Effects of Chronic Pelvic Pain on Heart Rate Variability in Women

Williams, DeWayne P.; Chelimsky, Gisela; McCabe, N. Patrick; Koenig, Julian; Singh, Partik; Janata, Jeffrey W.; Thayer, Julian F.; Buffington, C.A. Tony; Chelimsky, Thomas C.

doi:10.1016/j.juro.2015.04.101

Cited by 30 publications

(37 citation statements)

References 28 publications

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“…First, like subjects with fibromyalgia 6 , subjects with MPP appear to suffer from a mild to moderate autonomic neuropathy, not seen in subjects with IC/BPS alone. Second and previously reported 21 , like subjects with complex regional pain syndrome 26 , subjects with IC/BPS appear to demonstrate major withdrawal of autonomic innervation, with vagal withdrawal exceeding sympathetic withdrawal, resulting in sympathetic predominance. Third, irrespective of CPP type, all CPP subjects experience orthostatic intolerance, probably reflecting central sensitization and a change in homeostatic perception, not an autonomic efferent abnormality, based on current understanding, and perhaps associated with catastrophization.…”

Section: Resultsmentioning

confidence: 58%

“…In summary, taking the current study together with our previous publication on heart rate variability in subjects with CPP 21 , three major findings characterize this patient population. First, like subjects with fibromyalgia 6 , subjects with MPP appear to suffer from a mild to moderate autonomic neuropathy, not seen in subjects with IC/BPS alone.…”

Section: Resultsmentioning

confidence: 59%

“…Heart rate variability analysis in our patient sample confirms the presence of reduced cardiac vagal tone in all CPP groups, greatest in the IC/BPS group. In addition, sympathetic tone also seems to be reduced (albeit to a lesser extent than vagal tone), particularly in the IC/BPS group 21 . Thus, it appears that people with IC/BPS experience a state of reduced overall autonomic outflow affecting both parasympathetic and sympathetic functions.…”

Section: Discussionmentioning

confidence: 95%

“…Since almost no subjects demonstrated cardiac vagal dysfunction (seen in the deep breathing response, table 2), autonomic neuropathies seen in our population were at most mild to moderate. Since fibromyalgia is linked with small fiber neuropathy involving the autonomic fibers 6 , as well as with MPP (about 20% in IC/BPS alone, vs 50% in MPP with or without IC/BPS) 21 , fibromyalgia alone might have accounted entirely for this finding, but in fact does not. The presence or absence of MPP still accounts for the majority of the variance in autonomic neuropathy in this population.…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps the age of our subjects rendered this diagnosis less likely, as POTS peaks in teens and twenties, though it clearly occurs in the 30’s, the age of our population. The most intriguing hypothesis states that the reduced autonomic outflow (both sympathetic and parasympathetic) in IC/BPS 21 impairs autonomic reactivity to the point that POTS cannot be manifested. This hypothesis would not explain the low frequency of POTS in MPP, but the low sample size might be explanatory.…”

Section: Discussionmentioning

confidence: 99%

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Autonomic Testing in Women with Chronic Pelvic Pain

et al. 2016

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Purpose Determine if abnormal autonomic nervous system (ANS) innervation of the bladder underlies interstitial cystitis/bladder pain syndrome (IC/BPS) differently than other chronic pelvic pain (CPP). Material and Methods IRB approved protocol, 134 subjects enrolled, 3 excluded, 39 healthy controls (HC), 36 IC/BPS, 14 myofascial pelvic pain (MPP), 42 IC/BPS plus MPP. ANS evaluations: deep breathing, Valsalva maneuver, tilt table test (TTT), and sudomotor test (evaluates for autonomic neuropathy (AN)). A modified validated composite autonomic laboratory score was applied. Results IC/BPS group 47.5 (21, 78) yrs was older than HC 34 (20, 75)yrs (p=0.006), MPP group 33 (22, 56)yrs (p=0.004), and IC/BPS plus MPP 38 (18, 64)yrs (p= 0.03). BMI was not significantly different among groups, but the MPP and IC/BPS plus MPP groups had a higher BMI than HC (p=0.03 and p= 0.05 respectively). Cardiovascular and adrenergic indexes did not differ among groups. TTT showed more orthostatic intolerance (OI) in all CPP groups. TTT diagnoses (orthostatic hypotension, postural tachycardia syndrome -POTS, reflex syncope) occurred rarely. Baseline heart rate (HR) was higher in all CPP groups (p=0.004). All MPP groups showed significantly more clearcut AN (defined as sweat score ≥ 3) compare to HC (HC vs IC/BPS plus MPP p= 0.007; HC vs MPP p = 0.03). Conclusions Some CPP types show an autonomic neuropathy, and some show vagal withdrawal. In all types, orthostatic intolerance likely reflects cenral sensitization and perhaps catastrophization. Some of these findings suggest novel therapeutic targets.

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Section: Resultsmentioning

confidence: 58%

Section: Resultsmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Autonomic Testing in Women with Chronic Pelvic Pain

et al. 2016

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Autonomic response during bladder hydrodistention reflects the severity of symptoms in patients with bladder pain syndrome/interstitial cystitis

Kim

Son

Troya

et al. 2016

Neurourology and Urodynamics

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Autonomic neurophysiologic implications of disorders comorbid with bladder pain syndrome vs myofascial pelvic pain

Chelimsky

Yang

Sanses

et al. 2019

Neurourology and Urodynamics

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Aims The neuropathophysiology of a debilitating chronic urologic pain condition, bladder pain syndrome (BPS), remains unknown. Our recent data suggests withdrawal of cardiovagal modulation in subjects with BPS, in contrast to sympathetic nervous system dysfunction in another chronic pelvic pain syndrome, myofascial pelvic pain (MPP). We evaluated whether comorbid disorders differentially associated with BPS vs MPP shed additional light on these autonomic differences. Methods We compared the presence and relative time of onset of 27 other medical conditions in women with BPS, MPP, both syndromes, and healthy subjects. Analysis included an adjustment for multiple comparisons. Results Among 107 female subjects (BPS alone = 32; BPS with MPP = 36; MPP alone = 9; healthy controls = 30), comorbidities differentially associated with BPS included irritable bowel syndrome (IBS), dyspepsia, and chronic nausea, whereas those associated with MPP included migraine headache and dyspepsia, consistent with the distinct autonomic neurophysiologic signatures of the two disorders. PTSD (earliest), anxiety, depression, migraine headache, fibromyalgia, chronic fatigue, and IBS usually preceded BPS or MPP. PTSD and the presence of both pelvic pain disorders in the same subject correlated with significantly increased comorbid burden. Conclusions Our study suggests a distinct pattern of comorbid conditions in women with BPS. These findings further support our hypothesis of primary vagal defect in BPS as compared with primary sympathetic defect in MPP, suggesting a new model for chronic these pelvic pain syndromes. Chronologically, PTSD, migraine, dysmenorrhea, and IBS occurred early, supporting a role for PTSD or its trigger in the pathophysiology of chronic pelvic pain.

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Effects of Chronic Pelvic Pain on Heart Rate Variability in Women

Cited by 30 publications

References 28 publications

Autonomic Testing in Women with Chronic Pelvic Pain

Autonomic Testing in Women with Chronic Pelvic Pain

Autonomic response during bladder hydrodistention reflects the severity of symptoms in patients with bladder pain syndrome/interstitial cystitis

Autonomic neurophysiologic implications of disorders comorbid with bladder pain syndrome vs myofascial pelvic pain

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