Autonomic Testing in Women with Chronic Pelvic Pain
Open accessAbstract
PURPOSE: We determined whether abnormal autonomic nervous system innervation of the bladder underlies IC (interstitial cystitis)/BPS (bladder pain syndrome) differently than other chronic pelvic pain. MATERIALS AND METHODS: In this institutional review board approved protocol 39 healthy controls and 134 subjects were enrolled, including 36 with IC/BPS, 14 with myofascial pelvic pain and 42 with IC/BPS plus myofascial pelvic pain. Three subjects were excluded from study. Autonomic nervous system evaluations included deep breathing, the Valsalva maneuver, and the tilt table and sudomotor tests. The latter evaluates autonomic neuropathy. A modified validated composite autonomic laboratory score was applied. RESULTS: Median age in the IC/BPS group was 47.5 years (range 21 to 78), greater than in healthy controls (34 years, range 20 to 75, p = 0.006), the myofascial pelvic pain group (33 years, range 22 to 56, p = 0.004) and the IC/BPS plus myofascial pelvic pain group (38 years, range 18 to 64, p = 0.03). Body mass index did not significantly differ but the myofascial pelvic pain and IC/BPS plus myofascial pelvic pain groups had a higher body mass index than healthy controls (p = 0.05 and 0.03, respectively). Cardiovascular and adrenergic indexes did not differ. The tilt table test showed more orthostatic intolerance in all chronic pelvic pain groups. Tilt table test diagnoses (orthostatic hypotension, postural tachycardia syndrome and reflex syncope) were rare. Baseline heart rate was higher in all chronic pelvic pain groups (p = 0.004). Compared to healthy controls all myofascial pelvic pain groups showed significantly more clear-cut autonomic neuropathy, defined as a sweat score of 3 or greater (vs IC/BPS plus myofascial pelvic pain p = 0.007 and vs myofascial pelvic pain p = 0.03). CONCLUSIONS: Some chronic pelvic pain types show autonomic neuropathy and some show vagal withdrawal. In all types orthostatic intolerance likely reflects central sensitization and perhaps catastrophizing. Some of these findings suggest novel therapeutic targets.
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Orthostatic intolerance has been reported to occur more frequently in patients with chronic pelvic pain, including interstitial cystitis, bladder pain syndrome, and myofascial pelvic pain.
“Orthostatic intolerance has been reported to occur more frequently in patients with chronic pelvic pain, including interstitial cystitis, bladder pain syndrome, and myofascial pelvic pain (92).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [92]
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Cited by
Sorted by citations
Postural Orthostatic Tachycardia Syndrome
Bryarly, M., Phillips, L. T., Fu, Q., Vernino, S., & Levine, B. D. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.11.059 · Cited by 245 · see citing works
Bergeron, S., Reed, B. D., Wesselmann, U., & Bohm-Starke, N. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0164-2 · Cited by 158 · see citing works
- Authors
- Chelimsky, G., Simpson, P., McCabe, N., Zhang, L., Chelimsky, T., & collaborative Debra Erickson Dr., K. P. D.
- Affiliations
- Medical College of Wisconsin (US)
- Corresponding author
- Chelimsky, Thomas
- Venue
- Journal of Urology
- Published
- 2016-08
- Volume
- 196
- Issue
- 2
- Pages
- 429-434
- ISSN
- 0022-5347 (ISSN-L)
- 1527-3792
- PMC
- PMC4969223
- OpenAlex
- W2305031442
- Cited by
- 32
- References
- 5
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 5 · 2020: 4 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 2
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Urology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK083538)
- Topics
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- chronic pelvic pain, interstitial cystitis, autonomic nervous system, autonomic neuropathy, tilt table test, orthostatic intolerance, vagal withdrawal, central sensitization
- MeSH terms
- Adolescent, Adult, Aged, Autonomic Nervous System, Female, Humans, Middle Aged, Neurologic Examination, Prospective Studies, Case-Control Studies, Pelvic Pain, Cystitis, Interstitial, Young Adult, Chronic Pain
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