Multimodal Treatment with Cognitive Behavioral Therapeutic Intervention Plus Bladder Treatment Is More Effective than Monotherapy for Patients with Interstitial Cystitis/Bladder Pain Syndrome—A Randomized Clinical Trial

Abstract

(1) Background: Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) not only induces physiological damage but also greatly affects psychological stress. Multidisciplinary therapy has been recommended for IC/BPS treatment, but clinical trial data of combined bladder therapy and cognitive behavioral therapy (CBT) are lacking. This study evaluated CBT efficacy in patients with IC/BPS. (2) Methods: Patients with IC/BPS were randomized to the bladder monotherapy (BT) or combined CBT (CBT) group. The primary endpoint was the self-reported outcome by global response assessment (GRA). Secondary endpoints included IC symptoms and problem index, bladder pain score, Beck’s anxiety inventory (BAI), and depression inventory, and objective parameters were also compared. (3) Result: A total of 30 patients receiving BT and 30 receiving CBT therapy were enrolled. Significant improvement of the BAI at 8 (p = 0.045) and 12 weeks (p = 0.02) post-treatment was observed in the CBT group, with significantly greater GRA scores at 12 weeks (p < 0.001). Repeated measures analysis of variance showed a significant effect within the CBT group on IC/BPS patients’ self-reported treatment outcomes (p = 0.001) and anxiety severity BAI scores (p = 0.033). (4) Conclusion: A multimodal treatment of CBT combined with suitable bladder treatment more effectively improves anxiety severity and treatment outcomes in patients with IC/BPS.

Multimodal therapies and strategies for the treatment of interstitial cystitis/bladder pain syndrome in Taiwan

“…118,119 According to these studies, LESW and PTNS/TENS could improve bladder symptoms in most NHIC patients, [108][109][110]113,116,117 whereas education, CBT, and lifestyle modification might assist patients in coping with their symptoms regardless of their bladder condition. 96,98,100 PFMP may benefit from a combination of pelvic floor muscle treatment in patients who have pelvic floor myofascial pain. 119 Most experimental studies have indicated that the trigger points of PFMP contribute to peripheral and central sensitizations because they can affect peripheral nociceptors, spinal dorsal horn neurons, and brainstem.…”

“…14 Certainly, psychiatric treatments and stress therapy might be enrolled in both HIC and NHIC patients. 96,98,121 Most studies on NHIC have focused on monotherapy targeting the urinary bladder, with only partial evidence of durable effectiveness. Figure 1…”

“…92 Results of most studies proved that BoNT-A can decrease the exocytosis of proinflammatory and excitatory neurotransmitters and neuropeptides, such as substance P, from primary afferent fibers that transmit nociceptive pain and participate in the development of peripheral and central sensitizations and decreases the insertion of pain-sensitive ion channels. 93 Seven studies discussed lifestyle and psychological therapies such as CBT or mindfulness, [94][95][96] hypnosis, 97 lifestyle modification, 98 yoga, 99 and e-health application. 100 Seven studies focused on treatment with oral medications, including Th2 cytokine inhibitor suplatast tosilate, 101 α1 adrenoceptor blocker silodosin, 102 SHIP1 of amino acid protein activator, 103 fatty acid amide hydrolase inhibitor ASP3652, 104 anti-TNF-α agent, 105 phosphodiesterase type 5 inhibitor tadalafil, 106 and pentosan polysulfate sodium.…”

“…According to these studies, LESW and PTNS/TENS could improve bladder symptoms in most NHIC patients, 108–110,113,116,117 whereas education, CBT, and lifestyle modification might assist patients in coping with their symptoms regardless of their bladder condition 96,98,100 . PFMP may benefit from a combination of pelvic floor muscle treatment in patients who have pelvic floor myofascial pain 119 .…”

“…Current treatments of HIC should target at the bladder, ablation of inflammatory lesions, or partial cystectomy with or without enterocystoplasty, and treatments for NHIC should base on central sensitization and interorgan cross‐talk included controlling the dysfunctional epithelium, continuous replenishment of GAG layer, inhibiting detrusor hyperactivity by amitriptyline or DMSO, suppression of allergies with antihistamine or steroid, pain control with nonsteroidal anti‐Inflammatory drug, cyclooxygenase‐2 inhibitors, or tranquilizer 14 . Certainly, psychiatric treatments and stress therapy might be enrolled in both HIC and NHIC patients 96,98,121 …”