(213) Interstitial Cystitis/Bladder Pain Syndrome: A Systematic Review Regarding Anxiety and Depression
Authors: Della Camera P A , Borrello L , Antonelli P 
Published: March 2024

Abstract

Introduction
Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a urologic chronic pelvic pain syndrome with an unknown etiology and a variety of somatic and psychological symptoms, including elevated levels of anxiety and depression (Crawford, 2019). This often causes substantial impairment to quality of life: it is well known that unaddressed psychosocial elements of chronic pain can shape patient perceptions and behavior, and are associated with poorer functioning, adjustment, prognosis, and response to treatment (Piontek et al., 2022). Investigating the role of psychosocial factors in IC/BPS increase over the last years; however, prior to the last 5 years, there had been a scarcity of research on psychosocial factors compared to that in similar conditions (Windgassen et al., 2020).

Objective
Despite recommendations for the inclusion of non-pharmacological treatment in the management of IC/BPS, the focus so far has predominantly been on the inclusion of physical therapies with minimal discussion of psychological interventions. Therefore, this review aimed to examine the most recent studies regarding anxiety and depression in patients with IC/BPS, to stress the urgency of considering multidisciplinary care for individuals with this debilitating condition.

Methods
A literature search (PubMed and Google Scholar) of the past 5 years (January 2018 – March 2023) was conducted using key words related to IC/BPS, anxiety and depression, e.g., “(Interstitial cystitis OR Bladder pain syndrome) AND (Anxiety OR Depression OR Depressive disorder OR Psychology)”. The inclusion criteria were: to be empirical studies, to have been published within the last 5 years, to have included in the protocol measurements of anxiety and/or depression. A total of 28 studies were selected.

Results
There is a high rate of psychosocial comorbidities in IC/BPS; in particular, elevated levels of anxiety and depression, which are highly correlated with each other and with pain intensity. In addition, pain catastrophizing and helplessness seem to have a key role in the maintenance of the negative relationship between depression and pain over time in IC/BPS. Thus, there appears to be a complex interaction between psychopathologic and somatic symptoms. We assume that changes in mood and anxiety share a bidirectional relationship with IC/BPS pain severity: if pain increases, mood and anxiety likely worsen and, similarly, if mood and anxiety worsen it predicts an increased level of pain will follow.

Conclusions
IC/BPS is a complex condition that requires a management plan beyond the biomedical approach. Indeed, the psychological impact of IC/BPS is pervasive and severe. Our review supports the findings of previous studies that showed patients with this condition have a significantly higher risk of experiencing mental-emotional disorders compared to those without. These findings further strengthen the evidence base showing that anxiety and depression may not only be a consequence of this chronic pain condition but may also be involved in its maintenance. Our results suggest that it is crucial addressing anxiety and depression as early as possible in biopsychosocially oriented therapeutic interventions for patients with IC/BPS. Therefore, it is recommended that health care providers conduct a thorough assessment of this condition to identify therapeutic goals to pursue and possibly consider a multidisciplinary approach.

Disclosure
No.