Neurophysiologic & Autonomic Characterization of Interstitial Cystitis/Painful Bl

描述（由申请方提供）：间质性膀胱炎/膀胱疼痛综合征（IC/PBS）是一种常见的慢性特发性内脏疼痛综合征（约占人群的2.5%），可产生剧烈疼痛，并使正值青春期的年轻女性致残。尽管IC/PBS在历史上是从泌尿学角度概念化的，但膀胱壁异常的发现并没有导致有效的治疗。此外，IC/PBS的症状表明膀胱神经支配受损，包括感觉传入和自主传出。大量的自主神经紊乱的流行病学和临床与IC/PBS，支持这种重新概念化，并提出了更广泛和远程的核心缺陷。我们的长期目标是确定广泛的神经，心理和内分泌表型特征IC/PBS。我们假设IC/PBS实际上是一个更大的疾病家族的成员，这些疾病有一个共同的（家族性？）易患对压力、疼痛或威胁的异常中枢自主神经和感觉反应，通常在急性创伤事件（感染、损伤）后首次表现。这一假设预测，对IC/PBS患者及其家庭成员的仔细调查将揭示健康对照中不存在的特定神经缺陷。还将特别强调区分与IC/PBS特异性相关的结果，与非特异性慢性盆腔疼痛相反，通过将这些结果与无IC/PBS的肌筋膜盆腔疼痛患者的结果进行比较。我们建议通过调查神经泌尿系统、妇科、自主神经、胃肠和心理功能、暴露于早期不良经历以及这四组中的应激反应系统的功能来测试这一创新假设。这项研究是重要的，因为它将提供，第一次，在许多系统中的中枢，外周，传入和传出神经系统功能的详细临床研究，除了膀胱的IC/PBS患者。不仅与健康受试者进行比较，而且与患有慢性盆腔疼痛而没有IC/PBS的受试者进行比较，这对于在仅与疼痛存在相关的结果和真正与IC/PBS相关的结果之间进行分类至关重要。这种扩展的观点旨在更好地理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/膀胱疼痛综合征（IC/PBS）导致严重的膀胱疼痛和广泛的残疾，在一个大的年轻妇女群体在他们的生产生活的黄金期。对膀胱本身的广泛研究发现了许多异常，但我们不知道这些是疾病的原因还是结果。到目前为止，这些都没有导致任何真实的长期治疗进展。我们发现，其他植物神经功能紊乱经常发生在患者本身和IC/PBS患者的家庭成员中。因此，我们建议确定IC/PBS的主要异常是否实际上在于自主神经系统，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，无论是在休息时，还是在受控的心理压力下。我们将我们的测量结果与盆腔肌筋膜疼痛患者进行比较，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。

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.