Both early (ELA) and recent life adversity (RLA) have been linked with chronic pain conditions and persistent alterations of neuroendocrine and inflammatory responses. Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a chronic urologic disorder characterized by bladder and/or pelvic pain, and excessive urinary frequency and/or urgency. IC/BPS has been associated with high levels of ELA as well as a distinct inflammatory signature. However, associations between ELA and RLA with inflammatory mechanisms in IC/BPS that might underlie the link between adversity and symptoms have not been examined. Here we investigated ELA and RLA in women with IC/BPS as potential risk factors for inflammatory processes and hypothalamic-pituitary-adrenal (HPA) abnormalities using data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. Women with IC/BPS and healthy controls (n=154 and 32, respectively) completed surveys, collected salivary cortisol at awakening and bedtime for 3 days, and gave a blood sample which was analyzed for 7 LPS-stimulated cytokines and chemokines (IL-6, TNFα, IL-1β, MIP1α, MCP1, IL-8, and IL-10). Two cytokine/chemokine composites were identified using principal components analysis. Patients with greater exposure to RLA or cumulative ELA and RLA of at least moderate severity showed elevated levels of a composite of all cytokines, adjusting for age, body mass index, and study site. Furthermore, there was a trending relationship between ELA and the pro-inflammatory composite score. Nocturnal cortisol and cortisol slope were not associated with ELA, RLA, or inflammation. The present findings support the importance of adverse events in IC/BPS via a biological mechanism and suggest that ELA and RLA should be assessed as risk factors for inflammation as part of a clinical workup for IC/BPS.
Brain, behavior, and immunity. 2023 Mar 29 [Epub ahead of print]
Susan K Lutgendorf, Sharaf Zia, Yi Luo, Michael O'Donnell, Adrie van Bokhoven, Catherine S Bradley, Robert Gallup, Jennifer Pierce, Bayley J Taple, Bruce D Naliboff, J Quentin Clemens, Karl J Kreder, Andrew Schrepf
Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA; Department of Urology, University of Iowa, Iowa City, IA, USA; Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA. Electronic address: ., Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA., Department of Urology, University of Iowa, Iowa City, IA, USA., Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA., Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA., Department of Mathematics, West Chester University, West Chester, PA, USA., Departments of Anesthesiology, Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA., Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Department of Medicine David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA., Department of Urology, University of Michigan Ann Arbor, MI, USA.