Female pelvic medicine & reconstructive surgery, Mar 19, 2021
OBJECTIVES:Brain-derived neurotrophic factor (BDNF) has been implicated in central neurological p... more OBJECTIVES:Brain-derived neurotrophic factor (BDNF) has been implicated in central neurological processes. We hypothesize that greater pain catastrophizing is associated with higher urinary BDNF levels in women with bladder pain syndrome.METHODS:Secondary analysis of a database of women with urinary urgency. We identified women who met AUA criteria of bladder pain syndrome. Urinary symptoms, pain catastrophizing, and neuropathic pain were measured using the Female Genitourinary Pain Index (F-GUPI), Pain Catastrophizing Scale (PCS) and painDETECT questionnaires respectively. Relationship of catastrophizing score with urinary BDNF (primary outcome) and other urinary biomarkers including nerve growth factor (NGF), vascular endothelial growth factor (VEGF) and osteopontin was evaluated using univariable and multivariable analyses.RESULTS:In 62 women with bladder pain syndrome, 15 (24%) reported pain catastrophizing symptoms (PCS score >30). Higher catastrophizing scores were associated with worse urinary symptoms, greater pelvic pain, greater neuropathic pain, and worse quality of life scores (all p<0.01). On multivariable analysis, after controlling for age, BMI and urinary symptoms, higher pain catastrophizing score was associated with lower BDNF (p=0.04) and lower VEGF levels (p=0.03). Urinary urgency was associated with higher NGF level (p=0.04) while bladder pain was associated with higher levels of NGF (p=0.03) and VEGF (p=0.01).CONCLUSIONS:Neuroinflammatory mechanisms contribute to the central processing of pain in women with bladder pain syndrome. Worse urinary symptoms are associated with higher NGF and VEGF levels, but worse pain catastrophizing is associated with lower BDNF and VEGF levels. Urinary BDNF levels may be useful in phenotyping women who have central augmentation of pain processing.
Female pelvic medicine & reconstructive surgery, Oct 2, 2020
PURPOSE:The pathogenesis of bladder pain is poorly understood. Our hypothesis is that in women wi... more PURPOSE:The pathogenesis of bladder pain is poorly understood. Our hypothesis is that in women with urinary urgency without incontinence, bladder pain is associated with the presence of neurogenic inflammation in the bladder wall and neuroinflammatory biomarkers in the urine.METHODS:We conducted a prospective cross-sectional study of women with urinary urgency without incontinence. Urinary symptoms were measured using Female Genitourinary Pain Index. Neuropathic pain, a clinical biomarker of neuroinflammation, was measured using the PainDETECT questionnaire. Inflammatory neuropeptides measured in the urine included nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and osteopontin (Opn). Neuropathic pain scores and urinary neuropeptide levels were compared between patients with and without bladder pain using univariable and multivariable analysis.RESULTS:In 101 women with urinary urgency without incontinence, 62 (61%) were in the bladder pain group (VAS ≤ 3) while 39 (39%) were in the no bladder pain group. Urinary symptom scores (5.0 +/−3.1 versus 3.5 +/−2.4, p < .001) and neuropathic pain scores (13.3 ± 8.6 versus 5.1 ± 4.8, p <.001) were significantly higher for the bladder pain group than for the no bladder pain group. On multivariable analysis after controlling for age, BMI, and severity of urinary urgency, bladder pain score was significantly associated with elevated urinary levels of VEGF (p=0.04) and Opn (p=0.02) while neuropathic pain score was significantly associated with an increased NGF level (p=0.03).CONCLUSIONS:In women with urinary urgency without incontinence, bladder pain is associated with the presence of clinical and urinary biomarkers of neuroinflammation.
Female pelvic medicine & reconstructive surgery, Mar 19, 2021
OBJECTIVES:Brain-derived neurotrophic factor (BDNF) has been implicated in central neurological p... more OBJECTIVES:Brain-derived neurotrophic factor (BDNF) has been implicated in central neurological processes. We hypothesize that greater pain catastrophizing is associated with higher urinary BDNF levels in women with bladder pain syndrome.METHODS:Secondary analysis of a database of women with urinary urgency. We identified women who met AUA criteria of bladder pain syndrome. Urinary symptoms, pain catastrophizing, and neuropathic pain were measured using the Female Genitourinary Pain Index (F-GUPI), Pain Catastrophizing Scale (PCS) and painDETECT questionnaires respectively. Relationship of catastrophizing score with urinary BDNF (primary outcome) and other urinary biomarkers including nerve growth factor (NGF), vascular endothelial growth factor (VEGF) and osteopontin was evaluated using univariable and multivariable analyses.RESULTS:In 62 women with bladder pain syndrome, 15 (24%) reported pain catastrophizing symptoms (PCS score >30). Higher catastrophizing scores were associated with worse urinary symptoms, greater pelvic pain, greater neuropathic pain, and worse quality of life scores (all p<0.01). On multivariable analysis, after controlling for age, BMI and urinary symptoms, higher pain catastrophizing score was associated with lower BDNF (p=0.04) and lower VEGF levels (p=0.03). Urinary urgency was associated with higher NGF level (p=0.04) while bladder pain was associated with higher levels of NGF (p=0.03) and VEGF (p=0.01).CONCLUSIONS:Neuroinflammatory mechanisms contribute to the central processing of pain in women with bladder pain syndrome. Worse urinary symptoms are associated with higher NGF and VEGF levels, but worse pain catastrophizing is associated with lower BDNF and VEGF levels. Urinary BDNF levels may be useful in phenotyping women who have central augmentation of pain processing.
Female pelvic medicine & reconstructive surgery, Oct 2, 2020
PURPOSE:The pathogenesis of bladder pain is poorly understood. Our hypothesis is that in women wi... more PURPOSE:The pathogenesis of bladder pain is poorly understood. Our hypothesis is that in women with urinary urgency without incontinence, bladder pain is associated with the presence of neurogenic inflammation in the bladder wall and neuroinflammatory biomarkers in the urine.METHODS:We conducted a prospective cross-sectional study of women with urinary urgency without incontinence. Urinary symptoms were measured using Female Genitourinary Pain Index. Neuropathic pain, a clinical biomarker of neuroinflammation, was measured using the PainDETECT questionnaire. Inflammatory neuropeptides measured in the urine included nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and osteopontin (Opn). Neuropathic pain scores and urinary neuropeptide levels were compared between patients with and without bladder pain using univariable and multivariable analysis.RESULTS:In 101 women with urinary urgency without incontinence, 62 (61%) were in the bladder pain group (VAS ≤ 3) while 39 (39%) were in the no bladder pain group. Urinary symptom scores (5.0 +/−3.1 versus 3.5 +/−2.4, p < .001) and neuropathic pain scores (13.3 ± 8.6 versus 5.1 ± 4.8, p <.001) were significantly higher for the bladder pain group than for the no bladder pain group. On multivariable analysis after controlling for age, BMI, and severity of urinary urgency, bladder pain score was significantly associated with elevated urinary levels of VEGF (p=0.04) and Opn (p=0.02) while neuropathic pain score was significantly associated with an increased NGF level (p=0.03).CONCLUSIONS:In women with urinary urgency without incontinence, bladder pain is associated with the presence of clinical and urinary biomarkers of neuroinflammation.
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