Noninvasive experimental bladder pain assessment in painful bladder syndrome
Noninvasive experimental bladder pain assessment in painful bladder syndrome
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DOI：
10.1111/1471-0528.14433
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发表时间：
2017-01-01
影响因子：
5.8
通讯作者：
Hellman, K. M.
中科院分区：
文献类型：
--
作者：
Tu, F. F.;Kane, J. N.;Hellman, K. M.
目的比较盆腔疼痛患者与无痛、无创、控制性利尿膀胱扩张患者的膀胱敏感性。设计前瞻性观察性研究。背景：社区教学医院。人群：非膀胱慢性盆腔疼痛的育龄妇女（CPP，n = 23），膀胱疼痛综合征（PBS，n = 23）和盆腔无痛对照组（n = 42）。方法比较参与者的膀胱测压能力、盆底压力-疼痛阈值（PPT）、骨盆肌肉功能、O 'Leary-Sant膀胱问卷和使用Wilcoxon秩和检验的心理社会工具。结果PBS组膀胱扩张疼痛程度高于CPP组，两组疼痛程度均高于对照组（P < 0.05）。膀胱扩张疼痛与盆腔肌肉结构或疼痛敏感性测量之间没有显著相关性;然而，膀胱扩张疼痛与膀胱附近的阴道PPT（r = 0.46）和经阴道膀胱触诊疼痛（r = 0.56）呈正相关。躯体敏感性对最大扩张时疼痛的影响小于膀胱症状（r = 0.35比r = 0.59; P < 0.05）。多元回归确定了三个独立的组成部分，在PBS中的膀胱症状：膀胱膨胀疼痛，膀胱感觉，和躯体symptoms.Conclusions利尿剂引起的膀胱疼痛区分CPP从PBS。实验性膀胱疼痛不能通过骨盆底敏感性预测。与患者报告的结果相比，它似乎受心理因素的影响较小。需要进一步的研究来确定实验性膀胱疼痛敏感性筛查是否可以预测未来PBS的风险。
Objective To compare bladder sensitivity between patients with pelvic pain and patients who were pain free, undergoing noninvasive, controlled bladder distension via diuresis. We also sought to measure potential mechanisms underlying bladder sensitivity.Design Prospective observational study.Setting Community teaching hospital.Population Reproductive-age women with non-bladder chronic pelvic pain (CPP, n = 23), painful bladder syndrome (PBS, n = 23), and pelvic pain-free controls (n = 42)Methods Participants were compared on cystometric capacity, pelvic floor pressure-pain thresholds (PPTs), pelvic muscle function, O'Leary-Sant bladder questionnaire, and psychosocial instruments using Wilcoxon rank-sum tests. Multivariate regression was used to identify factors underlying bladder pain phenotypes.Main outcome measures Pelvic floor pain thresholds; self reported bladder distension pain.Results Participants with PBS exhibited higher bladder distension pain than those with CPP, with both groups reporting higher pain levels than controls (P < 0.05). No significant associations were found between bladder distension pain and pelvic muscle structure or pain sensitivity measures; however, bladder distension pain positively correlates with both vaginal PPTs adjacent to the bladder (r = 0.46) and pain with transvaginal bladder palpation (r = 0.56). Pain at maximal distension was less influenced by somatic sensitivity than bladder symptoms (r = 0.35 versus r = 0.59; P < 0.05). Multivariate regression identified three independent components of bladder symptoms in PBS: bladder distension pain, bladder sensation, and somatic symptoms.Conclusions Diuresis-induced bladder pain differentiates CPP from PBS. Experimental bladder pain is not predicted by pelvic floor sensitivity. Compared with patient-reported outcomes it appears less influenced by psychological factors. Further study is needed to determine whether screening for experimental bladder pain sensitivity could predict future risk of PBS.