Articles

Mapping of Pain Phenotypes in Female Patients with Bladder Pain Syndrome/Interstitial Cystitis and Controls

By: Dean A. Trippa lowast , J. Curtis Nickela, Jennifer Wonga, Michel Pontarib, Robert Moldwinc, Robert Mayerd, Lesley K. Carre, Ragi Doggweilerf, Claire C. Yangg, Nagendra Mishrah and Jorgen Nordlingi

Published online: 01 December 2012

Keywords: BPS/IC, Pain, Phenotype, Quality of life, Psychosocial

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Abstract

Background

Many bladder pain syndrome/interstitial cystitis (BPS/IC) patients report multiple pain locations outside the pelvis. No research has examined pain using a whole-body diagram, pain-associated adjustment factors, or the impact of pain in multiple body areas on patients’ quality of life (QoL).

Objective

Compare and contrast pain in BPS/IC patients and controls using a whole-body diagram (visible body areas). Examine the association between patient adjustment factors and greater number of body pain areas (pain phenotypes).

Design, setting, and participants

Validated questionnaires were collected from diagnosed, tertiary-care, outpatient, female BPS/IC patients (n=193) and age-matched controls (n=115). Scales included a body pain area diagram, demographics/history, pain severity, BPS/IC symptoms, pain, depression, catastrophizing, and QoL.

Outcome measurements and statistical analysis

Cross-tabulation and analysis of variance models addressed the patient and control differences.

Results and limitations

Patients reported more pain than controls in all reported body areas. Four pain phenotypes were created based on increasing counts of body locations (BPS/IC only, BPS/IC+plus 1–3 additional locations, BPS/IC plus 4–9, BPS/IC ≥10). Patients reported more body pain locations, pain, urinary symptoms, depression, catastrophizing, and diminished QoL than controls. The increased-pain phenotype was associated with poorer psychosocial adjustment and diminished physical QoL, but catastrophizing and low scores for mental QoL remained stable across all patient groups. This study was cross-sectional, relying on correlation-based analyses, thus causality cannot be established.

Conclusions

Patients reported numerous systemic pain symptoms outside the areas associated with the bladder/pelvic region, and increased numbers of body pain sites were associated with poorer patient outcomes (ie, pain severity, depression). This study illustrates the significant negative impact of pain on patient adjustment in BPS/IC. These findings suggest that clinicians carefully consider pain location distributions and the potential impact of body pain phenotypes during patient evaluation and treatment planning.

Take Home Message

This study illustrates the occurrence of multiple areas of body pain and the significant negative impact of such pain on patients’ biopsychosocial adjustment as reported by patients with interstitial cystitis. Addressing systemic pain is an important task in appropriate patient management.

Keywords: BPS/IC, Pain, Phenotype, Quality of life, Psychosocial.

Footnotes

a Queen's University, Kingston, ON, Canada

b Temple University, Philadelphia, PA, USA

c Hofstra University School of Medicine, New Hyde Park, NY, USA

d University of Rochester, Rochester, NY, USA

e University of Toronto, Toronto, ON, Canada

f University of Tennessee, Knoxville, TN, USA

g University of Washington, Seattle, WA, USA

h Jivraj Mehta Hospital, Ahmedabad, India

i University of Copenhagen, Herlev, Denmark

lowast Corresponding author. Departments of Psychology, Anesthesiology, and Urology, Humphrey Hall, 62 Arch Street, Queen's University, Kingston, Ontario K7L 3N6, Canada. Tel. +1 613 533 6955; Fax: +1 613 533 2499.