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. 2019 Jan;38(1):353-362.
doi: 10.1002/nau.23861. Epub 2018 Oct 23.

Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: Relationship to patient phenotype and clinical practice implications

Lindsey C McKernan  1   2 , Benjamin N Johnson  3 , William S Reynolds  4 , David A Williams  5 , Jennifer S Cheavens  6 , Roger R Dmochowski  4 , Leslie J Crofford  7
Affiliations

Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: Relationship to patient phenotype and clinical practice implications

Lindsey C McKernan et al. Neurourol Urodyn. 2019 Jan.

Abstract

Purpose: The relationship between exposure to abuse and interstitial cystitis/bladder pain syndrome (IC/BPS) is well-documented. However, studies have yet to examine posttraumatic stress disorder (PTSD), which develops following exposure to trauma and worsens health outcomes in chronic pain. We aimed to assess the prevalence and impact of PTSD in patients with IC/BPS, including their relation to genitourinary symptom presentation and widespread pain phenotype.

Materials and methods: We recruited 202 participants with chronic pain from an academic medical center and classified 64 individuals as IC/BPS based on validated epidemiological criteria. Participants completed self-reported questionnaires assessing trauma exposure, PTSD symptoms, emotional distress, pain, and urinary symptoms. Wilcoxon rank-sum tests assessed study aims comparing IC/BPS to other chronic pain.

Results: Although elevated, IC/BPS trauma exposure rates were equivalent to that of other chronic pain conditions in the sample. Despite this equivalence, in comparison, IC/BPS patients had significantly higher rates of PTSD symptoms, with 42% meeting provisional diagnostic criteria for PTSD. Among IC/BPS, those meeting provisional criteria for PTSD had significantly higher incidence of lifetime sexual abuse, childhood trauma, and presentations consistent with the widespread pain phenotype. In IC/BPS, there was no association between PTSD and genitourinary symptoms, but provisional PTSD was associated with more pain, emotional distress, and poorer quality of life.

Conclusions: We recommend that patients with IC/BPS and widespread pain have ongoing screening and monitoring of PTSD. We recommend using trauma-informed care practices with these patients to increase trust and safety, which could improve treatment compliance and follow-up.

Keywords: central sensitization; chronic; interstitial cystitis; pain; painful bladder syndrome; posttraumatic stress disorders.

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Figures

FIGURE 1
FIGURE 1
Study recruitment
FIGURE 2
FIGURE 2
Proportion of IC/BPS sample with central sensitization (CS) and posttraumatic stress disorder (PTSD)
See this image and copyright information in PMC

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