Disability in women suffering from interstitial cystitis/bladder pain syndrome
Authors: Katz Laura , Tripp Dean A. , Nickel J. Curtis , Mayer Robert , Reimann Maria , van Ophoven Arndt 
Published: May 2012

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 biopsychosocial framework represents an essential area of investigation.
Decreases in negative affect and catastrophizing will probably lead to improvements in pain‐related disability.