Autonomic Testing in Women with Chronic Pelvic Pain

Determine if abnormal autonomic nervous system (ANS) innervation of the bladder underlies interstitial cystitis/bladder pain syndrome (IC/BPS) differently than other chronic pelvic pain (CPP).

IRB approved protocol, 134 subjects enrolled, 3 excluded, 39 healthy controls (HC), 36 IC/BPS, 14 myofascial pelvic pain (MPP), 42 IC/BPS plus MPP. ANS evaluations: deep breathing, Valsalva maneuver, tilt table test (TTT), and sudomotor test (evaluates for autonomic neuropathy (AN)). A modified validated composite autonomic laboratory score was applied.

IC/BPS group 47.5 (21, 78) yrs was older than HC 34 (20, 75)yrs (p=0.006), MPP group 33 (22, 56)yrs (p=0.004), and IC/BPS plus MPP 38 (18, 64)yrs (p= 0.03) . BMI was not significantly different among groups, but the MPP and IC/BPS plus MPP groups had a higher BMI than HC (p=0.03 and p= 0.05 respectively). Cardiovascular and adrenergic indexes did not differ among groups. TTT showed more orthostatic intolerance (OI) in all CPP groups. TTT diagnoses (orthostatic hypotension, postural tachycardia syndrome -POTS, reflex syncope) occurred rarely. Baseline heart rate (HR) was higher in all CPP groups (p=0.004). All MPP groups showed significantly more clearcut AN (defined as sweat score ≥ 3) compare to HC (HC vs IC/BPS plus MPP p= 0.007; HC vs MPP p = 0.03).

Some CPP types show an autonomic neuropathy, and some show vagal withdrawal. In all types, orthostatic intolerance likely reflects cenral sensitization and perhaps catastrophization. Some of these findings suggest novel therapeutic targets.

The Journal of urology. 2016 Mar 26 [Epub ahead of print]

Gisela Chelimsky, Pippa Simpson, Noel McCabe, Liyun Zhang, Thomas Chelimsky

Medical College of Wisconsin, Milwaukee, 8701 W Watertown Plank Road WI, 53226 USA., Medical College of Wisconsin, Milwaukee, 8701 W Watertown Plank Road WI, 53226 USA., Case Western Reserve University, 10900 Euclid Avenue Cleveland, OH, 44106 USA., Medical College of Wisconsin, Milwaukee, 8701 W Watertown Plank Road WI, 53226 USA., Medical College of Wisconsin, Milwaukee, 8701 W Watertown Plank Road WI, 53226 USA. Electronic address: .

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