Disability in women suffering from interstitial cystitis/bladder pain syndrome

Abstract

What's known on the subject? and What does the study add? Interstitial cystitis/bladder pain syndrome (IC/BPS) is a disease that is associated with significant disability in the areas of self‐care, sexual functioning, occupation, family and home responsibilities, and social functions. Compared to age‐ and cohort‐matched controls, patients with IC/BPS reported poorer mental and physical quality of life (QoL), as well as greater pain, depression, anxiety, catastrophizing, sexual dysfunction and less social support. In particular, catastrophizing and depression are suggested to be important for understanding the factors promoting a poorer QoL in IC/BPS. The findings of the present study suggest that psychosocial factors are significant in mediating the relationship between impairments and patient disability, with negative affect (i.e. depression, anxiety) and pain catastrophizing acting as significant mediators. These findings argue that catastrophizing and negative affect may be the mechanisms by which pain and symptoms elevate reports of patient disability. Understanding how pain and pain‐associated symptoms may become disabling through cognitive mechanisms represents an importance advance for IC/BPS management. Clinical interventions in women suffering from IC/BPS should target catastrophizing and mood for reduction using cognitive behavioural strategies aiming to decrease pain‐related disability. Objectives To examine a biopsychosocial framework of patient disability in patients suffering from interstitial cystitis/bladder pain syndrome (IC/BPS). To evaluate the impact of psychosocial factors on the relationship between pain and disability within women with IC/BPS. Patients and Methods Women with IC/BPS completed questionnaires including demographics, symptoms and problems (IC Symptom and Problem Indices), pain (McGill Pain Questionnaire), quality of life (Medical Outcomes Study – Short Form 12), disability (Pain Disability Index) and psychosocial variables (Center for Epidemiological Studies – Depression Scale; State Trait Anxiety Inventory; Pain Catastrophizing Scale; Multidimensional Scale of Perceived Social Support). Exploratory and confirmatory factor analyses were employed to determine the factor structure and composition of the measured variables. Structural equation modelling was used to examine model fit and the mediation effect of the psychosocial factors (negative affect, catastrophizing and social support) on impairments and functional disability. Results Questionnaires completed by 196 women with IC/BPS provided data for the present study. The measurement model showed good fit to the data. Negative affect (P < 0.001) and catastrophizing (P < 0.001) were significant in explaining the relationship between impairments and functional disability, whereas social support did not. Conclusions Disability in patients suffering from IC/BPS is partially explained by the impact of negative affect and catastrophizing. As a result of the refractory nature of IC/BPS, patient management within a b...

Mechanisms of Quality of Life and Social Support in Inflammatory Bowel Disease

“…More specifically, helplessness catastrophizing (e.g., ''it's terrible and it's not going to get any better,'' ''it's awful and I feel that it overwhelms me'') is a cognitive mechanism that acts to decrease patients' ability to benefit from social support. Pain catastrophizing is a robust mediator and it is a key mechanism for understanding QoL relationships (Katz et al, 2013). Patients with IBD have lower perceived social support in comparison to controls (Jones et al, 2006), and their rates of marital distress may elevate over time (Bernstein et al, 2001).…”

“…Catastrophizing is a maladaptive cognitive appraisal process and has been defined as ''an exaggerated negative mental set brought to bear during an actual or anticipated painful experience'' (Sullivan et al, 2001). In some studies, greater catastrophizing is associated with less social support (Nickel et al, 2008;Raichle, Hanley, Jensen, & Cardenas, 2007;Tripp et al, 2006), but in others it was inconsistently associated with social support and spousal responses (Cano, Leong, Heller, & Lutz, 2009;Katz et al, 2013). Catastrophizing has been linked to intolerance of uncertainty (Meeten, Dash, Scarlet, & Davey, 2012), and the uncertain nature of IBD is a major concern for many patients.…”

“…Pain catastrophizing, a pain-related cognitive factor, is one of the strongest predictors of poorer patient outcomes across samples of chronic illness, including IBD (Drossman et al, 2000;Katz et al, 2013;Sullivan et al, 2001;Sullivan, Thorn, Rodgers, & Ward, 2004). Catastrophizing is a maladaptive cognitive appraisal process and has been defined as ''an exaggerated negative mental set brought to bear during an actual or anticipated painful experience'' (Sullivan et al, 2001).…”

Understanding pain and coping in women with interstitial cystitis/bladder pain syndrome

“…It has no clear aetiology and treatment is often focused on pain and symptom management . IC/BPS creates psychological distress, disability and pain in patients, and it is now perceived to be a chronic urological condition, much more complicated than a syndrome of pain and urination symptoms . Theoretical models examining such relationships do not exist in the IC/BPS literature.…”

“…Emotion regulation describes an individual's ability to regulate and manage strong emotions, and the process impacts a variety of health‐related coping and outcomes . Maladaptive cognitive strategies, such as catastrophizing (thinking that pain signals the worse will happen; there is nothing you can do about your pain) and suppression are associated with diminished mental health well‐being and increased pain , especially in patients with IC/BPS . In contrast, patient acceptance of their pain and the use of strategies to reappraise negative thinking are associated with decreases in pain, anxiety, depression, and disability .…”