Neurophysiologic & Autonomic Characterization of Interstitial Cystitis/Painful Bl

神经生理学

• 批准号: 7635653
• 负责人: Thomas C. Chelimsky
• 金额: $ 66.89万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7635653
• 关键词: Acute; Adverse event; Autonomic nervous system; Autonomic nervous system disorders; Axon; Bladder; Bladder Diseases; Body Temperature; Breathing; Cardiac; Cardiovascular system; Catecholamines; Characteristics; Chronic; Clinical Trials; Corticotropin; Defect; Development; Diagnostic; Disease; Dopamine; Double-Blind Method; Dysmenorrhea; Endocrine; Epinephrine; Equipment and supply inventories; Esthesia; Evaluation; Event; Exposure to; Family; Family member; Fiber; First Degree Relative; Gynecologic; Hormones; Hydrocortisone; Impairment; Infection; Injury; Interstitial Cystitis; Intestines; Investigation; Lead; Lidocaine; Life; Link; Lumbar nerve; Measurement; Methods; Myofascial Trigger Point; Nervous System Physiology; Nervous system structure; Neuraxis; Neurologic; Neurologic Examination; Neurophysiology - biologic function; Norepinephrine; Numeric Rating Scale; Pain; Patients; Pelvic Pain; Pelvic floor structure; Performance; Peripheral; Phenotype; Placebo Control; Plant Roots; Population; Predisposition; Prevention strategy; Principal Investigator; Process; Psychological Stress; Psychometrics; Quantitative Evaluations; Questionnaires; Recording of previous events; Reflex action; Relaxation; Research; Research Design; Rest; Salivary; Satiation; Screening procedure; Self Assessment; Sensory; Sorting - Cell Movement; Stomach; Stress; Structure; Sweat test; Symptoms; Syndrome; System; Testing; Tilt-Table Test; Time; Trauma; Validation; Valsalva Maneuver; Vasomotor; Visceral pain; Vulvodynia; Water; Woman; acronyms; autonomic neuropathy; biological adaptation to stress; cell motility; chronic pelvic pain; design; diaries; disability; early childhood; effective therapy; gastrointestinal; innovation; instrument; member; nerve supply; neurophysiology; novel; painful bladder syndrome; psychologic; psychosocial; public health relevance; relating to nervous system; response; stressor; urologic

DESCRIPTION (provided by applicant): Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) is a chronic idiopathic visceral pain syndrome that occurs commonly (about 2.5% of the population), produces severe pain, and disables young women in the prime of their lives. Although IC/PBS has historically been conceptualized from a urologic perspective, the finding of bladder wall abnormalities has not led to effective treatment. Further, the symptoms of IC/PBS suggest impairment of bladder innervation, both sensory afferent and autonomic efferent. The large number of autonomic disorders epidemiologically and clinically associated with IC/PBS, support this reconceptualization and suggest a more widespread and remote core defect. Our long-term aim is to define the broad neural, psychological, and endocrine phenotypes that characterize IC/PBS. We hypothesize that IC/PBS actually is a member of a larger family of disorders that share a common (familial?) predisposition to aberrant central autonomic and sensory responses to stress, pain or threat, usually first manifested following an acute traumatic event (infection, injury). This hypothesis predicts that careful investigation of patients with IC/PBS and their family members will reveal specific neural defects that are not present in healthy controls. Special emphasis will also be placed on distinguishing findings that are specifically associated with IC/PBS, in contrast to non-specific chronic pelvic pain, by comparing the findings to those in patients with myofascial pelvic pain without IC/PBS. We propose to test this innovative hypothesis by investigating neuro-urologic, gynecologic, autonomic, gastrointestinal, and psychological function, exposure to early adverse experience, and function of the stress response system in each of these four groups,. This research is important because it will provide, for the first time, a detailed clinical investigation of central, peripheral, afferent and efferent nervous system function in many systems in addition to the bladder in patients with IC/PBS. The comparison with not only healthy subjects, but also subjects who have chronic pelvic pain without IC/PBS will be crucial to sort between findings related simply to the presence of pain, and those truly related to IC/PBS. This expanded view is designed to lead to a better understanding of causal factors that contribute to the disease process, and to suggest novel treatment or prevention strategies. PUBLIC HEALTH RELEVANCE: Interstitial cystitis/painful bladder syndrome (IC/PBS) causes severe bladder pain and extensive disability in a large group of young women in the prime of their productive lives. Extensive study of the bladder itself has uncovered many abnormalities, but we do not know if these are a cause or a result of the disorder. None of these has led to any real long-term progress in treatment, so far. We have found that other autonomic disorders often occur in both the patients themselves and in the family members of patients with IC/PBS. We therefore propose to determine whether the main abnormality in IC/PBS actually lies in the autonomic nervous system, rather than the bladder. We will do this through careful measurements of autonomic function and sensation in patients who have IC/PBS, both at rest, and under controlled psychological stress. We will compare our measurements to patients with myofascial pelvic pain, to know which abnormalities are truly linked to IC/PBS, and which simply reflect the presence of pelvic pain.

描述(申请人提供)：间质性膀胱炎/痛性膀胱综合征(IC/PBS)是一种慢性特发性内脏疼痛综合征，常见(约占人口的2.5%)，产生剧烈疼痛，并使处于壮年的年轻女性残疾。虽然IC/PBS历史上是从泌尿学的角度被概念化的，但膀胱壁异常的发现并没有带来有效的治疗。此外，IC/PBS的症状提示膀胱神经传入和自主神经传出功能受损。在流行病学和临床上与IC/PBS相关的大量自主神经障碍支持了这种重新定义，并暗示了更广泛和更遥远的核心缺陷。我们的长期目标是确定IC/PBS的广泛的神经、心理和内分泌表型。我们假设IC/PBS实际上是一个更大的疾病家族的成员，这些疾病共享一个共同的(家族性？)对压力、疼痛或威胁的异常中枢自主神经和感觉反应的易感性，通常在急性创伤事件(感染、损伤)后首次表现出来。这一假设预测，对IC/PBS患者及其家人的仔细调查将发现健康对照组中不存在的特定神经缺陷。还将特别强调通过将这些发现与没有IC/PBS的肌筋膜盆腔疼痛患者的结果进行比较，区分与IC/PBS相关的特殊表现与非特定的慢性盆腔疼痛。我们建议通过调查这四组中的每一组的神经泌尿学、妇科、自主神经、胃肠和心理功能、暴露于早期不良经历和应激反应系统的功能来检验这一创新假设。这项研究很重要，因为它将首次对IC/PBS患者的中枢、外周、传入和传出神经系统功能进行详细的临床研究，除了膀胱。不仅与健康受试者，而且与没有IC/PBS的慢性盆腔疼痛的受试者进行比较，对于区分单纯与疼痛的存在有关的结果和与IC/PBS真正相关的结果至关重要。这一扩展的观点旨在更好地了解导致疾病过程的因果因素，并提出新的治疗或预防策略。公共卫生相关性：间质性膀胱炎/痛性膀胱症(IC/PBS)在一大群处于生育壮年的年轻妇女中导致严重的膀胱痛和广泛的残疾。对膀胱本身的广泛研究已经发现了许多异常，但我们不知道这些是疾病的原因还是结果。到目前为止，所有这些都没有带来任何真正的长期治疗进展。我们发现，其他自主神经障碍经常发生在患者本身和IC/PBS患者的家人中。因此，我们建议确定IC/PBS的主要异常是否实际上存在于自主神经系统，而不是膀胱。我们将通过仔细测量IC/PBS患者的自主神经功能和感觉来做到这一点，无论是在静息状态下，还是在受控的心理压力下。我们将把我们的测量结果与肌筋膜骨盆疼痛的患者进行比较，以了解哪些异常与IC/PBS真正相关，哪些只是反映了盆腔疼痛的存在。