (2466 females (76.5%), 758 male (23.5%) mean age 48.9 ± 16.4 yr). 1436 SoDi, 2872 non-SoDi. mean age 48.4 ± 16.4. IC pts 79.6% females HCs 76.5% femalesLo. Case-control and retrospective cohort studies. OdR for SoDi calculated with conditional logistic regression and HR for IC in SoDi pts estimated with Cox regression, cumulative risk with Kaplan-MeierOdR for SoDi = 2.46. mean time until IC development in HCs = 11.5 ± 1.3 yr (shorter in SoDi pts, 6.3 ± 3.6 yr). HR for developing IC = 2.2. Pts and HCs differed in cumulative survival probability for IC (P < 0 .05)SoDi can be used as a predictor of IC. While examining pts with IC, it is recommended to investigate past history of SoDi
Chiu et al[54], 201794 females IC/BPS pts. mean age 40.6 ± 10.0 yrCS. Link between urogenital syms, psychiatric syms, and potentially traumatizing experience CTQ, BVAQ, BDI-II, BAI, TDSThe high-CTQ group had ↑ dep, ↑ anxiety, ↑ dissociation, ↑ alexithymia and ↓initial and follow-up bladder capacities. A combination of higher scores of cognitive alexithymia and lower scores of affective alexithymia was associated with ↑ bladder capacityIn pts with IC/BPS, ↑ anaesthetic bladder capacity was associated with a set of psychological factors that commonly prevail in functional somatic syndrome. This result suggests that a psychological mechanism independent of a bladder- centric defect may underlie the mental and somatic symptoms of a subgroup of pts with IC/BPS and that IC/BPS in a subgroup of pts may represent a functional somatic syndrome
Chiu et al[55], 201794 females IC/BPS pts. mean age 40.6 ± 10.0 yr. 47 females with AC. mean age 43.4 ± 9.9 yrCS. Childhood trauma and urological sym in pts wit IC/BPS. FUP, OSQ, BBTS, BDI-II, TDS, BAI, SDQ-20Pts in the IC/BPS group reported ↑ abusive experiences than did the AC group pts; however, this difference reached significance for physical abuse. Pts in the IC/BPS group reported ↑ childhood trauma by close othersThe study hypothesizes that IC/BPS may be a heterogeneous condition that involves a multifactorial aetiology where a psychosocial phenotype of IC/BPS with a unique pathogenetic mechanism may exist; in which, CT may play an important role
Hosier et al[56], 20182007 pts (1523 male mean age 45 ± 13.5, 484 females mean age 45.7 ± 17.4 yr) with UCPPS from a single siteLo. Retrospective study. Demographics. sym scores, pain scales, described clinical UPOINT scoring between 1998 and 2016 (data from UCPPS clinic)Male had ↑ prevalence of dep (31% vs 18.4%), and ↑ alcohol use (44.2% vs 10.8%), ↑ IBS, ↑chronic fatigue syndrome, ↑ fibromyalgia, ↑ drug allergies, ↑ diabetes compared to females with UCPPS (all P < 0.001)Male with UCPPS have ↑ prevalence of systemic disorders/syms and worse urinary symptoms than females with UCPPS. Findings indicate that male and females with UCPPS have distinct and different clinical phenotypes
Liang et al[57], 201830 female pts IC undergoing several intravesical HA instillations with time vs 30 age-matched HCsLo. Prospective study. HADS, O'Leary-Sant score, PISQ-12, and a pain visual analogue scale completed before and after treatment; same for the HCIC pts had a significant ↑ in HADS dep subscale and total scores. After HA treatment, 73% of IC pts showed ↓ in their urological syms, but no significant changes in HADS and PISQ-12 scoresBladder pain and lower urinary tract syms in pts with IC/BPS may ↓ after a 6-mo intravesical HA treatment. No significant changes in psychological and sexual functional scores
Muere et al[58], 2018341 females IC mean age 49.77 ± 14.49CS. Demographics. CES-D, PCS. BCPCIPts who reported ↑ dep symps and with a ↑ tendency to catastrophize were more likely to engage in illness-focused coping strategies, which contributed to the reporting of ↑ sensory and affective painTo manage pain in IC/BPS we need evidence-based techniques that ↓ catastrophising, ↓ illness-focused coping, and ↓ dep. These techniques seem to function most in pts with ↑ dep
Van Moh et al[59], 2018150 participants, 36% male (11/31) and 25% females (30/119) with HLs. The difference in median age was 17 yr (58 vs 41, P < 0.001)Lo. Pelvic syms assessed with the following questionnaires: (1) ICSI, ICPI; and (2) PUF. Presence and distribution of non-urologic pain assessed with: (1) Self-reported history of IBS, fibromyalgia, chronic fatigue syndrome, migraine headache, vulvodynia (females only), and (2) using a body map diagram described previously to identify participants who reported “pelvic pain and beyond” and “widespread pain” patterns, and the number of pain sites beyond the pelvis. The intensity of non-urologic pain was assessed using a 0-10 numeric rating scale. BPI was used to assess pain severity and pain interference. Psychosocial health was assessed by: History of depression, history of anxiety attacks, and somatic symptom burden27% (n = 41) had HLs (36% of male, 25% of females). Participants with HLs were significantly older (median age 58 vs 41, P < 0.001) and reported less intense urologic pain (5 vs 7, P = 0.024) but more nocturia (ICSI nocturia symptom score: 4 vs 3, P = 0.007). had less frequently a history of IBS (15% vs 36%, P = 0.013) and anxiety attacks (22% vs 44%, P = 0.013)HLs can be identified in both females and male. The presence of HLs was associated with older age, less bladder pain, more nocturia, and lower probability of IBS and anxiety attacks
Rodríguez et al[60], 2019233 females and 191 male UCPPS. Pts with sym duration < 2 vs ≥ 2 yr compared for sym severity, COPC, and mental health comorbiditiesCS. HAD, PCSMale (but not females) with UCPPS sym duration ≥ 2 yr had ↑ severe syms than those with < 2 yr (P = 0.045). Participants with shorter (< 2 yr) and longer (≥ 2 yr) sym duration were as likely to experience COPCSym duration did not appear to affect severity of UCPPS pain. male with UCPPS syms ≥ 2 yr experienced more severe urinary syms than male with syms < 2 yr
Carty et al[61], 201937 female pts with CUP+ 25 controls (mean age 45 yr, primarily Caucasian and relatively well educated, and more than half (58.9%) were married or in a committed relationship)Lo. RCT. Females with CUP received either a single 90-minute life stress interview (n = 37) or no interview (treatment-as-usual control; n = 25). Self-report measures of pain severity (primary outcome), pain interference, pelvic floor symptoms, and psychological symptoms (anx and dep) were completed at BL and 6-wk fupPain severity was significantly ↓ at fup in the interview condition than the control condition (F(1, 58) = 4.52, P = 0.038), with a medium effect size. Within the interview condition, there was a ↓ in pain over time (ns), whereas among controls, there was ↑ in pain (ns). Pelvic floor symptoms were significantly ↓ at fup for the interview condition than the control condition (F(1, 58) = 8.01, P = 0.006), with a large effect size. The interview condition had a significant ↓ in pelvic floor symptoms over time (t(36) = 2.95, P = 0.006), but controls did not change (t(24) = 0.09, P = 0.93). Finally, the two conditions did not differ at fup on pain interference (F(1,58) = 1.02, P = 0.62), anx symptoms (F(1, 58) = 0.30, P = 0.59), or dep symptoms (F(1, 59) = 0.20, P = 0.66)An intensive life stress emotional awareness expression interview improved physical but not psychological symptoms among females with CUP
Cepeda et al[62], 20193973695 eligible non-IC at BL from the general population (2011471 females, 1962224 male)Lo. Comparative descriptive study using retrospectively recorded data in a US claims database (Optimum). The first outpatient visit was the ID for the general population, and the diagnosis of dep was the ID for pts with dep3973695 people from the general population; 2293 (0.06%) developed IC within 2 yr [mean age (yr) 50.87 ± 16.86 vs 47.47 ± 18.30 of non-IC; n = 1995 (87%) females]. Of 249200 individuals with dep, 320 (0.13%) developed IC↑ Incidence of IC in pts with dep. Pts who developed IC had ↑ chronic pain conditions, dep, malaise, and inflammatory disorders
Thu et al[63], 201951 OAB [39 females, 12 males; mean age (yr) 53.8 ± 11.9], 27 IC/BPS (all females; mean age (yr) 44.8 ± 16.6), and 30 [17 females, 13 males; mean age (yr) 54.2 ± 12.3] CTRLLo. Non-urologic pain was assessed using a whole-body map and BPI. Urologic pain was assessed using the IC Symptom and Problem indexes, Genitourinary Pain Index, and 0-10 pain scale. Urogenital pain was assessed using a genital map, and report of pain related to bladder filling and urinationOAB pts with pelvic pain had worse urinary symptoms (OAB-q SS: 21.7 vs 17.2, P = 0.025; OAB-q HRQOL: 39.7 vs 25.4, P = 0.015; UDI-6: 16.5 vs 10.8, P = 0.004; IIQ-7: 16.2 vs 5.1, P < 0.001), anx (HADS-A, 10.1 vs 6.1, P = 0.003) and dep (HADS-D, 7.6 vs 4.1, P = 0.004) compared to OAB pts without pelvic pain. The P-value for PSS almost reached statistical significance (P = 0.05)OAB pts has pain inside and/or outside the pelvis. The intensity and distribution of pain in OAB was intermediate between IC/BPS and controls. OAB pts with pelvic pain have worse urinary symptoms and PSS. Systemic processes such as central sensitization should be examined in this population
Lai et al[64], 2019211 pts IC/BPS or chronic prostatitis/CPPS (159 females, 52 males; mean age [years] 43.1 ± 15.9)CS. Clinical variables included in k-means clustering (uro- and non-uro pain severity, urinary urgency, frequency and UPOINT scoring)The k-means clustering algorithm identified 3 pt clusters: (1) Mild pelvic syms in approximately 30%; (2) severe pelvic syms approximately 40%; and (3) systemic syms approximately 30%. The clusters had an equal likelihood to have HLs in bladderPts in the systemic cluster were younger by approximately 5-7 yr and more likely to be females. They had the most severe urinary syms, the most severe pelvic and nonpelvic pain and were more likely to have chronic overlapping pain conditions, psychosocial issues (dep, anxiety and somatic syms) and poorer QoL than pts in the other two pelvic clusters
Crawford et al[65], 2019135 females IC recruited from tertiary care clinics, mean age 52.57 yrLo. PHQ-9 for dep, PCS for pain, DERS for emotion regulation at BL, 6 mo, and 1 yr. Serial mediation was used to test models of pain, catastrophising, and depThe significant indirect path was from BL dep to catastrophising at 6 mo to pain at 1 yr (b = 0.10; 95%CI: 0.0049-0.2520). Helplessness was the key factor of catastrophising driving this relationship (b = 0.17; CI: 0.0282-0.3826)↓ Feelings of helplessness and ↑ pt feelings of control are important ways to limit the effect of low mood on pt’s pain experience. De-catastrophising interventions should be part of the referral strategy for IC sym management
Tu et al[66], 2020212 females with moderate-to-severe dysmenorrhoea [166 with dysmenorrhoea (mean age 24.5 ± 0.5 yr) and 46 dysmenorrhoea with bladder sensitivity (mean age 23.8 ± 0.9 yr)], 44 HCs (mean age 23.8 ± 1.0 yr), and 27 BPS pts (mean age 29.0 ± 1.1 yr) aged 18-45 yrLo. Prospective cohort study. Medical/menstrual history and pain history were evaluated with questionnaires. Psychosocial profile and impact were measured with PROMIS and a BSIParticipants with dysmenorrhea plus bladder pain had PROMIS Physical T-scores of 47.7 ± 0.9, lower than in females with dysmenorrhea only (52.3 ± 0.5), and healthy controls 56.1 ± 0.7 (P < 0.001). Similar specific impairments were observed on PROMIS for anxiety, depression, and sleep in participants with dysmenorrhea plus bladder pain vs healthy controlsFemales with dysmenorrhea who are unaware they also have bladder sensitivity exhibit broad somatic sensitivity and elevated psychological distress
McKernan et al[67], 202027 females with IC/BPS (mean age = 45 ± 16.30 yr)CS. 27 females with IC/BPS participated in a focus group and completed validated self-report assessments evaluating urinary symptoms, pain emotional functioning and affective vulnerability using PHQ-9 and PROMISPts voiced pervasive and severe emotional distress related to IC/BPS. They acknowledged the reciprocal nature between emotional states and symptomology, with emotional distress both preceding and following symptoms. Both anxiety and depression symptoms were correlated with overall severity of IC/BPS, rPROMIS = 0.48, P = 0.013; rPHQ-9 = 0.68, P < 0.001The physiological and emotional consequences of IC/BPS were reported, highlighting their impact on interpersonal relationships and challenges obtaining appropriate treatment for IC/BPS. Dep symptoms appeared to better capture the role of psychological factors better than anx symptoms since quantitative analysis showed dep levels were significantly associated with worsened IC/BPS symptomology
Krsmanovic[68], 202087 females IC/BPS, mean age = 46.3 ± 14.6 (treatment group = 49; controls = 38)Lo. Case-control study. 49 pts enrolled in the online self-management treatment program+38 controls. Outcome measures divided into primary (physical and mental QoL → SF-12) and secondary outcomes (IC/BPS syms → ICSI/ICPI, pain → VAS, dep → PHQ-9, pain catastrophising → PCS. social support → MSPSS, disability → PDI). Primary outcome completed at BL, mid-study (week 5), endpoint (1-wk post survey/program completion), and during 3-mo fup assessment. Measures on IC/BPS syms and disability completed at BL and endpoint only, pain, dep, pain catastrophising, and social support assessed at all timepointsStudy pts did not obtain statistically significant improvements in physical and mental QoL, dep, pain catastrophising, or social support following study completionGiven the lack of understanding of pathophysiological mechanisms of this condition, and the inadequacy of medical treatment, it is pertinent to develop treatments that can improve pt outcomes
Volpe et al[69], 20202301 females with IC and 4459 females with CPP and OAB (mean age IC group = 53.1 ± 15.5 yr; mean age OAB/CPP group = 52.5 ± 13.6 yr)CS. Case-control study. Pts were enrolled using the ICD-9 or ICD-10 diagnosis code for IC/BPS. Using ICD-9 and ICD-10 codes they identified comorbidities common in IC/BPS population including history of dep, history of alcohol abuse, history of PTSDAt BL, females with OAB and CPP were more likely to identify as minority (P < 0.001). Anx (57.3% vs 49.5%), dep (39.0% vs 46.0%), and PTSD (29.7 vs 26.4%) were all more common in the CPP and OAB group than in the IC groupA history of depression (P = 0.030) and IBS (P = 0.021) were statistically more prevalent among females with IC/BPS than HC
Clemens et al[70], 2020A total of 191 male and 233 females with IC/BPS or CPPSLo. Prospective cohort study Pts were followed for 12 mo with bimonthly completion of SF-12 to assess general mental and physical HRQOL and with biweekly assessment of condition-specific HRQOL using GPIHigher levels of BL problems most connected to the domain seemed to be the best predictors of declining outcome on that domain after controlling for initial HRQOL levels. Mental HRQOL outcomes were impacted by being male, BL UCPPS sym(s), widespread pain, non-urologic medical sym(s), and all measured psychosocial variables. Stress, dep, and being male remained independently associated with poorer HRQOL, Dep Score OR 0.907 (0.840–0.980) P = 0.0130, Perceived Stress OR 0.932 (0.894–0.972) P = 0.0010, being male OR 0.580 (0.380–0.885) P = 0.0115These findings primarily highlight the impact of psychosocial factors on the HRQOL of UCPPS pts. Clinicians who treat UCPPS should involve mental health care in the management of pts who exhibit syms of dep, stress, or poor coping
Lai et al[71], 2021385 females and 193 males with UCPPS. Among them, 12.5% had HL and 87.5% did notLo. COPC were assessed using the CMSI. Anx and dep were assessed using HADS. Stress and pain catastrophising were assessed using PSS and CSQ respectively. Quality of life measures included the SF-12 and GUPIUCPPS without HL also had higher anx (HADS 7.2 vs 4.1), perceived stress (PSS: 15.9 vs 12.5), and pain catastrophising (CSQ: 11.9 vs 8.3) than those with HL, but there was no difference in depUCPPS pts without HL were more likely to have a systemic pain syndrome outside the pelvis compared to those with HL associated with more psychosocial syms
Crawford et al[72], 2021Females’ pts with IC/BPS (T0) → n 226, mean age = 49.29 ± 15.67; (T2) → n 183, mean age = 51.53 ± 15.47; (T3) → n 151, mean age = 53.22 ± 14.82Lo. Pts were asked to complete the same set of questionnaires at T0, 6 mo after the initial urology appointment (T2) and 1-yr post-appointment (T3). Those included: Demographics. SF-MPQ, PCSSF-MPQ score (mean ± SD): T0 = 16.77 ± 11.19; T2 = 14.27 ± 11.32; T3 = 13.11 ± 10.98; PCS score (mean ± SD): T0 = 23.68 ± 14.39; T1 = 19.88 ± 14.36; T3 = 17.96 ± 3.05; early changes in magnification predicted later changes in pain (P < 0.001); early changes in pain predicted later changes in rumination (P = 0.03); early changes in pain predicted later changes in helplessness (P = 0.03); and early changes in helplessness predicted later changes in pain (P = 0.001)Pain catastrophising should be considered a prime target in psychological treatment for chronic pain in pts with IC/BPS
Laden et al[73], 2021872 IC/BPS pts; mean age = 57.1 ± 15.3 yr [355 (41%) male, 517 (59%) females] and 558 non-IC/BPS pts mean age = 53.9 ± 16.2 yr; [291 (52%) male, 267 (48%) females]CS. Case-control study Pts were identified from random samples of females and male pts with and without an ICD-9/ICD-10 diagnosis of IC/BPS. Presence of comorbidities and psychosocial factors (alcohol abuse, PTSD, sexual trauma, and history of dep) were determined using ICD-9 and ICD-10 codesThe odds of psychosocial factors was higher in the IC/BPS cohort (OR = 1.9; 95%CI: 1.5-2.4; P < 0.001). Notably, the odds of a PTSD diagnosis were higher among IC/BPS pts than non-IC/BPS pts (OR = 2.0; 95%CI: 1.5-2.5; P < 0.001), like Dep History (OR = 2.0; 95%CI: 1.6-2.6; P < 0.001). Health behaviours including alcohol abuse, smoking history, and diabetes were not significantly different between IC/ BPS and non-IC/BPS pts (P = 0.083, P = 0.067, P = 0.626 respectively). females IC/BPS pts had greater odds of psychosocial factors than male IC/BPS pts (OR = 1.9; 95%CI: 1.3-2.8; P < 0.001). The females IC/BPS pts had a significantly higher prevalence of sexual trauma compared to the females non-IC/BPS pts (13% vs 6%, P < 0.05), while none of the male, IC/BPS reported sexual traumaThis study bolsters the existing literature that psychosocial comorbidities are more common among IC/BPS pts and vary by sex
Lee et al[74], 2021Male = 1.479 (49.3%); females = 1.521 (50.7%), Age: 40 s = 1.037 (34.6%); 50 s = 982 (32.7%); 60 s = 608 (20.3%); 70 s = 373 (12.4%)Lo. All participants were surveyed using PUF, Patient Symptom Scale and GDS. The primary outcome was the prevalence of BPS-like symptoms, defined as a total PUF score of ≥ 12The prevalence of BPS-like symptoms was 16.4% (483 of 3000 participants). females (21.4%) had a significantly > prevalence of BPS-like symptoms than male (10.7%; P < 0.01). The prevalence by age was significantly > in the 70 s group than in the other age groups (P < 0.01), and ↑ significantly with the ↑ severity of dep on the GDS (P < 0.01)BPS-like symptoms are widespread among the general population of South Korea and can negatively affect many people's QoL
Yang et al[75], 20211103 IC/BPS pts and 4412 non-IC/BPS pts (5515; 4495 females, 1020 male). 81.5% females and 18.5% male, in both IC/BPS group and HC. Age: 22.57% < 35 yr; 30.28% = 35-50 yr; 25.93% = 50-65 yr; 21.21% > 65 yrCS. Case-control study. The study investigated in the association between SRDs and a subsequent association of IC/BPS using ICD-9 codesFor all SRDs, the significantly increased risks were obtained in 2 yr before IC/BPS diagnosis, and the higher OR was observed within 3 mo before the diagnosis of IC/BPS. dep (OR = 1.54, 95%CI: 1.24-1.91), sleep disorders (OR = 1.45, 95%CI: 1.19-1.78), within 2 yr had a significant risk of IC/BPS. OR for dep [2.04 (1.52 to 2.75)] and sleep disorder [1.59 (1.18 to 2.15)] is even higher when they appeared in the past 3 moThe study demonstrates that the health care for SRDs within the previous 2 yr is associated with an ↑ risk of subsequent IC/BPS also the study demonstrates that most SRDs are associated with an ↑ risk of subsequent IC/BPS, especially when peptic ulcer, IBS, dep, sleep disorders, and allergic rhinitis appeared in the past 3 mo
Tripp et al[76], 2021Females IC/BPS pts (n = 813; range 18–80 yr, mean = 46.60 ± 14.10)CS. This research reports suicide risk prevalence and its biopsychosocial predictors for a community IC/BPS sample. Pts were assessed with the following scales: SHS, PHQ-9, PAS, SBQ-RUsing the adult general population SBQ-R cutoff created an at-risk group (n = 310, M 9.73, SD 2.65) and a not at-risk group (n = 503, M 3.96, SD 1.11), with 38.1% of the sample meeting the suicide risk threshold. In the suicide risk group he predictors of greater risk included a previously reported exposure to suicide (odds ratio OR 2.71, 95%CI: 1.84-4.01), and the greater presence of psychological factors, such as psychache (i.e. psychological pain) (OR 1.04, 95%CI: 1.02-1.07), greater hopelessness (OR 1.12, 95%CI: 1.06-1.17), and more perceptions that the participant was a burden to others (i.e. perceived burdensomeness; OR 1.07, 95%CI: 1.03-1.11). Pts were also classified for pain group and predictors such as exposure to suicide, psychache, hopelessness, and perceived burdensomeness predicted suicide risk in all groupsThe results confirm that suicide risk is a significant concern within the IC/BPS population and work is needed to understand how to address the increased needs of the at-risk females. Suicide risk is more related to psychosocial factors than physical IC/BPS factors. In particular, hopelessness, psychache, perceived burdensomeness, and exposure to previous suicide are important predictor
Brünahl et al[77], 202136 pts included in the intervention group [mean age = 48.6 ± 14.8; n = 19 (52.8%) females; n = 17 (47.2%) males] and 24 in the CTRL group [mean age = 50.6 ± 14.5; n = 14 (58.3%) females; n = 10 (41.7%) males]Lo. Pts were non-randomly allocated to the intervention group with two consecutive treatment modules (physiotherapy and CBT) with a duration of 9 wk each or to the control group (treatment as usual) + Psychometric assessments (BL and post-treatment): GAD-7, PCS. PDI, PHQ-9, PHQ-15, PSQ, SF-12 PCS; SF-12 MCS; SF-MPQ total, SF-MPQ Sen, SF-MPQ aff., NIH-CPSI total Pain subscale, Urinary subscale, QoL subscaleThe intervention group reported significantly ↓ symptom burden as measured by the PDI (P = 0.02, d = −0.73), and the PHQ-9 (P = 0.04, d = −0.62), but no significant changes in the SF-12 and othersThe combination of physiotherapy and psychotherapy for pts with CPPS seems to be feasible and potentially promising with regard to effect
van Knippenberg et al[78], 202277 pts (46 females, 31 male), 29 with OBS and 48 with UPS (mean age = 54 yr, range 27-78)CS. Retrospective observational cohort study. The objective of the study is to investigate the effect of integrated outpatient care by a urologist and a psychiatrist on the symptomatology of pts with functional urological disorders. Pts were screened with HADS, OAB-questionnaire and ICSIAn association was found between pelvic pain and anx (P = 0.032) and panic disorders (P = 0.040). OR were 0.22 (0.06–0.76) for anx disorders and 0.26 (0.08–0.87) for panic disorders. An even stronger association was found between these variables in the group of urological pain syndromes (P = 0.001 in both groups). For anx disorders the OR was 0.02 (0.00–0.18) and for panic disorders 0.03 (0.00–0.24). A psychological trauma in the past was associated with a dep disorder (P = 0.044), with an OR of 2.93 (1.01–8.50). Of the pts with a psychological trauma in the past, 62.3% had urological pain syndromes and 83.3% suffered from pelvic pain. After a multidisciplinary intervention the integrated approach led to the following results: o difference is noticed in both groups (P = 0.219) in the HADS-Anx score before and after the multidisciplinary treatment. However, a significant 2-point reduction in the HADS-dep score is found (P = 0.001). The GAF score ↑to the category 71–80, which indicates no more than slight impairment in social, occupational, or school functioningThe study reveals a pre–post comparison before and after multidisciplinary treatment by urologist and psychiatrist. A significant ↓ in HADS-depression scores was observed, and the GAF shows an ↑in functioning
Yu et al[79], 202260 pts with IC/BPS, 55 females, 5 males (mean age = 53.5 ± 12.6 yr)Lo. Pts with IC/BPS were randomized to the bladder monotherapy (BT) or combined CBT (CBT) group. The primary endpoint was the self-reported outcome GRA. Secondary endpoints included IC symptoms, BAI, and depression inventory, and objective parameters were also compared. Psychological assessments including DS14 PSS-10 were also performedPost-treatment anxiety according to BAI showed significant improvement at 8 and 12 wk. Between-group changes also showed significant differences in BAI and GRA at 12 wk. The study showed a significant effect on self-reported treatment outcomes [F(2, 108) = 7.161, P = 0.001] and anx severity [F(2, 108) = 3.519, P = 0.033] within the CBT groupThis study reveals that multimodal treatment including CBT combined with suitable bladder treatment was more effective than bladder treatment alone. The CBT intervention significantly improved subjective treatment outcomes and severity of anx in pts with IC/BPS with moderate anxiety refractory to conventional therapy
Wuestenberghs et al[80], 20221453 pts with dyspeptic symptoms, of whom 61% with FD. BPS present in 16% of pts without FD, 22.2% of pts with only FD and 36.4% of pts with overlapping FD and IBS. (mean age = 47.4 ± 15.7 yr, sex ratio male/females, = 0.35); 187 females and 53 males with BPSCS. Functional dyspepsia and IBS were diagnosed according to Rome III and IV criteria. Pts were assessed with GIOLI to assess QoL, HADS for anxiety and depression, PSQI for sleep quality, and ISI for insomniaIn PTS with BPS overlapping with FD, dyspeptic symptoms severity, anxiety, depression, and insomnia levels were ↑, while quality of life and sleep quality were ↓, (P < 0.05 for all). These results were even more pronounced in case of overlap with IBS, Factors independently associated with overlapping BPS in FD pts were altered QoL and overlap with IBSBPS is present in 26.9% of FD pts and is associated with higher gastrointestinal sym(s), psychological distresses, sleep symptom burdens, and with reduced quality of life. The presence of overlap with BPS or IBS in FD is associated with younger age, increased female predominance, reduced QoL, ↑ symptoms severity, ↑, anx and dep levels
Sutherland et al[81], 202355 females with IC (mean age = 55.05 ± 14.97 yr)CS. The study focuses on the hypothesis that greater use of compensatory coping behaviours would be significantly associated with greater psychological distress. Compensatory bladder behaviours assessed with the OABq-QoL, anxiety and depression with the PROMISThe use of coping strategies related to greater symptoms of depression, but not anxiety. Depressive symptoms positively predicted use of compensatory coping, t(52) = 2.33, P = 0.024; while anxiety was not significantly related to compensatory coping, t(52) = 1.310, P = 0.142↑ Use of compensatory coping behaviours related to ↑ dep syms, even after controlling for level of bladder impairment
Şahin et al[82], 202335 BPS pts, (mean age = 50.2 ± 13.32; 24 females and 11 malesLo. Pts were administered the KHQ, BAI, BDI, OAB-V8, and VAS at each visit. The same questionnaires were completed and compared with pre-pandemic scores to examine the possible clinical aggregation of the pandemic period on BPS ptsThree (8.6%) of our pts had an asymptomatic COVID-19 infection, but no one had an active disease diagnosis. The mean OAB-V8, BAI, BDI, and VAS scores of the pts at their last visits before the pandemic period were 8.54 ± 4.33, 5.66 ± 7.77, 5.37 ± 5.92, and 4.54 ± 2.03, respectively. All scores of these questionnaires ↑ during the pandemic period, but only the OAB-V8 and VAS scores ↑ statistically significantly (P = 0.02 and 0.02, respectively)BPS pts have been negatively affected by the emotional effects of the COVID-19 pandemic and their BPS symptoms exacerbated
Cardaillac et al[83], 2023CPP females with a HSS (High Score of sensitisation) → n = 29; mean age = 37 ± 10; CPP females with a LSS (Low Score of sensitisation) → n = 24; mean age = 40 ± 10Lo. females with CPP and a HSS (> 5/10; n = 29) vs LSS (< 5/10; n = 24) according to the Convergences PP criteria underwent a non-invasive bladder sensory test, a rectal barostat test, and a muscular and a vulvar sensory test+ poststimulation pain (minutes), QoL (MOS SF-12/SF-36) and psychological state, comprising anx (STAI), dep (BDI-SF), and catastrophising (PCS), were assessedPts mostly suffered from endometriosis (35.8%), IBS (35.8%), BPS (32.1%), and vestibulodynia (28.3%). BL characteristics were similar. CPP females with a high sensitization score had more painful diseases diagnosed (2.7 ± 1.3 vs 1.6 ± 0.8; P = 002) and suffered for longer (11 ± 8 vs 6 ± 5 yr; P = 0.028) than pts with a low score. The bladder maximum capacity was equivalent between pts, however, the pain felt at each cystometric threshold was ↑in females with HSS. A longer period was needed for pts with HSS to obtain a VAS < 3/10 after bladder (4.52 ± 5.26 vs 1.27 ± 2.96 minutes; P = 0.01), rectum (3.75 ± 3.81 vs 1.19 ± 1.23 min; P = 0.009), and muscles (1.46 ± 1.69 vs 0.64 ± 0.40 min; P = 0.002) stimulation. The psychological state was equivalent between groups. No association was found between the sensory thresholds and the psychological state results. The physical component of the QoL score was ↓ in females with HSS (P = 0.0005), with no difference in the mental componentThere are objective elements to assess for the presence of central sensitization, independently of psychological factors; high- vs low-sensitisation pts did not differ on catastrophising
Panisch et al[84], 2023133 females, diagnosis of CPP, aged 18-65 yr (mean age = 60%)CS. All pts completed a survey assessing symptoms of somatoform dissociation (SDQ-20), PTSD, pelvic pain severity, history of CPP-related surgeries, and mental and physical HRQOL17% had SDQ-20 scores ≥ 35 (cutoff). 60% had experienced at least 1 traumatic event and 57% had PC-PTSD-5 scores ≥ 3 (cutoff). Bivariate correlations revealed significant relationships between somatoform dissociation and PTSD symptoms (r = 0.30, P = 0.12) and mental (r = −0.49, P < 0.001) and physical (r = −0.47, P < 0.001) HRQOL. Inverse relationships were also found between PTSD symptoms and mental (r = −0.49, P < 0.001) and physical (r = −0.37, P < 0.001) HRQOL. Mental HRQOL was also correlated with seeking counselling services (r = −0.34, P < 0.001) and physical HRQOL was associated with pelvic pain severity (r = 0.50, P < 0.001) HRQOL. Multiple regression analysis revealed that mental HRQOL was significantly related to symptoms of both somatoform dissociation and PTSD and that physical HRQOL was significantly associated with pelvic pain severity and symptoms of somatoform dissociation. A post-hoc correlation analysis showed that pts with CPP had high correlations between Mental and Physical QOL measures and sensory alterations, more localized pain and functional difficulties related to the genital region and greater generalized analgesia and numbness in relation to the body as a wholeAn integrated approach in care protocols for females with IC or CPP that takes into account assessments of trauma exposure and symptoms of somatoform dissociation should be encouraged
Porru et al[85], 202369 female pts, mean age = 49,4; 42 with BPS/IC + 27 with chronic non neoplastic painCS. Administered questionnaires included PHQ-9; ICSI-ICPI, BPI (pain short questionnaire), psychological interview; other psychosocial variablesMean PHQ-9 scores, 10.3 in pts with IC/BPS and 6.9 in CTRL. The main SD in group 0 had a CI: 8.4-12.19, with 95% of pts having a total value in this range. The CI in the second group was 4.7-9.12 (the difference was statistically significant, P < 0.02)BPI and CI have an important psychological impact; psychosocial factors are involved in the evolution of the clinical picture
Table 2 Studies emerging from searching the ClinicalTrials.gov site on the November 7, 2023. Strategy used: Condition/disease: Interstitial cystitis; Other terms: Psychological symptoms; Intervention/treatment: blank (not required)
Study title
NCT number
Dates
Status
Conditions
Interventions
Sponsor
Responsible
Results
Study type
Ref.
Smartphone-based Self-care Education Program for Women with Interstitial Cystitis: Educational Remote IC AideNCT05260112February 17, 2022 Last, April 1, 2023CompletedCystitis, InterstitialOther: ERICAUniversity of Pennsylvania, Philadelphia, PA, United StatesEdward KimSubmitted March 31, 2023, quality control still not concludedInterventionalNone
Interstitial Cystitis: Monitoring of the Psychic State and Counseling Intervention in the COVID-19 EraNCT05752344February 28, 2023CompletedCystitis, InterstitialOther: CounsellingFondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyMarianna MazzaNot submitted; study conducted from November 1, 2020 to November 1, 2022ObservationalNone
Safety and Efficacy of Aloe Vera in the Management of the Symptoms of Interstitial CystitisNCT04734106February 1, 2021 Last, January 24, 2024Not yet recruitingInterstitial Cystitis Chronic Interstitial Cystitis Bladder Pain SyndromeDrug: Desert Harvest Aloe Vera Capsules Other: Placebo CapsulesWake Forest University Health Sciences, Winston-Salem, N.C., United StatesWake Forest University Health SciencesNot startedInterventionalNone
Biopsychosocial and Conventional Approach in Bladder Pain SyndromeNCT05155384December 10, 2021 Last, January 3, 2022Unknown statusInterstitial Cystitis/Bladder Pain Syndrome, Randomised Control TrialOther: Pain Neuroscience Education; Relaxation exercises; Cognition target exercise; Pelvic floor stretching exercises; Transcutaneous electrical nerve stimulationHacettepe University, Ankara, TurkeyCeren GursenSome results submitted; quality control still not concluded; completion estimated October 15, 2022; no notice since thenInterventionalNone
Study of Biomarkers and the Relaxation Response Using Guided Imagery in Women With ICNCT00420550September 1, 2007, Last March 21, 2012CompletedInterstitial Cystitis Pelvic PainBehavioural: Relaxation Response using Guided Imagery, Phase 2William Beaumont Hospitals, Royal Oak, MI, United StatesKenneth PetersNo results postedInterventionalNone
Quality of Life Analysis in Bladder Pain Syndrome/Interstitial CystitisNCT05630742November 18, 2022, Last November 30, 2022CompletedInterstitial Cystitis, Bladder Pain Syndrome, Quality of LifeOther: chronic non-neoplastic painIRCCS Policlinico S. Matteo, Pavia, ItalyDaniele PorruResults not postedObservationalPorru et al[75]
Identifying Predictors of Treatment Success in Painful Bladder SyndromeNCT01410461August 4, 2011, Last August 5, 2011Unknown statusPainful Bladder SyndromeDevice: quantitative sensory testing; Ultrasound testingRambam Health Care Campus, Haifa, IsraelLior Lowenstein, Dalia KesnerNo results postedObservationalNone
Bladder Instillations Versus Onabotulinumtoxin A for Treatment of Interstitial Cystitis/Bladder Pain SyndromeNCT04401176May 19, 2020, Last October 12, 2023CompletedInterstitial Cystitis Bladder Pain SyndromeDrug: Heparin & Alkalinized Lidocaine Bladder Instillation; Onabotulinum Toxin A, Phase 2Walter Reed National Military Medical Center, Bethesda, Maryland, United StatesEva Kwong WelchNo results postedInterventionalNone
Interstitial Cystitis: Elucidation of the Psychophysiologic and Autonomic Characteristics (ICEPAC) StudyNCT01616992June 8, 2012, Last February 4, 2015CompletedInterstitial Cystitis/Painful Bladder Syndrome Myofascial Pelvic PainDrug: BupivacaineCase Western Reserve University, Cleveland, Ohio, United StatesThomas C Chelimsky, Medical College of Wisconsin; Jeffrey Janata, University Hosp. ClevelandResults not postedObservationalWilliams et al[150]
Vestibulodynia: Understanding Pathophysiology and Determining Appropriate TreatmentsNCT03844412February 15, 2019, Last November 29, 2023RecruitingVestibulodynia Temporomandibular Disorder Fibromyalgia SyndromeDrug: 5% lidocaine/5 mg/ml 0.02% oestradiol compound cream; Nortriptyline; Placebo creamDuke University, Durham, North Carolina, United StatesAndrea Nackley – Duke, Andrea Rapkin – UCLA, Erin Carey-Elizabeth Geller – DukeTo be completed on December 1, 2024 (estimated)InterventionalNone
Translational Research in Pelvic PainNCT04001244May 16, 2019, Last April 4, 2023CompletedEndometriosis Bladder Pain Syndrome/Chronic PainDifferentiate between two types of pelvic pain condition (endometriosis-associated pain and bladder pain syndrome)University of Oxford, United Kingdom – IBMC Porto, Portugal – Boston Children's Hospital - Michigan State University – Bayer Grünenthal GmbH – Esteve – Queen Mary University of London – Aalborg University – Endometriosis.org – International Painful Bladder Foundation – Pelvic Pain Support Network – King's College London – Universität Heidelberg – University of Edinburgh – Universität Jena – Universität MünsterKaty Vincent – University of OxfordNo results postedObservationalDimitriou et al[149]
Life-Stress Interview for Women With Chronic Urogenital Pain ConditionsNCT02286115November 5, 2014, Last December 14, 2016CompletedChronic Urogenital PainBehavioural: Life-Stress InterviewWilliam Beaumont Hospitals, Royal Oak, MI, United StatesJennifer Carty, Mark A. Lumley – Wayne State UniversityNo results postedInterventionalImamura et al[151]; mentioned in Carty et al[152] and Carty[153]
Improving Female Sexual WellnessNCT04824820March 29, 2021, Last April 5, 2023CompletedUrinary Incontinence, Sexual Dysfunction, Pelvic Organ Prolapse, Pelvic Floor Disorders, Interstitial Cystitis, Female Sexual Dysfunction, Hypoactive Sexual Desire Disorder, Sexuality Orgasmic Disorder, Sexual Desire DisorderBehavioural: VibratorCedars-Sinai Medical Center, Los Angeles, CA, United StatesKaryn Eilber, principal investigator; contact: Alexandra DubinskayaNo results postedInterventionalNone
Safety and Clinical Outcomes Study: SVF Deployment for Orthopedic, Neurologic, Urologic, and Cardio-pulmonary ConditionsNCT01953523September 2, 2013, Last September 25, 2018CompletedNeurodegenerative Diseases Osteoarthritis, Erectile Dysfunction, Autoimmune Diseases, Cardiomyopathies, EmphysemaProcedure: Administration of autologous adipose derived SVFElliot Lander, Rancho Mirage, CA, United StatesMark H BermanCompleted January 1, 2017; No results postedInterventionalWyles et al[154] and Khera et al[155]
Table 3 Neuroimaging studies in urologic chronic pelvic pain syndrome, i.e. interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome and other pelvic or chronic pain conditions by year of publication
Ref.
Population
Technique
Findings
Farmer et al[123], 2011Male 19 with CP/CPPS vs 16 HCsfMRI during pain rating task; NMR, VBM; DTI↑ FC in right anterior insula correlating with pain intensity; no GM differences between groups, but GM density in anterior insula and ACC correlated with pain intensity and chronicity; the normal correlation between WM FA and neocortex GM volume lost in CP/CPPS Pts
Bagarinao et al[124], 2014Female 33 with IC/BPS (mean age = 39.51 ± 12.09 yr, 7 with vulvodynia and 8 with TMJD) vs 33 HCs (mean age = 38.95 ± 11.64 yr)NMR, T1-weighted analysed with SPM8; used SVM algorithm; ROI approachSVM predicted accurately to which group cases belonged in 73% of cases. SVM identified ↑ GM density areas in bilateral PSC, left preSMA, bilateral hippocampus, left amygdala. Correlation of ↑ cortical GM density with pain, symptom and mood self-ratings
Kilpatrick et al[125], 2014Female 82 IC/BPS vs 85 HCsfMRI, RSOscillation frequency power at lower frequencies ↑ in IC/BPS vs HCs in postcentral gyrus, anterior paracentral lobule, ventral and medial SMA and ↓ in right posterior insula; ↑ FC in Pts vs HCs between medial SMA and right midbrain, ventral SMA and cerebellum/bilateral midbrain, between anterior paracentral lobule and superior parietal Cx/cerebellum/right midbrain; ↓ FC in Pts vs HCs between right posterior insula and right medial insula
Farmer et al[126], 2015Female 22 with IC/BPS (mean age = 37.73 ± 12.98 yr; no comorbidity or abnormal pelvis) vs 32 HCs (mean age = 32.84 ± 10.29 yr)DTI, NMR T1-weighted, voxel-wise analysisIC/BPS vs HCs ↓ WM density in left cerebellar corticospinal tract, right cerebellar ATR, right IFOF in right frontal orbital Cx, right ILF in lateral occipital Cx, left forceps major adjacent to precuneus, right ATR in right frontal pole, SLF in parietal Cx, and 8) temporal part of left SLF near ACC; ↑ FA in ILF, IFOF at right insula border, forceps major near left ACC, SLF in right postcentral gyrus and left PSC, and corticospinal tract passing through left PSC
Kutch et al[127], 2015Male 28 with CP/CPPS vs 27 HCsfMRI, RS↓ FC between precentral gyrus/STG/IFG and right posterior insula in CP/CPPS Pts vs HCs
Gupta et al[128], 2015Female 29 LPVD, 29 HCs, and 29 IBSfMRIIntrinsic connectivity LPVD > HCs in SMA, LPVD > IBS in left PMC, left and right SMA, IBS > LPVD in right STC and left and right PSC
Martucci et al[129], 2015Female 45 UCPPS vs 45 HCsfMRI, RS↓ FC in DMN in PoMeCx (left precuneus and PCC); ↑ FC between PCC and insula, DLPFC, thalamus, pallidum, putamen, amygdala and hippocampus; ↓ FC between left precuneus and OFC, ACC, VMPFC, AG, SPL, IPL
Kairys et al[47], 2015Female 33 with IC/BPS (mean age = 39.5 ± 12 yr; no comorbidity) vs 33 HCs (mean age = 39 ± 11.6 yr)VBM, NMR, T1-weighted analysed with SPM8 under MATLAB® 7.6↑ GM volume in IC/BPS vs HCs; SVM identified ↑ GM density areas in bilateral PSC, left preSMA, bilateral hippocampus, left amygdala. Correlation of ↑ cortical GM density with pain, symptom and mood self-ratings
Woodworth et al[130], 201545 UCPPS (19 female IC/BPS, 26 male CP/CPPS; mean age = 40 ± 14 yr) 56 HCs (26 female, 30 male, mean age = 38 ± 13 yr), 39 IBS (23 female, 16 male, mean age = 35 ± 12 yr)DTI, 3T NMR post-bladder emptying; voxel-wise SPM; Pts were administered McGPQ and PANAS↑ MD in UCPPS vs HCs in left/right putamen, left globus pallidus, right posterior coronal radiate, right left forceps minor and GCC, SplCC, right/left sensorimotor integration fibres, right ACC, right external and internal capsules, left posterior SLF, right left ILF, left precentral gyrus association fibres, right prefrontal WM projections; ↑ MD in UCPPS vs IBS in basal ganglia, right periventricular WM, temporal lobe projections, and fibres projecting to right primary motor cortex and association fibres in right hemisphere frontal areas; longer symptom duration correlated with MD and FA in WM clusters differing in MD between UCPPS and HCs
Kleinhans et al[131], 2016Female 10 twins (5 mono- and 5 dizygotic) discordant for UCPPS (10 UCCPS vs 10 asymptomatic)fMRI, RS after urination and 50 minutes after drinking 1/2 Lt of water; 3T NMR. ROIs bilateral PAG and amygdalaThe symptomatic twins reported more pain at all timepoints and more urgency before scan; ↑ FC in symptomatic twins following water consumption and stable thereafter; in asymptomatic twins, ↑ FC only after bladder distention; ↑ FC in in asymptomatic twins between right PAG and cerebellar/cortical regions involved in sensorimotor planning; ↑ FC between laterobasal amygdala to ACC, insula, somatosensory, premotor Cxs, thalamus and VMPFC
Wei et al[132], 2016Female 46 PDM vs 49 HCsfMRI during menstruation and periovulatory phasePDM, adaptive hyperconnectivity between PAG and SMCx during painful menstruation; maladaptive hypoconnectivity between PAG and DLPFC and DMN during menstruation or periovulatory phase
Deutsch et al[133], 2016Female 11 with IC/BPS (4 non-comorbid; 5 comorbid with fibromyalgia, 5 vulvodynia, 4 IBS, 3 chronic fatigue) vs 11 HCsASL fMRI rCBF at BL, empty bladder and heat pain; 3T NMRAt empty bladder, ↓ rCBF in bilateral insula, middle and PCC in Pts with IC/BPS vs HCs. Bladder distension associated with ↑ rCBF in IC/BPS vs HCs SMA, motor and sensory Cxs, bilateral insula, hippocampus, and middle and PCC in Pts with IC/BPS. During heat pain, ↓ rCBF in IC/BPS Pts vs HCs, who showed ↑ rCBF in bilateral amygdala
Huang et al[134], 201652 UCPPS (23 female, 29 male), 39 IBS (24 female, 15 male), 61 HCs (32 female, 29 male)3T NMR, T1-weighted; DTI, FA↑ FA in UCPPS in left corticospinal tract, left forceps major, left SLF at precentral gyrus; left superior corona radiata at ACC; forceps major, right IFOF, ILF and cingulum projecting to parahippocampal gyri at precuneous compared to IBS and HCs; ↑ FA in right ATR in IBS compared to HCs; regional changes independent of local grey matter FA and density
Kutch et al[135], 201752 UCPPS (34 female IC/BPS; 18 male CP/CPPS), mean age = 38.8 ± 11.9 yrfMRI, RS; 3T NMR; clinical reassessment after 3, 6, and 12 moStrong BL FC, particularly in the fronto-parietal network, was associated with symptom improvement at 3 mo, but not at 6 mo or 12 mo. FC data predicted accurately the improver/non-improver status at 3 mo for 73.1% of the sample, with 69.2% sensitivity and 75.0% specificity; improver status was not maintained at later timepoints
Kutch et al[136], 201748 female (IC/BPS) 24 male (CP/CPPS) with UCPPS (n = 110) vs 23 female fibromyalgia vs 49 female HCsfMRI, NMRPts with UCPPS and widespread pain show ↑ GM volume in right SMA and cingulate Cx and bilateral SMCx as well as ↑ FC between SMCx and insula with the salience circuit, compared to UCPPS Pts with localised pain and controls
Harper et al[137], 2018Female 18 UCPPS (mean age = 34.8 ± 11.0 yr) vs 20 HCs (mean age = 34.7 ± 12.3 yr)1H-MRS, T1-weighted scans; McGPQ, PANAS, HADSUCPPS Pts had ↓ GABA and ↑ choline and choline-to-total creatine ratio than HCs in the ACC; the two groups did not differ for other metabolites (glutamate + glutamine; glutamate; N-acetylaspartate; and inositol); ↑ ACC choline level correlated with McGPQ pain, HADS Depression and PANAS negative affect scores
Woodworth et al[138], 201830 UCPPS (13 female IC/BPS; 17 male CP/CPPS); mean age = 39.9 ± 13.5 yrDTI (FA, ADC), correlations with urinary proteinsADC in a small WM cluster adjacent to right motor cortex correlated with urinary MMP2; ADC in a WM cluster in DRN and LCC correlated with MMP9 and MMP9/NGAL complex; FA in SMCx-connecting areas correlated with MMP9 as did midbrain areas and left SMCx with MMP9/NGAL complex; large WM clusters’ ADC and FA correlated with NGAL urinary concentrations; no correlations with VEGF
Gupta et al[139], 201985 UCPPS mean age = 39.36 ± 12.80 yr (56 female IC/BPS, mean age = 38.96 ± 12.41 yr; 29 male CP/CPPS; mean age = 40.11 ± 13.71 yr) vs 86 HCs mean age = 37.90 ± 12.23 (59 female mean age = 35.44 ± 10.82 yr; 27 males; mean age = 49.60 ± 13.55 yr)fMRI, RS; CTES to measure EALEs. Network centrality was measured for each of the main brain networks* (DMN, basal ganglia, sensorimotor, executive control and salience) using graph theoryUCPPS Pts with → ↓ centrality in right anterior insula than HCs (salience network hub). UCPPS male → ↓ centrality in right anterior insula than male HCs. UCPPS female → ↑ centrality in right caudate nucleus and left angular gyrus than female HCs [condition effects]. UCPPS male → ↓ centrality in left PCC (DMN), angular gyrus, middle temporal gyrus, and superior temporal sulcus; UCPPS male → ↑ centrality in precuneus and anterior mid-cingulate Cx than UCPPS female [sex effect]. ↑ reports of EALEs associated with ↑ centrality in left precuneus and left anterior mid-cingulate Cx in UCPPS female. Moderating effect of CTES on condition effect on betweenness centrality of right anterior insula (salience network hub); EALEs moderated centrality in amygdala at high CTES scores
Fenske et al[140], 2020100 UCPPS mean age = 39.2 ± 13.3 male/female = 34/66 vs 109 HCs mean age = 36.7 ± 12.2 male/female = 34/75fMRI, RS; PAG characterisation as a ROI according to the MNI↑ FC in HCs vs Pts in right (pars triangularis) and left IFG (pars opercularis); right PCC, left IFG (pars orbitalis) and left IPL shown when Pts and HCs were compared on the MNI-trace ROI compared to the MNI-sphere ROI

  • Citation: Mazza M, Margoni S, Mandracchia G, Donofrio G, Fischetti A, Kotzalidis GD, Marano G, Simonetti A, Janiri D, Moccia L, Marcelli I, Sfratta G, De Berardis D, Ferrara O, Bernardi E, Restaino A, Lisci FM, D'Onofrio AM, Brisi C, Grisoni F, Calderoni C, Ciliberto M, Brugnami A, Rossi S, Spera MC, De Masi V, Marzo EM, Abate F, Boggio G, Anesini MB, Falsini C, Quintano A, Torresi A, Milintenda M, Bartolucci G, Biscosi M, Ruggiero S, Lo Giudice L, Mastroeni G, Benini E, Di Benedetto L, Caso R, Pesaresi F, Traccis F, Onori L, Chisari L, Monacelli L, Acanfora M, Gaetani E, Marturano M, Barbonetti S, Specogna E, Bardi F, De Chiara E, Stella G, Zanzarri A, Tavoletta F, Crupi A, Battisti G, Monti L, Camardese G, Chieffo D, Gasbarrini A, Scambia G, Sani G. This pain drives me crazy: Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome. World J Psychiatry 2024; 14(6): 954-984
  • URL: https://www.wjgnet.com/2220-3206/full/v14/i6/954.htm
  • DOI: https://dx.doi.org/10.5498/wjp.v14.i6.954