Editor's Commentary - Interstitial cystitis/painful bladder syndrome: What do patients mean by "perceived" bladder pain?

BERKELEY, CA (UroToday.com) -

 

What is Pain Perceived to be Related to the Bladder?

 

Because many of the proffered definitions of BPS/IC have described its pain as “associated with,” “related to,” or “perceived to be related to” the urinary bladder, John Warren and his group from Baltimore wondered what characteristics lead the patient to believe that the pain involves the bladder. They used the 18 month follow up period of their “Events Preceding Interstitial Cystitis” (EPIC) study to ask the 210 of the original 312 women with recent onset of disease who could be reached for the interview.

Interestingly, 31 patients reported no pain in the previous week and did not answer the open-ended question “how you know the bladder is the source of this pain?” Forty percent of the remaining 179 mentioned a single reason, 6% did not know how, and 54% related multiple reasons for this assumption. Forty-one percent stated that the location of pain was the reason they perceived the bladder as its source, 34% noted pain increasing with bladder filling and/or decreasing with bladder emptying, and 31% stated the presence of urinary urgency (“constant feeling of having to urinate“) and/or frequency as the reason(s). Nocturia was not noted as a reason by any patient. Pain worsening during or after urination was cited as a rationale for associating it with the bladder for 23% of the respondents.

Overall, 96% of the women used symptoms based on the bladder or lower urinary tract to “perceive” that their pain involved the bladder. Warren and colleagues were unable to distinguish a patient’s native insight from what was learned from a physician or other sources such as the Internet, and note that the findings might be an amalgam of what patients and their clinicians used to “perceive” that the bladder was the source of pain.

This excellent research team has again taken something we might assume as a given, and investigated what it really means in a scientific manner, and how we might use this information to further the science. This study shows perception of a bladder origin involves location, changes with the urinary cycle, and association with other urinary symptoms. Warren and colleagues conclude that to clarify the relationship of BPS/IC to other chronic pain syndromes that can be comorbid conditions, these features of BPS/IC should be queried.

Warren JW, Diggs C, Horne L, Greenberg P

Urology. 2011 Feb;77(2):309-12
10.1016/j.urology.2010.08.030

PubMed Abstract
PMID: 21146863

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