Identification of experimental bladder sensitivity among dysmenorrhea sufferers.
Identification of experimental bladder sensitivity among dysmenorrhea sufferers.
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DOI：
10.1016/j.ajog.2018.04.030
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发表时间：
2018-07
影响因子：
9.8
通讯作者：
Tu FF
中科院分区：
文献类型：
--
作者：
Hellman KM;Datta A;Steiner ND;Kane Morlock JN;Garrison EF;Clauw DJ;Tu FF
痛经是一种常见的危险因素，慢性疼痛的条件，包括膀胱疼痛综合征。很少有研究正式评估痛经患者的无症状膀胱疼痛敏感性，以及这是否在很大程度上反映了由于共病心理功能障碍导致的过度盆腔症状报告。我们试图确定在考虑焦虑和抑郁因素后，膀胱超敏反应是否在报告中度或重度痛经、其他部位无慢性疼痛的女性中更常见。证明这一点将表明，痛经可能是内脏或广泛疼痛超敏反应的早期线索，并提高对膀胱疼痛综合征潜在前兆的理解。我们比较了一组定期月经的女性，没有其他慢性疼痛的投诉，a）报告中度至重度痛经（n=98）和B）报告低水平或无月经疼痛（n=35）。参与者在标准的饮水方案后进行快速膀胱充盈，连续评定膀胱疼痛和随后扩张期间的相对紧迫性。膀胱容量的潜在差异通过标准膀胱测量阈值下的超声测量来控制。还在其他时间分别采用补充措施测量膀胱敏感性，包括简化的快速充盈试验、膀胱壁触诊和通过门诊自我报告。焦虑和抑郁的评估与国家卫生研究所患者报告的结果测量信息系统的措施。与对照组相比，中度至重度痛经的女性报告了更多的泌尿系统症状，最大容量较低（498 ± 18 mL vs. 619 ± 34 mL，p<0.001），诱发的膀胱充盈疼痛更多（0-100视觉模拟量表：25 ± 3 vs. 12 ± 3，p<0.001）。无论月经疼痛的严重程度、焦虑、抑郁或膀胱疼痛，痛经与膀胱容量的关系仍然显著（R2=0.13，p=0.006）。月经疼痛的严重程度预测诱发性膀胱疼痛（R2=0.10，p=0.008）独立于焦虑（p=0.21）和抑郁（p=0.21）。有中度至重度痛经的女性（24/98，24%）在筛选时快速膀胱试验（p<0.001）、经阴道膀胱触诊（p<0.015）和前瞻性每日日记（p<0.001）中的疼痛程度也高于无诱发膀胱疼痛的痛经女性。经历中度至重度痛经的女性对自然诱发的膀胱扩张也有更高的疼痛反应。非侵入性膀胱刺激需要在痛经患者中进行进一步的纵向测试，以表征内脏敏感性的过程，并确定它是否有助于预测个体在膀胱或其他地方发生后续疼痛的风险。
Dysmenorrhea is a common risk factor for chronic pain conditions including bladder pain syndrome. Few studies have formally evaluated asymptomatic bladder pain sensitivity in dysmenorrhea, and whether this largely reflects excess pelvic symptom reporting due to comorbid psychological dysfunction. We sought to determine whether bladder hypersensitivity is more common among women reporting moderate or greater dysmenorrhea, without chronic pain elsewhere, after accounting for anxiety and depression. Demonstrating this would suggest that dysmenorrhea might be an early clue for visceral or widespread pain hypersensitivity and improve understanding of potential precursors to bladder pain syndrome. We compared cohorts of regularly menstruating women, without complaints of chronic pain elsewhere, a) reporting moderate-to-severe dysmenorrhea (n=98) and b) reporting low levels or no menstrual pain (n=35). Participants underwent rapid bladder filling following a standard water ingestion protocol, serially rating bladder pain and relative urgency during subsequent distension. Potential differences in bladder volumes were controlled for by sonographic measurement at standard cystometric thresholds. Bladder sensitivity was also measured with complementary measures at other times separately including a simplified rapid filling test, palpation of the bladder wall, and through ambulatory self-report. Anxiety and depression were evaluated with the National Institute of Health Patient-Reported Outcomes Measurement Information System measures. Women with moderate-to-severe dysmenorrhea reported more urinary symptoms than controls and had a lower maximum capacity (498 ± 18 mL vs. 619 ± 34 mL, p<0.001) and more evoked bladder filling pain (0–100 visual analog scale: 25 ± 3 vs. 12 ± 3, p<0.001). The dysmenorrhea-bladder capacity relationship remained significant irrespective of menstrual pain severity, anxiety, depression, or bladder pain (R2=0.13, p=0.006). Severity of menstrual pain predicted evoked bladder pain (R2=0.10, p=0.008) independent of anxiety (p=0.21) and depression (p=0.21). Women with moderate-to-severe dysmenorrhea exhibiting provoked bladder pain (24/98, 24%) also reported higher pain during the screening rapid bladder test (p<0.001), in response to transvaginal bladder palpation (p<0.015), and on prospective daily diaries (p<0.001) than women with dysmenorrhea without provoked bladder pain. Women experiencing moderate-to-severe dysmenorrhea also harbor a higher pain response to naturally evoked bladder distension. Non-invasive bladder provocation needs to be tested further longitudinally in dysmenorrhea sufferers to characterize the course of visceral sensitivity and determine if it may help predict individuals at risk for developing subsequent pain in the bladder or elsewhere.
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影响因子：
9.8
作者：
Lentz, GM;Bavendam, T;Smalldridge, J
通讯作者：
Smalldridge, J
影响因子：
105.7
作者：
Latthe, P;Mignini, L;Khan, K
通讯作者：
Khan, K
DOI：
10.1111/1471-0528.14433
发表时间：
2017-01-01
影响因子：
5.8
作者：
Tu, F. F.;Kane, J. N.;Hellman, K. M.
通讯作者：
Hellman, K. M.
影响因子：
7.4
作者：
Costantini, Raffaele;Affaitati, Giannapia;Giamberardino, Maria Adele
通讯作者：
Giamberardino, Maria Adele
影响因子：
6.6
作者：
Nickel, J. Curtis;Tripp, Dean A.;Nordling, Jorgen
通讯作者：
Nordling, Jorgen