Identification of experimental bladder sensitivity among dysmenorrhea sufferers

Hellman, Kevin M.; Datta, Avisek; Steiner, Nicole; Morlock, Julia N. Kane; Garrison, Ellen F.; Clauw, Daniel J.; Tu, Frank F.

doi:10.1016/j.ajog.2018.04.030

Cited by 28 publications

(38 citation statements)

References 39 publications

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“…Next, we examined the effect of natural bladder filling on reported pain and HRV. As we have previously reported 29 , dysmenorrheic participants reported more pain during bladder filling than healthy controls (Fig. 2, p < 0.001).…”

Section: Resultssupporting

confidence: 75%

“…This is a substudy from a larger prospective study to investigate the mechanisms of sensory hypersensitivity in women with visceral pain disorders. The larger study focused heavily on women with dysmenorrhea, and used standard quantitative sensory tests such as pressure pain algometry, visceral distension, and conditioned pain modulation, while also assessing for other postulated contributors to pain sensitivity, including autonomic measures, psychosocial profiles, and endocrine measurements 29 . The parent study design heavily skews the sample size for this substudy towards women with dysmenorrhea by a ratio of 4 to 1 to enrich for phenotypic characterization.…”

Section: Methodsmentioning

confidence: 99%

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Persistent autonomic dysfunction and bladder sensitivity in primary dysmenorrhea

Oladosu

Hellman

Ham

et al. 2019

Sci Rep

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Menstrual pain, also known as dysmenorrhea, is a leading risk factor for bladder pain syndrome (BPS). A better understanding of the mechanisms that predispose dysmenorrheic women to BPS is needed to develop prophylactic strategies. Abnormal autonomic regulation, a key factor implicated in BPS and chronic pain, has not been adequately characterized in women with dysmenorrhea. Thus, we examined heart rate variability (HRV) in healthy (n = 34), dysmenorrheic (n = 103), and BPS participants (n = 23) in their luteal phase across a bladder-filling task. Both dysmenorrheic and BPS participants reported increased bladder pain sensitivity when compared to controls (p’s < 0.001). Similarly, dysmenorrheic and BPS participants had increased heart rate (p’s < 0.01), increased diastolic blood pressure (p’s < 0.01), and reduced HRV (p’s < 0.05) when compared to controls. Dysmenorrheic participants also exhibited little change in heart rate between maximum bladder capacity and after micturition when compared to controls (p = 0.013). Our findings demonstrate menstrual pain’s association with abnormal autonomic activity and bladder sensitivity, even two weeks after menses. Our findings of autonomic dysfunction in both early episodic and chronic visceral pain states points to an urgent need to elucidate the development of such imbalance, perhaps beginning in adolescence.

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Section: Resultssupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

Persistent autonomic dysfunction and bladder sensitivity in primary dysmenorrhea

Oladosu

Hellman

Ham

et al. 2019

Sci Rep

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“…64 Pelvic organ cross-sensitization, which has been demonstrated experimentally and clinically (between bladder pain and uterine pain), also may be the consequence of both peripheral and central neural changes. [70][71][72] Afferent cross-sensitization of hypogastric, splanchnic, pelvic, and pudendal nerves has been shown in animal models to occur, as they course to their corresponding dorsal root ganglia and then to the central nervous system. Noxious activation of afferent signaling then activates reflexive pathways promoting release of neuromodulators and neuropeptides; the resulting inflammation can activate ascending nociceptive tracts to the cerebral cortex, leading to central interpretation of the experience as painful.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

“…121 Female patients were more likely to have PSPS IC/BPS than males, and while overall severity of pain was similar for both men and women with these pelvic pain syndromes, women were likely to report more bladder-focused symptoms such as urgency, frequency, and suprapubic pain. 70,122 This distinction between IC/BPS with and without comorbidities may be of great prognostic value, given that preexisting chronic pain disorders such as IBS greatly increase the risk of a woman with IC/BPS to undergo hysterectomy. 123 Preexisting comorbidities in women with IC/PBS further increase the risk of ultimately hysterectomy.…”

Section: Clinical Featuresmentioning

confidence: 99%

Interstitial Cystitis/Bladder Pain Syndrome

Marcu

Campian

2018

Semin Reprod Med

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Interstitial cystitis/bladder pain syndrome is an uncommon but potentially devastating pelvic pain disorder affecting both women and men. This condition is often confusable and comorbid with other pelvic pain disorders. Although our understanding of the underlying pathophysiology is growing, the exact longitudinal course by which peripheral and central aberrations involving the bladder mucosa, peripheral inflammation, and central dysregulation of bladder sensitivity create painful bladder symptoms remains an area in need of further study. Only a limited number of drugs have been approved for treatment by the Food and Drug Administration, and overall durable efficacy of the many treatments reviewed in recent American Urological Association guidelines remains suboptimal, making awareness, early diagnosis, and use of effective treatments early in the disease course, where neural changes may still be reversible, imperative.

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“…Scores were summed across these questions for each participant and provided a total BSI score, hereafter referred to as "somatic symptoms." A standardized pelvic exam was performed by a gynecologist (FFT) to identify potential causes of menstrual pain on the first 98 participants (Hellman et al, 2018). Potential clinical exam findings were only observed in eight participants and followed up with ultrasonography.…”

Section: Methodsmentioning

confidence: 99%

Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain

Kmiecik

Silton

et al. 2020

Preprint

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Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.

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Identification of experimental bladder sensitivity among dysmenorrhea sufferers

Cited by 28 publications

References 39 publications

Persistent autonomic dysfunction and bladder sensitivity in primary dysmenorrhea

Persistent autonomic dysfunction and bladder sensitivity in primary dysmenorrhea

Interstitial Cystitis/Bladder Pain Syndrome

Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain

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