Autonomic neurophysiologic implications of disorders comorbid with bladder pain syndrome vs myofascial pelvic pain
Autor: | Patrick McCabe, Denniz Zolnoun, Sheng Yang, C.A. Tony Buffington, Tatiana Sanses, Thomas C. Chelimsky, Sarah Ialacci, Adonis Hijaz, S.T. Mahajan, Mary Alice Dombroski, Jeffrey W. Janata, Gisela Chelimsky, Curtis Tatsuoka |
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Rok vydání: | 2019 |
Předmět: |
Adult
medicine.medical_specialty Fibromyalgia Adolescent Urology 030232 urology & nephrology Cystitis Interstitial urologic and male genital diseases Autonomic Nervous System Pelvic Pain Article Irritable Bowel Syndrome 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine medicine Humans Myofascial Pain Syndromes Irritable bowel syndrome Depression (differential diagnoses) Aged Aged 80 and over 030219 obstetrics & reproductive medicine business.industry Pelvic pain Interstitial cystitis Chronic fatigue Middle Aged medicine.disease Migraine Anxiety Female Neurology (clinical) medicine.symptom Chronic Pain business hormones hormone substitutes and hormone antagonists |
Zdroj: | Neurourol Urodyn |
ISSN: | 1520-6777 |
Popis: | Aims The neuropathophysiology of a debilitating chronic urologic pain condition, bladder pain syndrome (BPS), remains unknown. Our recent data suggests withdrawal of cardiovagal modulation in subjects with BPS, in contrast to sympathetic nervous system dysfunction in another chronic pelvic pain syndrome, myofascial pelvic pain (MPP). We evaluated whether comorbid disorders differentially associated with BPS vs MPP shed additional light on these autonomic differences. Methods We compared the presence and relative time of onset of 27 other medical conditions in women with BPS, MPP, both syndromes, and healthy subjects. Analysis included an adjustment for multiple comparisons. Results Among 107 female subjects (BPS alone = 32; BPS with MPP = 36; MPP alone = 9; healthy controls = 30), comorbidities differentially associated with BPS included irritable bowel syndrome (IBS), dyspepsia, and chronic nausea, whereas those associated with MPP included migraine headache and dyspepsia, consistent with the distinct autonomic neurophysiologic signatures of the two disorders. PTSD (earliest), anxiety, depression, migraine headache, fibromyalgia, chronic fatigue, and IBS usually preceded BPS or MPP. PTSD and the presence of both pelvic pain disorders in the same subject correlated with significantly increased comorbid burden. Conclusions Our study suggests a distinct pattern of comorbid conditions in women with BPS. These findings further support our hypothesis of primary vagal defect in BPS as compared with primary sympathetic defect in MPP, suggesting a new model for chronic these pelvic pain syndromes. Chronologically, PTSD, migraine, dysmenorrhea, and IBS occurred early, supporting a role for PTSD or its trigger in the pathophysiology of chronic pelvic pain. |
Databáze: | OpenAIRE |
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